Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed...

59
Importance of CPR Robert S. Cole

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Transcript of Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed...

Page 1: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Importance of CPR

Robert S Cole

Credit where Credit is Due

bull Adapted from presentation by Ahamed Idris MD ndash Professor of Emergency Medicine University

of Texas Southwestern Medical Center at Dallas

Special Thanks

bull Dr Peter Safarbull Father of

Resuscitation medicine

bull Helped develop CPRbull Directly responsible

for the research used in therapeutic hypothermia

Objectives

bull Importance of maximizing CPRbull Why compressionventilation ratio 302 bull Complete chest wall recoilbull Danger of hyperventilationbull CPR First vs shock firstbull 1 shock vs 3 shocksbull Minimize delay to shockbull Impedance Threshold Device (ITD) Science

A need for changehellip

bull Approximately 350000 persons die from out-of-hospital cardiac arrest each year in North America

bull Survival rate is poor among these patients and most do not survive to hospital discharge

bull New research suggests CPR has a much greater impact on cardiac arrest survival than previously thought

bull Other research suggests that an impedance threshold device (ITD) may improve outcome

CPR in Hollywoodhellip

bull ROSC (Getting a pulse back) 75bull discharged neurologically Intact 67

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 2: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Credit where Credit is Due

bull Adapted from presentation by Ahamed Idris MD ndash Professor of Emergency Medicine University

of Texas Southwestern Medical Center at Dallas

Special Thanks

bull Dr Peter Safarbull Father of

Resuscitation medicine

bull Helped develop CPRbull Directly responsible

for the research used in therapeutic hypothermia

Objectives

bull Importance of maximizing CPRbull Why compressionventilation ratio 302 bull Complete chest wall recoilbull Danger of hyperventilationbull CPR First vs shock firstbull 1 shock vs 3 shocksbull Minimize delay to shockbull Impedance Threshold Device (ITD) Science

A need for changehellip

bull Approximately 350000 persons die from out-of-hospital cardiac arrest each year in North America

bull Survival rate is poor among these patients and most do not survive to hospital discharge

bull New research suggests CPR has a much greater impact on cardiac arrest survival than previously thought

bull Other research suggests that an impedance threshold device (ITD) may improve outcome

CPR in Hollywoodhellip

bull ROSC (Getting a pulse back) 75bull discharged neurologically Intact 67

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 3: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Special Thanks

bull Dr Peter Safarbull Father of

Resuscitation medicine

bull Helped develop CPRbull Directly responsible

for the research used in therapeutic hypothermia

Objectives

bull Importance of maximizing CPRbull Why compressionventilation ratio 302 bull Complete chest wall recoilbull Danger of hyperventilationbull CPR First vs shock firstbull 1 shock vs 3 shocksbull Minimize delay to shockbull Impedance Threshold Device (ITD) Science

A need for changehellip

bull Approximately 350000 persons die from out-of-hospital cardiac arrest each year in North America

bull Survival rate is poor among these patients and most do not survive to hospital discharge

bull New research suggests CPR has a much greater impact on cardiac arrest survival than previously thought

bull Other research suggests that an impedance threshold device (ITD) may improve outcome

CPR in Hollywoodhellip

bull ROSC (Getting a pulse back) 75bull discharged neurologically Intact 67

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 4: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Objectives

bull Importance of maximizing CPRbull Why compressionventilation ratio 302 bull Complete chest wall recoilbull Danger of hyperventilationbull CPR First vs shock firstbull 1 shock vs 3 shocksbull Minimize delay to shockbull Impedance Threshold Device (ITD) Science

A need for changehellip

bull Approximately 350000 persons die from out-of-hospital cardiac arrest each year in North America

bull Survival rate is poor among these patients and most do not survive to hospital discharge

bull New research suggests CPR has a much greater impact on cardiac arrest survival than previously thought

bull Other research suggests that an impedance threshold device (ITD) may improve outcome

CPR in Hollywoodhellip

bull ROSC (Getting a pulse back) 75bull discharged neurologically Intact 67

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 5: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

A need for changehellip

bull Approximately 350000 persons die from out-of-hospital cardiac arrest each year in North America

bull Survival rate is poor among these patients and most do not survive to hospital discharge

bull New research suggests CPR has a much greater impact on cardiac arrest survival than previously thought

bull Other research suggests that an impedance threshold device (ITD) may improve outcome

CPR in Hollywoodhellip

bull ROSC (Getting a pulse back) 75bull discharged neurologically Intact 67

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 6: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR in Hollywoodhellip

bull ROSC (Getting a pulse back) 75bull discharged neurologically Intact 67

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 7: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR in Real Life

bull ROSC between 01 and 49ndash 3-7 typical

bull Survival to Hospital Admission 23bull Survival to Discharge 76

ndash THIS HAS NOT IMPROVED SIGNIFICANTLY IN 30YEARS

bull Good Neurological Outcome 01 and 30

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-AnalysisComilla Sasson Mary AM Rogers Jason Dahl and Arthur L KellermannCirc Cardiovasc Qual Outcomes 2010363-81 published online before print November 10

