RESUSITASI JANTUNG

PARU OTAK
ASEP IWA

Definisi
Resusitasi : segala bentuk usaha medis
yang dilakukan terhadap mereka yang
berada dalam keadaan gawat atau kritis
untuk mencegah kematian
Kematian : hilangnya kesadaran dan
semua refleks, disertai berhentinya
pernafasan dan peredaran darah yang
irreversibel
Resusitasi : mengembalikan fungsi sistem
pernafasan, sirkulasi, dan syaraf

Pendahuluan
350,000 cardiac arrest di AS/ th
1 kejadian setiap 90 dtk
36% (di RS)
18% of which survive to discharge

64% (di luar RS)

2-9% of which survive to discharge

3-7% of survivors return to normal

neurologic functioning

 Sebagian besar karena VF

Angka keberhasilan tinggi bila
defibrilasi 5 menit 50%
Kompresi dada sangat penting pre
dan post defibrilasi

Historical Perspective
Early 1900s: Shafer Method

Historical Perspective
1960s Peter Safar
Prone position inadequate
Expired air did provide sufficient O2.
Head tilt, chin lift kept patent airway

Historical Perspective
1955: Paul Zoll: 1st successful closed
chest defibrillation, external pacing

RJPO
Peter Safar (1981)
Basic Life Support
Advance Life Support
Prolonged Life Support

BLS
Fundamental aspects of BLS
Immediate recognition of sudden
cardiac arrest
Activation of the emergency
response system
Early cardiopulmonary resuscitation
(CPR)
Rapid defibrillation with an
automated external defibrillator (AED).

Key changes and continued points of

emphasis from the 2005 BLS
Guidelines:
1. Immediate recognition of SCA based
on assessing unresponsiveness and
absence of normal breathing
2. Look, Listen, and Feel removed
from the BLS algorithm

3. Encouraging Hands-Only CPR for the

untrained lay-rescuer
4. Sequence change to chest compressions
before rescue breaths (CAB rather than
ABC)
5. Health care providers continue effective
chest compressions/CPR until return of
spontaneous circulation (ROSC) or
termination of resuscitative efforts

6. Increased focus on methods to ensure that

high-quality CPR is performed (PENTING!!!)
7. Continued de-emphasis on pulse check for
health care providers
8. A simplified adult BLS algorithm is introduced
with the revised traditional algorithm
9. Recommendation of a simultaneous,
choreographed approach for chest
compressions, airway management, rescue
breathing, rhythm detection, and shocks (if
appropriate) by an integrated team of highlytrained rescuers in appropriate settings

Chains of Survival
Karena heterogenisitas pasien
Out/ in hospital

Simplified
adult BLS

Emphasis on High-Quality CPR

2010 Guidelines
To provide effective chest
compressions, push hard and push
fast. compress the adult chest at
a rate of at least 100 compressions
per minute with a compression
depth of at least 2 inches/5 cm.
allow complete recoil of the chest
after each compression, to allow
the heart to fill completely before
the next compression. minimize
the frequency and duration of
interruptions in compressions to
maximize the number of
compressions delivered per minute.

Highlights
This is a re-emphasis from 2005.
For effective compressions:

Push fast
Push hard
Allow chest to fully recoil
Minimize any interruptions

High-quality chest compressions within

CPR continues to be a critical focal point.
Well-performed compressions increase the
likelihood of survival.

 Create blood flow by increasing

intrathoracic pressure and directly
compressing the heart
This generates blood flow and
oxygen delivery to the myocardium
and brain

Compression Hand Position

2010 Guidelines
The rescuer should place the heel of one
hand on the center (middle) of the
victims chest (which is the lower half of
the sternum) and the heel of the other
hand on top of the first so that
the hands are overlapped and parallel.
(Berg, et al. Circulation. 2010;122;S685S705)

Highlights

Hands in center of the chest.

Lower half of breastbone
Second hand on top of the first.
Not on lowest part of breastbone.
Use of the nipple line as a landmark for
hand placement was found to be
unreliable.

Compression Rate
2010 Guidelines
It is reasonable for
laypersons and healthcare
providers to compress the
adult chest at a rate of at
least 100 compressions
per minute with a
compression depth of at least
2 inches
(5 cm.)
(Berg, et al. Circulation. 2010;122;S685S705)

Highlights
At least 100 times per minute.
It is okay to be a little faster.
It has been found that higher survival
rates are associated with an increase in
the number of compressions provided
per minute.

Compression Depth
2010 Guidelines
It is reasonable for laypersons and
healthcare
providers to compress the adult chest at a
rate of at least 100 compressions per
minute with a compression depth of at
least 2 inches/5 cm.
(Berg, et al. Circulation. 2010;122;S685S705)

Highlights
At least 2 inches on an adult.
It is okay to compress a little deeper.
Not enough information to define upper
limit.
Research indicates the tendency for
CPR providers to not compress deep
enough, even with the emphasis to
"push hard.

Breathing Assessment
2010 Guidelines
After activation of the emergency response system, all rescuers
should immediately begin CPR for adult victims who are
unresponsive with no breathing or no normal breathing (only
gasping).
(Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
No more look, listen, and feel.
Quick look for no breathing or no normal
breathing.
Agonal breaths remain a concern.
Simplifying the breathing assessment is
intended to help laypersons respond more
quickly with chest compressions and CPR.
There is a high likelihood of agonal, or
irregular, gasping breaths to occur early in
cardiac arrest and confuse rescuers.

CPR Sequence - Lay

2010 Guidelines
For an unresponsive person, activate EMS,
then assess breathing. If the person is not
breathing or not breathing normally, begin
CPR with 30 compressions followed by
opening the airway and giving 2 rescue
breaths. Repeat cycles of 30:2 (CAB
method).
(Summary from Berg, et al. Circulation.
2010;122;S685-S705)

Highlights
Initial assessment steps:

Assess responsiveness
Activate EMS
Assess breathing
Perform CPR

CAB begin CPR cycles with compressions,

followed by airway and breathing.
Guideline applies to adults, children, and infants.
The science indicates the importance of not
delaying chest compressions to perform rescue
breaths.
Early chest compression can immediately
circulate oxygen that is still in the bloodstream.

CPR Sequence - HCP

2010 Guidelines
For an unresponsive person who is not
breathing or not breathing normally, and
has no obvious pulse, activate EMS and
begin CPR with 30 compressions followed
by opening the airway and giving 2 rescue
breaths. Repeat cycles of 30:2 (CAB
method).
(Summary from Berg, et al. Circulation.
2010;122;S685-S705)

Highlights
Initial assessment approach:

Assess responsiveness and breathing

Activate EMS
Assess pulse
Perform CPR

CAB begin CPR cycles with compressions,

followed by airway and breathing.

Terminasi Resusitasi-BLS

Terminasi Resusitasi-ALS