1. 2005 AHA Guidelines CPR & ECC Bill Cayley Jr MD Augusta Family Medicine

2. Learning Objectives Describe 2005 CPR, ACLS & ECC guidelines Discuss reasons for guideline revisions

3. Introduction Comprehensive evidence review –ILCOR –AHA Eight Task Forces –Basic life support –Advanced life support –Acute coronary syndromes –Pediatric life support –Neonatal life support –Stroke –First aid –Education

4. Lessons learned… CPR must be started ASAP to be effective Best results with lay rescuer CPR require –Trained and motivated bystanders –Short response times –Readily available (AED) equipment Studies have shown that during asphyxial arrest chest compressions alone are better than doing nothing Lay bystanders may be reluctant to perform CPR –Feel it is too complicated –Feel training is inadequate –Fear the transmission of disease during mouth-to-mouth resuscitation

5. Emphases Streamlined algorithms Less information to learn Focus on mastering crucial skills

6. “ABCD” – Simplified Airway Breathing Circulation Defibrillation Universal ratio – 30:2 –30 compressions –2 ventilations No pulse check for lay rescuers Key Message: –Push hard, push fast, full chest recoil, minimize interruptions in chest compressions

7. Adult BLS 1.Call for help and an AED 2.Open the victim's airway, check for breathing, give two breaths 3.Start CPR - 30 compressions to 2 ventilations (100 compressions/minute) 4.On arrival of a defibrillator or AED, check for a shockable rhythm 5.Give one shock if indicated then resume CPR for another 5 cycles 6.If no shock is indicated continue another 5 cycles of CPR

8. Note! Minimize pulse checks Minimize interruptions to compressions

9. Defibrillation No “stacked” shocks Single energy dose 200 Joules biphasic defibrillator or 360 Joules monophasic Witnessed collapse –Immediate defibrillation best Unwitnessed collapse –May give CPR for 2 minutes first –CPR may help with blood flow to fibrillating heart

10. Defibrillation Apply AED or Defibrillator Hunt for VF/VT Single shock Resume CPR

11. Secondary ABCD Few changes IV or IO ASAP Medications –Epinephrine –Vasopressin Anti-dysrhythmics –Amiodarone –Lidocaine GOOD CPR!

12. Pediatric BLS and ACLS Classification –Health Care Professionals Pre-adolescent (age 1 up to age 12-14 or the presence of secondary sex characteristics) Adult –Lay Rescuers Child (age 1-8) Adult (over age 8)

13. Pediatric Arrest Most often respiratory Lone-rescuer –5 cycles CPR, then activate EMS Two-rescuer CPR –15 :2

14. Pediatric ACLS No vasopressin or atropine Pediatric AED attenuator if available IO access if no IV

15. Other changes…. 1.All breaths should be given over 1 second – watch for chest rise 2.Neonatal resuscitation 100% oxygen or lower concentration Supplemental O2 should available if no improvement in 90 seconds 3.New recommendations for ACS and CVA 4.Special topics electrolyte abnormalities, drowning, hypothermia, near-fatal asthma, anaphylaxis, electric shock.

16. Complete Guidelines Circulation http://circ.ahajournals.org/content/vol112/24_suppl/

17. Summary - 8 steps of ACLS Open AIRWAY Rescue BREATHING CIRCULATION with CPR DEFIBRILLATE VF/VT Definitive AIRWAY BREATHING by confirmation of ventilation CIRCULATION with IV access and cardiac rhythm DIFFERENTIAL DIAGNOSIS

18. Remember!!! Push hard, push fast, full chest recoil, minimize interruptions in CPR!

19. THANKS!