2009 doi101161CIRCOUTCOMES1098895 6

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 8: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Today Nearly everyone dieshellip

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 9: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

But there is hopehellip

Howard Snitzer 59 survived 96 minutes of CPR with no neuro Deficits

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 10: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Importance Of CPR

10-20 of normal blood flow to the heart

20-30 of normal blood flow to the brain

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 11: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

3 Phase Model

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 12: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Cardiac Output During CPR

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 13: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

KEY POINT

CPR not PARAMEDICS save lives in most Cardiac Arrests

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 14: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Understanding Coronary Perfusion Pressure

Note this is Aortic Pressure CPP is ldquoroughlyrdquo half Aortic Pressure

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 15: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Understanding Chest Compressions

Compressionbull Increased intrathoracic

pressurebull Compression of heart and

lungs

Decompression (recoil)bull Decreased intrathoracic

pressurebull Refilling of heart and

lungs

Complete chest recoil is critical

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 16: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

ROSC Associated with CPP

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 17: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Benefit of Continuous Chest Compressions

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 18: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Intra-thoracic Pressure and CPR

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 19: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

New Cardiac Guidelines (2005)

bull Rate of 100minutebull Depth of 1 12ndash2 inches

ndash (or more in larger people)bull Complete chest recoil after each compressionbull Ventilation (less is more)

ndash No more than 10 ventilations per minutendash Inspiration phase of no more than 1 second

bull Minimize interruptions in chest compressionsbull Rotate compressors every 2ndash3 minutes to

minimize fatigue

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 20: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

2005 to 2010 changeshellip

Component of CPR 2005 ECC recommendations

2010 ECC Recommendations

DEPTH OF COMPRESSION

1 frac12 - 2 inches Greater than 2 inches

RATE 100 MINUTE At least 100 MIN

VENTILATION 8-10 MINUTE 8-10 MINUTE

CHEST RECOIL 100 100

INTURUPTIONS Minimized Less than 10 seconds goal

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 21: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Who does good CPR

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 22: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 23: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Answer NO ONE

Studies showedhellipbull Chest compressions were not delivered

about half of the time (too much ldquohands offrdquo)

bull Most compressions were not deep enough

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 24: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Compression DEPTH

bull Target = 38-51 mm with complete releasebull Reality = only 27 achieve target

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 25: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

No-Flow Ratio (Interruption of CPR)

bull Target = less than 20bull Reality = 48

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 26: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Compression Rate

bull Target = ~100min with complete releasebull Reality = 60min due to ldquoNo Flow Ratiordquo

Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac ArrestWik et al JAMA 2005

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 27: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Compression Ratehellip

Percent segmentswithin 10 cpmof AHA Guidelines

31

369

Abella et al 2005 Circulation

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 28: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Compression Ratehellip

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 29: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Barriers to staying on the chesthellip

bull Pausing for proceduresndash intubation IV pulse check etc)

bull Pausing for rhythm analysisbull Pausing after shock to await post-shock

rhythmbull Pausing to charge clear and shockbull Unaware of importance of CPR in ldquobig

picturerdquo

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 30: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Importance of complete recoil

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 31: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Get EVERY Compression Right

Critical pressure for ROSC(Paradis et al JAMA19902633257-8)

Abella et al 2005 Circulation

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 32: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Cerebral Perfusion Pressures and CPR

Abella et al 2005 Circulation

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 33: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Current Guidelines for Ventilation

bull CPR with Advanced Airway 8 ndash 10 breathsminute

bull Post-resuscitation 10 ndash 12min

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 34: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Compression-Ventilation Ratio

bull Ventilation rate = 12minbull Compression rate = 78minbull Large amplitude waves = ventilationsbull Small amplitude waves = compressionsbull Each strip records 16 seconds of time

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 35: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Reality Suckshellip

bull Compression Ventilation Ratio 21bull 47-48 Breaths a minute

47 Nails in a coffin

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 36: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Prolonged Ventilations

bull 1048707Ventilation Duration = 436 seconds breathbull 1048707Ventilation Rate = 11 breaths minutebull 1048707 time under Positive Pressure = 80

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 37: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Everyone sucks

bull Milwaukeendash Mean Ventilation Rate 37minutendash AFTER 2 months training 22minute

bull Dallas 30minutebull Tuscan 34minutebull Chicago gt30minute

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 38: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Effect of Vent Rate on CPP

