Guidelines Writing Group Chairs Michael R. Sayre, MD

1. Guidelines Writing Group Chairs Michael R. Sayre, MD 2010年AHA 心肺复苏指南介绍 贵阳医学院附院麻醉科 曾庆繁

2. 2010心肺复苏50周年 1960------------2010 Kouwenhoven

3. 2010 International Consensus Conference 356 位专家 来自29 个国家 历时36个月讨论 Robert A. Berg University of Pennsylvania Professor of Anesthesiology and Critical Care Medicine, Division Chief, Pediatric Critical Care

4. Cardiac arrest can be caused by 4 rhythms • 室颤 VF • 室速(无脉)VT • 无脉性电活动PEA • 心博停止asystole. • 无脉性心动过缓Pulseless bradycardia

5. 室颤 无脉性室速 • VF/Pulseless VT • chest compressions (CC) • early Defibrillation (DF)

6. Early recognitioncardiac arrest • 及早识别心跳骤停

7. 外行急救lay rescuer 不检查脉搏Not check for a pulse 1.突然晕倒 suddenly collapse 2.意识消失 Unresponsive 3.无呼吸或无正常呼吸 not breathing 4.Seizure (not normally,gasping) . • cardiac arrest • 降低脉搏检查的重要性 • Minimize the importance of pulse checks

8. NO: “Look, Listen, Feel for Breathing”* 不看 不听 不觉 • 2005 (Old): • “Look, listen, and feel” • 2010 (New): • NO: “Look, Listen, Feel • for Breathing”* • 30 compressions 2 breaths

9. 复苏步骤 • “Adults” • Children • infants • (excluding the • newly born) A Change From A-B-C to C-A-B

11. What about Oxygen? VF-CA: 中心血液中富含氧 Experimental work has shown Arterial Sats remain acceptable for up to 10 min of CCC 呼吸停- 通气! Respiratory Arrest-Different ! Ventilation crucial to replace Oxygen 心 脑 关键:CCC

12. C-A-B • chest compressions initiated sooner 及早按压

13. 心脑复苏新概念Cardiocerebral Resuscitation • Forget CPR, Give CCR Instead 代之CCR 忘了CPR

14. Continuous Chest Compressions Standard CPR: 30:2

15. 心脑复苏概念Cardiocerebral Resuscitation Single shock if Indicated without pulse check or rhythm analysis Single shock if Indicated without pulse check or rhythm analysis Single shock without pulse Check or rhythm analysis EMS arrival CC Only• 200 chest compressions 200 chest compressions 200 chest compressions 200 chest compressions Analysis Analysis Analysis BVM or Passive Insuflation 100% FIO2 Begin IV Administer 1 mg IV Epinephrine Resume Standard ACLS Consider Endotracheal Intubation • If adequate bystander chest compressions are provided, EMS providers • perform immediate rhythm analysis

16. Three-Phase Model of Resuscitation Circulatory Electrical Metabolic Phase Phase Phase 100% Myocardial ATP 0 rapid defibrillation good chest compressions little we can do 0 2 4 6 8 10 12 14 16 18 20 Arrest Time (min) Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8

17. 外行成人CPR : CCC+DF 简化成人基本生命支持

18. Chest Compressions* • 2010 (New): • Hands-Only™ • “push hard and fast” • on the center of the chest • 动手不动口 • 30 compressions to 2 breaths

19. Chest Compression Rate: At Least 100 per Minute* • 2010 (New): • chest compressions at a rate of • at least 100/min.(快 ! 不间断) • 2005 (Old): • Compress at a rate of about 100/min.

20. Chest CompressionDepth* • 2010 (New): hard ! • The adult sternum should be depressed • at least 2 inches (5 cm). • 2005 (Old): • approximately 1,1/2 to 2 inches • (approximately 4 to 5 cm).

22. C A B

23. 电击治疗ELECTRICAL THERAPIES • AED Use in Children Now Includes Infants • 2010 (New): • <1 year of age. • 2005 (Old): • Not use of AEDs for infants <1 year of age.

24. 先除颤 VS 先CPR ? • CPR • <3min • Defibrillation • However, in monitored patients, the time from VF to shock delivery should be under 3 minutes

25. 1次除颤 vs 3连续除颤? • 2010 (No Change From 2005): • 一次电击后 • 立即CPR

26. CC200 -shockcc200 (不检查脉搏/心律分析) Single shock if Indicated without pulse check or rhythm analysis Single shock if Indicated without pulse check or rhythm analysis Single shock without pulse Check or rhythm analysis EMS arrival CC Only• 200 chest compressions 200 chest compressions 200 chest compressions 200 chest compressions Analysis Analysis Analysis BVM or Passive Insuflation 100% FIO2 Begin IV Administer 1 mg IV Epinephrine Resume Standard ACLS Consider Endotracheal Intubation • If adequate bystander chest compressions are provided, EMS providers • perform immediate rhythm analysis

27. 电极放置Electrode Placement • 2010 (Modification of Previous Recommendation): AED electrode pads positions : lateral posterior Anterior left infra scapular right infrascapular 胸骨旁(锁骨下)

28. 2005 (Old): • conventional sternal-apical (anteriorlateral) position. • Right pad left pad • Sternal apical • 胸骨旁(锁骨下) 心尖 • right or left upper back.

29. ADVANCED CARDIOVASCULAR LIFE SUPPORT

30. CPR质量 监测PETCO2 : 1.确定气管导管位置 confirming tracheal tube placement 2.监测CPR有效性 monitoring CPR quality 3.检查心跳恢复 detecting ROSC

32. 药物New Medication Protocols 2005 (Old): • 2010 (New): • 阿托品不常规 • 用于PEA/asystole • Atropine • not routine use • for PEA/asystole 阿托品用于高级心血管生命支持 Atropine included in the ACLS 心搏停止 asystole or slow PEA 可用阿托品 Atropincould be considered..

33. 心动过速tachycardia 2010 (New) 2005 (Old): • 规律的Regular • 单型monomorphic • 宽QRS 心动过速 • wide-complex tachycardia • 腺苷Adenosine • (rhythm is regular) adenosine 只用于规则的窄QRS 的折返性室上速 only for suspected regular narrow-complex reentry supraventricular tachycardia

34. 不规律的宽QRS 心动过速 • irregular wide-complex tachycardias • 不用腺苷 • Adenosine should not be used • (may cause degeneration of the rhythm to VF)

35. 心动过缓Bradycardia 2010 (New) 2005 (Old): • 症状性不稳定心动过缓 • symptomatic unstable Bradycardia • 变时性药物输注 • chronotropic drug infusions (an alternative to pacing) atropine while awaiting a pacer or if pacing was ineffective. chronotropic drug infusions

36. 避免过度通气Avoiding Hyperventilation • 10 -12 breaths per minute • PETCO2 of 35 - 40 mm Hg • PaCO2 of 40 -45 mm Hg.

37. ACLS Cardiac Arrest Algorithm

39. Post–Cardiac Arrest Care

43. 谢谢!