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SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR) Rasim ENAR; M.D Professor of Cardiology İstanbul University Cerrahpaşa Medical.

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Presentation on theme: "SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR) Rasim ENAR; M.D Professor of Cardiology İstanbul University Cerrahpaşa Medical."— Presentation transcript:

1 SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR) Rasim ENAR; M.D Professor of Cardiology İstanbul University Cerrahpaşa Medical Faculty Department of Cardiology

2 SUDDEN CARDIAC DEATH (SCD) Definition: Natural Death due to cardiac causes Natural Death due to cardiac causes (1) Loss of consciousness within one hour after start of the symptoms (2) Pre-existing heart disease may be present; but the cause or the timing of the death can not be predicted Keys of Definition : (a) Non-taumatic nature (a) Non-taumatic nature (b) Unexpected and sudden

3 CARDIAC ARREST Definition: Sudden cessation of cardiac pump function Reversible with rapid and effective intervention; otherwise cardiac death is unevitable The common electrophysological mechanism which cause cardiac arrest as a cause of SCD: The common electrophysological mechanism which cause cardiac arrest as a cause of SCD: (1)- Ventricular Tachyarrhytmias; Ventricular Fibrillation, Ventricular Tachycardia (1)- Ventricular Tachyarrhytmias; Ventricular Fibrillation, Ventricular Tachycardia (2)- Non-Tachyarrhytmic causes ; Other important causes of cardiac arrest; Pulseless electrical activity (Electromachanical Dissosiation); Asistoly; Bradiarrhythmias Bradiarrhythmias

4 ECG:Sınus arrest No P waves.

5 ECG: VF

6 ECG: Polimorphic VT (Torsade de Pointes)

7 ECG: Complete AV Block Dissociate P an QRS waves. Dissociate P an QRS waves.

8 ETY-1: SCD- CARDIOVASCULAR DISEASES:. 1- Coronary artery disease1- Coronary artery disease Acute coronary sydrome, Acute coronary sydrome, Chronic ischemic heart disease Chronic ischemic heart disease 2- Dilated cardiomyopathy2- Dilated cardiomyopathy * The above two cinical states is responsible for >90% of SCD events. 3- Other cardiomyopathies;3- Other cardiomyopathies; (a) hipertrophic cardiomyopathy, (a) hipertrophic cardiomyopathy, (b) arrhythmogenic right ventricular cardiomyopathy (b) arrhythmogenic right ventricular cardiomyopathy 4- Primary electrical disturbances.4- Primary electrical disturbances. 5- Mechanical cardiovascular diseases.5- Mechanical cardiovascular diseases.

9 ETY -2: 4- Primary electrical disturbances: (a) Long QT syndrome (b) Brugada syndrome (c) Cathecholaminergic polimorphic VT. (d) Wolf-Parkinson-White syndrome (WPW). (e) Sinus and AV node related conduction disturbances disturbances

10 ETY-3 SCD - Mechanical Cardiyovascular Diseases; a- Aortic stenosis. b- Mitral valve prolapse c- Myocardial bridging d- Anolomous coronary artery origin ETY-4 SCD- Other Causes: (a) Myocarditis (b) Chest trauma (c) Drug overdose - Torsade de Pointes (d) Atheletes heart _ trained heart (e) SCD in normal heart (idiopathic VF).

11 Prevention from SCD: Principal: Multi-factorial etiology and various treatment targets.Principal: Multi-factorial etiology and various treatment targets Primary prophlaxis: Prevention of fatal arrhythmias in patients without prior sustainead VT and high risk for SCDPrimary prophlaxis: Prevention of fatal arrhythmias in patients without prior sustainead VT and high risk for SCD Secondary prophlaxis: Prevention of fatal arrhythmias in patients who exprerienced cardiac arrest and sustained ventricular tachyarrhytmiasSecondary prophlaxis: Prevention of fatal arrhythmias in patients who exprerienced cardiac arrest and sustained ventricular tachyarrhytmias

12 Primary Proflaxis: 3 different proflactic treatment modalities: 1- Drugs without electrophysiologic effects 2- Drugs with electrophysiologic effects 3- ICD(Implantable Cardiac Defibrillator)

13 1- Drugs without electrophysiologic effects : Importance of the treatment: Both total mortality and SCD is reduced different class drugs: 1- ACE-I (angiootensin converting enzyme inhibitors), ARB ( +? ) 2- Aldosterone receptor blockers 3- Poli-unsaturated fatty acids (omega-3) +- Statins +- Statins