12 RR minute

CPP 234 plusmn 10mmHg

MIP 71 plusmn 07 mmHgmin

20 RR minute

CPP 195 plusmn 18 mmHgMIP 116 plusmn 07 mmHgmin

30 RR minute

CPP 169 plusmn 18 mmHgMIP 175 plusmn 10 mmHgmin

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 39: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Aware of importance of CPR

19781975

1980s and 1990rsquos

King CountySeattle Medic One EMS System Data Cobb

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 40: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR FIRST

ROSC

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 41: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR FIRST BEFORE DEFIB

bull The rate of survival improved (24 percent to 30 percent) when CPR was initiated prior to external defibrillation especially in patients with delayed initial response intervals (longer than 4 minutes) 27 percent with CPR versus 17 percent without CPR The overall proportion that survived with favorable neurologic recovery also improved from 17 percent to 23 percent

Cobb LA et al Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillationJAMA 1999 Apr 7 281

1182-1188

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 42: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR IMPROVING DEFIB

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 43: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR Whats Next

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 44: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

bull 90 of all changes to 2010 ECC are right in the BLS segment

bull Builds on and further enhances the changes and research discussed in the 2005 guidelines

bull COMPRESSIONS are the single most emphasized segment of resuscitation

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 45: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Hands Only CPR

bull Single biggest changebull ldquoHands Only CPRrdquo AKA

Compression only CPR for lay persons and non HCP first responders

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 46: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

KEY POINT

bull HANDS ONLY CPR MAY IMPROVE ROSC BY 7 OVER TRADITIONAL CPR

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 47: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CAB

bull Sequence change to chest compressions before rescue breaths (CAB rather than ABC)

bull This is expected to reduce time from assessment of responsiveness to first compression by 30 or more seconds

bull This reduction in time during this critical period early in the arrest is expected to improve survival and also response to first shock

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 48: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Pulse Check

bull Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse

bull The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally

bull Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and if the rescuer does not definitely feel a pulse within that time period the rescuer should begin CPR

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 49: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Look Listen and Feel

bull Confusion in Agonal Respirations vs Good Respirations

bull ldquoLook Listen and Feelrdquo de- emphasized

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 50: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

CPR Prompts

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 51: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Therapeutic Hypothermia

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 52: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

New CPR Guidelines

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 53: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

Traditional Healthcare Version

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 54: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

IMPORTANT POINT

bull RATE

bull DEPTH

bull RELEASE

bull UNINTERRUPTED

bull DECREASED VENTILATION

5 KEY ASPECTS

OF GOOD CPR

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59
Page 55: Importance of CPR Robert S. Cole. Credit where Credit is Due Adapted from presentation by Ahamed Idris, MD, –Professor of Emergency Medicine University.

ldquoIt is up to us to save the worldrdquo- Peter Safar

  • Importance of CPR
  • Credit where Credit is Due
  • Special Thanks
  • Objectives
  • A need for changehellip
  • CPR in Hollywoodhellip
  • CPR in Real Life
  • Today Nearly everyone dieshellip
  • But there is hopehellip
  • Importance Of CPR
  • 3 Phase Model
  • Cardiac Output During CPR
  • Slide 13
  • KEY POINT
  • Understanding Coronary Perfusion Pressure
  • Understanding Chest Compressions
  • ROSC Associated with CPP
  • Benefit of Continuous Chest Compressions
  • Intra-thoracic Pressure and CPR
  • New Cardiac Guidelines (2005)
  • 2005 to 2010 changeshellip
  • Who does good CPR
  • Answer NO ONE
  • Answer NO ONE (2)
  • Compression DEPTH
  • No-Flow Ratio (Interruption of CPR)
  • Compression Rate
  • Compression Ratehellip
  • Compression Ratehellip (2)
  • Barriers to staying on the chesthellip
  • Importance of complete recoil
  • Get EVERY Compression Right
  • Cerebral Perfusion Pressures and CPR
  • Current Guidelines for Ventilation
  • Compression-Ventilation Ratio
  • Reality Suckshellip
  • Prolonged Ventilations
  • Everyone sucks
  • Effect of Vent Rate on CPP
  • Aware of importance of CPR
  • Slide 41
  • CPR FIRST
  • CPR FIRST BEFORE DEFIB
  • CPR IMPROVING DEFIB
  • Slide 45
  • Slide 46
  • CPR Whats Next
  • Slide 48
  • Hands Only CPR
  • KEY POINT
  • CAB
  • Pulse Check
  • Look Listen and Feel
  • CPR Prompts
  • Therapeutic Hypothermia
  • New CPR Guidelines
  • Traditional Healthcare Version
  • IMPORTANT POINT
  • Slide 59

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Idris Jala Strategy

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BIOGRAFISHAIKHAHMADB. IDRIS - UM

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Mohammed Ben-Idris (Benidris)

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