Post on 03-Jun-2018
transcript
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 1/16
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 2/16
Quality of chest compressions: rate
10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 100-110 110-120 R>120
Chest compression rate (rate per minute)
A m o u n t o f t i m e
a t a g i v e n r a
t e300
250
200
150
100
50
0
Abella et al, 2005
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 3/16
Clinical importance of chest compression rate
Abella et al, 2005
No ROSC
ROSC
10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 100-110 110-120 >120
Chest compression rate (per minute)
Mean rate, ROSC group
90 17
Mean rate,no ROSC group
79 18
210
180
150
120
90
60
30
0
A m o u n t o f t i
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 4/16
What this means: CPR guidelines 2010
New directions in CPR:
Hands-only CPR – evidencesuggests mouth-to-mouth maynot be required, especially forbystander response
New for 2010 guidelines:
Airway-Breathing-Circulationis now
Circulation-Airway-Breathing
CA B
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 5/16
Pause before shock
4:55 5:00 5:05 5:10
C o m p r e s s i o n s
E C G
Does CPR quality affect defibrillation?
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 6/16
0
20
40
60
80
100
≤10.3 10.5-13.9 14.4-30.4 ≥33.2
S h o c k s u c c e s s ,
% 90%
10%
55%
64%
Edelson et al, 2006
Pause before a shock – it really makes a big difference!
Pre-shock pause, sec
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 7/16
Adenosine triphosphate
How your cells store energy
(“charged battery”)
Adenosine diphosphate
Depleted energy store
(“spent battery”)
Visual model for how CPR may restore the heart
First, a little refresher from biology class….
energy
blood flow, oxygen
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 8/16
Visual model for how CPR may restore the heart
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 9/16
0-20 21-40 41-60 61-80 81-100
comp fraction, %
S u r v
i v a l t o d i s c
h a r g e ,
%
0
1 0
2 0
3 0
Compression “fraction” – amount of compressions given to a patient
Chr istenson J et al, Circ 2009
poo r surv iva l wi th lowest
compress ion fract ion in OHCA
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 10/16
40
32
24
16
8
0
1 2 3
CPR duration, min
C o r o n a
r y a r t e r y
B l o o d p
r e s s u r e
ICCM, 2005
2 inches vs 1.5 inches Survival:
100%
15%
The DETAILS of CPR delivery makes a big difference
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 11/16
More on chest compression depths
What is the role of chest compression depth during out-of-hospital
cardiac arrest resuscitation?
Ian G. Stiell, MD et al Critical Care Medicine 2012
20 30 40 50 60
0
1 0 %
2 0 %
3 0 %
s u
r v i v a l
compression depth
>2 inches
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 12/16
Aufderheide et al, 2004
Study of paramedic ventilations:mean ventilation rate was 30 per minute!(AHA recommended rate 8-10 per minute)
first group: 37 4 after retraining: 22 3
Does the quality of ventilations matter?
Slowerbreaths
Fasterbreaths
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 13/16
Aufderheide et al, 2004
Study of paramedic ventilations:mean ventilation rate was 30 per minute!(AHA recommended rate 8-10 per minute)
first group: 37 4 after retraining: 22 3
Does the quality of ventilations matter?
Slowerbreaths
Fasterbreaths
These rapid ventilations were tested in animals placed
in cardiac arrest and it KILLED ALL THE ANIMALSThe publication was entitled “DEATH BY HYPERVENTILATION”
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 14/16
May represent fatiguing (rescuer getting tired)
Other challenges to CPR performance: fatiguing during compressions
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 15/16
30 60 90 120 150
120
115
110
105
100
95
90
85
80
0
Time (sec)
C
C r a t e ( c o m p s p e r m i n )
Sugerman et al, Resusc 2009
Other challenges to CPR performance: fatiguing during compressions
8/12/2019 ROSC Lecture 2 Part 2
http://slidepdf.com/reader/full/rosc-lecture-2-part-2 16/16
30 60 90 120 150
Time (sec)
C C d e p t h ( m m )
Sugerman et al, Resusc 2009
Other challenges to CPR performance: fatiguing during compressions
55
50
45
40
35
0