EMmedonline

Chest compression ratio

30:2

chest compression rate

100 -120/minute . (AHA 2015 )

Depth

2 inches (5cm ) to 2.4 inches (6cm)

Ventilation

2 breaths after 30 compressions, each breath delivered for 1 second

Advanced Airway : 1 breath every 6 seconds

Interruption

<10 seconds

• Hypoxia

• Hypovolemia

• Hydrogen ions (Acidosis)

• Hypothermia

• Hypo/hyperkalemia

• Tension pneumothorax

• Tamponade, cardiac

• Toxins

• Thrombosis, pulmonary

• Thrombosis, coronary

Airway Device

Ventilation During Cardiac Arrest

Ventilation During Respiratory Arrest

Bag Mask

Adult : 2 breaths after every 30 compressions.

Child & Infants : 2 breaths every 30 compressions.

2 rescuer : 2 breaths every 15 compressions.

Adults :1 breath every 5 to 6 seconds (10-12 bpm)

Childrens : 1 breath every 3 – 5 sec. (12 – 20 bpm)

Any advanced airway

1 Ventilation every 6 to 8 sec (8 – 10 bpm)

Rationale & Other Important Points

• During low blood flow states such as CPR, oxygen delivery to heart and brain is limited by blood flow rather than arterial oxygen content. Hence rescue breaths are less important than chest compressions during first few minutes of resuscitation. Placement of advanced airway in cardiac arrest should not delay initial CPR And defibrillation for VF cardiac arrest . (Class I, C)

• Studies has shown that routine use of atropine during PEA or asystole is unlikely to have a therapeutic benefit.

• Empirical use of 100 % inspired oxygen during CPR optimizes arterial oxyhemoglobin content and in turn oxygen delivery; so it is reasonable during resuscitation from cardiac arrest. Class IIa, C

• Routine use of cricoid pressure is not recommended as it may impede ventilation and interfere with placement of supraglottic airway or intubation. Class III,C

• If advanced airway placement will interrupt chest compressions, providers may consider deferring insertion of the airway until the patient fails to respond to initial CPR and defibrillation attempts or demonstrates ROSC. Class IIb, C.

• At present there is inadequate evidence to define the optimal timing of advanced airway placement in relation to other interventions during resuscitation from cardiac arrest. Recent studies have shown that delayed endotracheal intubation combined with passive oxygen delivery and minimally interrupted chest compressions was associated with improved neurologically intact survival after out-of-hospital cardiac arrest in patients with witnessed VF/VT.

• Supraglottic airway, esophegeal-tracheal tube , laryngeal tube, laryngeal mask airway is considered as an acceptable alternative to bag mask ventilation or endotracheal intubation for airway management in cardiac arrest.

Cardiac Arrest Rhythm and Outcome

• In patients with VF/ VT as initial rhythm likelihood of survival is 60%.

• Only 2% of patients with PEA survive to hospital discharge.