Cardiopulmonary cerebral resuscitation (Proceedings)

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Cardiopulmonary cerebral resuscitation (Proceedings)

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Apr 01, 2009

Recognition of Cardiopulmonary Arrest

• Unconscious- nonresponsive
• Lack of pulse or heartbeat
• Lack of breathing
• Other signs

Prognosis

• Most will die
• Some can be resuscitated
• Some should be resuscitated

Basic Life Support - CPR

• Recognition of arrest
• Call for help
• Verify and secure patent airway - Positive pressure ventilation with 100% oxygen if available
• Cardiac massage at 90-120/minute with choice of technique based on pulse quality

Cardiac arrest is a life threatening emergency which must be recognized and treated IMMEDIATELY!!

Cardiopulmonary Resuscitation
a. Airway
b. Breathing
c. Circulation

Airway
• Visual Inspection

Breathing
• Anesthesia Circuit or Mouth to tube or muzzle or Resuscitation Bag AMBU Bag
• Breathing Rate of 8-12 per minute

Circulation (External Cardiac Compression) optimize technique
• Technique - guided by monitoring equipment
• Use pulse oximeter for pulse wave-form as well as for hemoglobin saturation
• Use capnometer for evidence of tissue perfusion as well as for appropriate ventilation
• Circulation (Internal Cardiac Compression)
• Advantages: efficient, effective (C.O. 80% open vs. 30% closed)
• Disadvantages are substantial: not quick enough, traumatic (patient, owner, & personnel), poor results
• Reserve Internal Cardiac Compression for very limited situations

Newer Cardiovascular Pharmacology in CPR

• Magnesium therapy in CPR - Many causes of hypomagnesemia in patients at risk:
GI and renal losses increased in the critically ill, diuretics, diabetic ketoacidosis, hyperthyroidism, primary hyperparathyroidism, cholestatic liver disease, hypothermia, blood transfusions, etc.
Emperical administration of 100mg/kg MgSO4 over 5-10 min improves defibrillation, improves chances of resuscitation and ultimate recovery. Proper use of cardiovascular pharmacology during resuscitation is based on identification of the type of arrest...

1. Ventricular or Complete Asystole
• "Flat line" ECG - Full vagolytic doses of Atropine are recommended for asystole & bradycardic arrests
• May Result in...
• Electrical-mechanical dissociation
• Ventricular tachycardia
• Ventricular fibrillation
• Normal sinus rhythm
• Recurring asystole
• Sinus bradycardia

2. Ventricular Fibrillation
• May Result in...
• Normal sinus rhythm
• Ventricular tachycardia
• Recurring ventricular fibrillation
• Asystole

3. Pulseless Electrical Activity (PEA) AKA Electrical-Mechanical Dissociation (EMD)
• Therapies for PEA - Continued BLS plus:
• Bicarbonate
• Calcium (controversial - detrimental)
• Dopamine, Ephedrine, Dobutamine (or other inotropes)
• May Result in...
• Continued PEA
• Asystole
• Fibrillation