BASIC CARDIOPULMONARY RESUSCITATION

BASIC CARDIOPULMONARY RESUSCITATION

1. TEAM-FOCUSED CARDIOPULMONARY RESUSCITATION

   • Out-of-hospital cardiac arrest has high rates of morbidity and mortality.
     • More than 356,000 out-of-hospital cardiac arrests occur each year.
       • OBJECTIVE: Return of spontaneous circulation, survival to hospital admission, survival to hospital discharge and, most importantly, survival with intact neurologic function.
   • OBJECTIVE OF ARTICLE: Examine commonly used cardiac arrest interventions, including early defibrillation or high-quality chest compressions.
     • The American Heart Association (AHA) reaffirmed the two cornerstones of early cardiac arrest resuscitation as
       • Quality chest compressions.
       • Early defibrillation for shockable cardiac rhythms.
   • Process
     • CPR is performed in sequential cycles of 200 compressions each
     • The clinician performing compressions counts aloud each twentieth compression.
     • Ventilated breaths are administered in conjunction with each twentieth compression to avoid hyperventilation and gastric overinflation.
     • The defibrillator is charged when the compressor announces the 180th compression.
     • A team member's check for a pulse.
     • When the 200th compression is finished, all other providers automatically stand clear of the patient, and cardiac rhythm analysis occurs simultaneously with pulse .
     • Epinephrine is the only intra-arrest drug administered.
   • Results
     • Good neurologic outcomes.
   • Process variables
     • Airway Management
       • Airway management in cardiac arrest remains a controversial topic with a paucity of available in-hospital data.
         • Increased neurologically intact survival with bagvalve-mask alone when compared to advanced airway placement.
     • Vascular Access
       • Intraosseous access is effective for administration of all drugs and fluid used in the cardiac arrest setting, and is also suitable for blood sampling and laboratory evaluation

2. CARDIOPULMONARY RESUSCITATION QUALITY ISSUES

   • High-quality cardiopulmonary resuscitation (CPR) and defibrillation, if indicated, are the central interventions in the initial resuscitation from sudden cardiac arrest.
     • Issues
       • Chest compressions are often given either too slow or too fast or include inappropriate pressure on the chest during relaxation.
       • Inappropriately fast compression rates may have deleterious effects due to inadequate time for filling of the heart.
       • Compression depths greater than 5.1 cm were associated with a decrease in survival with good neurologic outcomes.
       • Production of intrathoracic pressure.
       • The quality of resuscitation deteriorates after 2 minutes.
     • Evidence
       • Resuscitation treatment recommendations pertinent to cardiopulmonary resuscitation quality.
         • 60-10 compressions/min.
         • Strategies have been proposed to attempt to optimize perfusion and/or to minimize pauses during chest compressions.
           • The provision of continuous compressions with asynchronous ventilation.
           • Cardiocerebral resuscitation.
           • Perform CPR with 30 compressions to 2 ventilations.
           • Continuous chest compression with positive pressure ventilation delivered without pausing chest compressions until a tracheal tube.
         • The depth of the compression should be 5 cm.
   • Conclusion
     • Need to refocus on basic resuscitation component susing strategies known to improve outcomes, particularly improving the quality of CPR.
   • Measurement and performance improvement.
     • Use a software for reviewing subsequent events that can capture metrics related to the quality of the CPR.
       • Eliminating or significantly minimizing pauses during CPR is a good target for improvement.

3. CARDIOPULMONARY RESUSCITATION: EVOLUTION OF SURVIVAL IN CARDIAC ARREST WITH AGE IN ELDERLY PATIENTS: IS RESUSCITATION A DEAD END?

   • Some studies question whether cardiopulmonary resuscitation (CPR) in the elderly could be futile.
     • Analyze the differences in resuscitation interventions according to age.
       • Although resuscitation in older adults can save lives, the futility of CPR in older patients is still under debate .
   • The major elements influencing the survival of patients are
     • The noflow duration.
     • Low flow duration.
     • Initial cardiac rhythm.
   • One of the main challenges concerning CPR in older adults is to differentiate between patients in whom resuscitation should be attempted and those who should not be resuscitated.
   • Materials and methods
     • The resuscitation team is composed of at least one emergency physician, a nurse, and an emergency medical technician.
       • Results
         • International CA guidelines do not define age as a discrimination criterion for resuscitation. Yet, the main result of this study is that survival of older persons decreased linearly at a rate of 3% every 5 years.
         • they found that the more the patient gets older the more the resuscitation efforts shorten and get less intensive.

4. TIMELY RECOGNITION OF VENTRICULAR FIBRILLATION AND INITATION OF CARDIOPULMONARY RESUSCITATION BY INTENSIVE CARE UNIT NURSES

   • Causes of cardiac arrest
     • Ventricular tachyarrhythmias, such as pulseless ventricular tachycardia (TV) and ventricular fibrillation.
       • Are both defibrillable rhythms.
     • The pulseless electric current activity and asystole.
   • Further research should investigate the impact of nurse initiated defibrillation on patient outcomes.
   • An automated external defibrillator for basic life support or with a manual defibrillator for advanced cardiovascular life support also been shown to increase survival in the context of VT or VF.
   • Nurse-initiated manual defibrillation before the arrival of the attending physician is not a frequent practice in the context of an in-hospital cardiac arrest
   • Barriers
     • Real or perceived lack of appropriate training in life support and defibrillation.
     • Lack of opportunities to apply this knowledge.
     • Reluctance to perform defibrillation even with appropriate background.
   • For example
     • In Canada, it is an ethical and professional obligation for nurses to be competent in interventions such as CPR.
   • Objective
     • ¿Do ICU nurses’ have the proper skills to initiate the first critical steps of CPR?
       • The population was a group of 82 nurses from four different ICU.
         • Phases of the research study
           • 1. Survey evaluating their knowledge.
             • 2. Asked to complete a brief demographic.
               • 3. Clinical simulation.
                 • The patient first complained of dyspnea
                 • The patient would gasp, and a VF rhythm was then displayed on the cardiac monitor.
                 • Cardiopulmonary resuscitation.
   • Conclusion
     • Conclusion Most ICU nurses in our sample quickly called for help and began chest compressions; they were able to identify VF and the requirement for immediate defibrillation in a simulated setting.
     • Proper training regarding the identification of pulseless ventricular tachydysrhythmias remains an important matter to address.

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