ADJUNCTS FOR

RESUSCITATION

DR. Med. dr. Untung Widodo, SpAn.KIC.

Bagian Anestesiologi & Reanimasi
Fakultas Kedokteran
UGM, Yogyakarta
2010

I. Pendahuluan

CPR Guidelines 2005 (update from 2000)

(ILCOR, International Liaison Committee on Resuscitation.
Agreed in Int. consensus confe-rence on CPR and emergency
cardiovascular care science )

- No assessing pulse
- Chest compression- ventilation = 30:2
- Compression rate : 100 x/minute
- No mouth to mouth breath w/o chest comp.
(for lay rescuer)
1. "Adult Basic Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-19
2. Basic Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-156.
3. Adult Basic Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5
4."Pediatric Basic and Advanced Life Support". American Heart Association.
http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-73

Device example :

For healthcare provider

5 cycles of CPR before DC-shock

Check pulse after 5 cycles of CPR
Minimize CPR interruption for insert
A device, reassessment or drugs ad.
1 DC shock only, then CPR
Reaffirmation of tPA i.v. for stroke, &
should be administered by physician
Increased emphasis on ventilation, & deemphasis on using high conc. O2 for new
born

Circulation 2005;112;IV-1-IV-5; originally published online Nov 28,

2005; part 1 : Introduction

Compression only CPR

(= cardiocerebral resuscitation, CCR)

1.
2.

A study by the University of Arizona,

claimed that CCR had a 300% greater
success rate over standard CPR ( The
exceptions were in the case of
drowning or drug overdose )

Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study"
Lancet 69(9565): 9206. March 17, 2007.
Heart Association: Hands-only CPR works

to improve survival of CPR

Immediate CPR followed by defibrillation

within 35 minutes of sudden VF cardiac
arrest improve survival.
Widespread CPR training.
(In cities such as Seattle where CPR training is widespread

and defibrillation by EMS personnel follows quickly, the

survival rate is about 30 percent. In cities such as New York
City, without those advantages, the survival rate is only 1
2 percent )

II. Adjuncts for Airway control &

Ventilation

Bag-Mask Ventilation, (with sufficient Vt to

produce chest arise, 6-7 ml/kg b.w. or
500-600 ml over 1 second)
2 x vent. then 30 chest compression
If ET/Combitube/LMA in place,
give breath 8-10 x/minute,
chest compression rate 100 x/minute
Dont attempt to syncronize

Circulation 2005;112;IV-51-IV-57; originally published online Nov 28, 2005;

Part 7.1 : Adjuncts for Airway Control and Ventilation

Aduncts for Airway

Oropharyngeal airway
Nasopharyngeal airway
Advances airway :
Esophageal-tracheal Combitube
Laryngeal Mask
Endotracheal tube (dont >10sec. for
insertion)

Oropharyngeal tube

Nasopharyngeal tube

LMA

Esophageal-tracheal combiyube

Endotracheal tube

Bag-mask

III. Adjuncts for CPR

To date no adjunct has consistently

been shown to be superior to
standard manual CPR for out-ofhospital basic life support, and no
device other than a defibrillator has
consistently improved long-term
survival from out-of-hospital cardiac
arrest.

Circulation 2005;112;IV-47-IV-50; originally published online Nov 28, 2005;

techniques

High-Frequency Chest Compressions

(100 x/minute )
Open-Chest CPR (during cardiac surgery)
Interposed Abdominal Compression
to improve cardiac preload)
Cough CPR (during awake monitored VT/VF

devices

Automatic and Mechanical Transport

Ventilators
Active Compression-Decompression CPR
Impedance Threshold Device
Mechanical Piston Device
Load-Distributing Band CPR or Vest CPR
Phased Thoracic-Abdominal CompressionDecompression CPR With a Hand-Held Device
Extracorporeal Techniques and Invasive
Perfusion Devices

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