14 RESSUSİTATION. Return of spontaneous circulation (ROS) can be achived only 15% of cardiac arrest cases, and only 50% of those could be discharged Return of spontaneous circulation (ROS) can be achived only 15% of cardiac arrest cases, and only 50% of those could be discharged As a result; There is only a 5-7% chance of survival in cardiac arrst victims. As a result; There is only a 5-7% chance of survival in cardiac arrst victims. Survival from cardiac arrest: Survival from cardiac arrest: (a) Etiolgy of cardiac arrest (VF>EM-Diss), (a) Etiolgy of cardiac arrest (VF>EM-Diss), (b) Pre- cardiac arrest status, (b) Pre- cardiac arrest status, (c) Unwitnessed cardiac arrest (c) Unwitnessed cardiac arrest (d) Emergency CPR and availability of (d) Emergency CPR and availability of automated external defibrilator automated external defibrilator

15 CHAIN OF SURVIVAL: (ABLS: Adult Basic Life Support) Call 112,+Chest compression +Defibrilltor + IV DrugTherapy.

16 Electrical meaning of Ressussitation: VF is the most common cause of cardiac arrest VF is the most common cause of cardiac arrest Spontaneous termination does not occur Spontaneous termination does not occur VF more than 3-4 minutes causes irrversible organ damage. VF more than 3-4 minutes causes irrversible organ damage. Prevention of death secondary to cardiac arrest Prevention of death secondary to cardiac arrest Immediate, rapid Defibrillation (DFB). Immediate, rapid Defibrillation (DFB). * Every minute delay with DFB reduces life expactancy by 7-10% according to direct CPR with chest compression or entubation

17 External Defibrillator. Devices with automated rhythm analysis and shock delivery features Devices with automated rhythm analysis and shock delivery features External defibrilator (EDFB); should be used only in patients who are unresponsive, not breathing and without effective circulation External defibrilator (EDFB); should be used only in patients who are unresponsive, not breathing and without effective circulation

18 DEFIBRILATOR(DFB): Manually operated; Paddeles and Monitore.

19 Eksternal Defibrilator- Localization of Pedals

20 Return of NSR (arrow sign) after DFB of VF

21 CPR; Cardio-Pulmonary Ressussitation If immediate DFB is not possible, then CPR should be started without delay. If immediate DFB is not possible, then CPR should be started without delay. Late-CPR and/or advanced cardiac life support (ACLS) should be discouraged. Late-CPR and/or advanced cardiac life support (ACLS) should be discouraged. Only 10-20% of out-of hospital VF cases survive and 50% of those will have neurological problems. Only 10-20% of out-of hospital VF cases survive and 50% of those will have neurological problems. As a result: If cardiac arrest is not diagnosed within 4 minutes and CPR and DFB is not given within 8 minutes; ressussitation will be unsuccessful. As a result: If cardiac arrest is not diagnosed within 4 minutes and CPR and DFB is not given within 8 minutes; ressussitation will be unsuccessful.

22 How to do CPR ? BLS (Basıc Life Support) Algorhthm: BLS (Basıc Life Support) Algorhthm: Check the responsiveness ; if unresponsive- start CPR: 1- Check the responsiveness ; if unresponsive- start CPR: 2- Open Airway; Head tilt-jaw trust 2- Open Airway; Head tilt-jaw trust 3- Check the breathing- not breathing; Start mouth-to- mouth breathing 3- Check the breathing- not breathing; Start mouth-to- mouth breathing 4- Give your breath ; - Give 1-1,5 seconds break for breathing and observe the patient after the first two full breaths 4- Give your breath ; - Give 1-1,5 seconds break for breathing and observe the patient after the first two full breaths 5- Assess circulation;- Check pulse at carotide artery 5- Assess circulation;- Check pulse at carotide artery 6- If no sign of circulation (no pulse); start chest compression 6- If no sign of circulation (no pulse); start chest compression rescuer CPR : 15 compression - 2 ventilation rescuer CPR : 15 compression - 2 ventilation. Rate of compression : /min Rate of compression : /min At the end of compression 2 full breaths should be given; At the end of compression 2 full breaths should be given; if endotracheal tube is inplace; 5 chest compression / 1 ventilation if endotracheal tube is inplace; 5 chest compression / 1 ventilation

23 ABC of CPR

24 Autamated External DFB.

25 CPR: The moment every thing is over or started again That moment(?!?): First-aid ( Semi-autamated DFB).

26 -- VF,-DFB and -Sinüs rhythm. -- Geçmiş olsun….


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