Prof Folayemi Faponle

Department of Anaesthesia and

Intensive Care,
OAU/OAUTHC
Ile-Ife
 Introduction
 Some Basic Definitions
 Historical Background
 The Chain of Survival
 Causes OF Cardiac Arrest
 Basic Techniques
 2015 Resuscitation Guidelines Algorithms
 Final words

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 Cardiac Arrest(CA):sudden unexpected
cessation of spontaneous, effective pump
function. It may be reversible by prompt
intervention but will lead to death in the
absence of such intervention

 Basic Life Support(BLS):First phase of

emergency cardiac care and involves prompt
recognition of cardio-respiratory arrest, initial
attempts to artificially ventilate and maintain
circulation by whatever means is available

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 Advanced Life Support(ALS): second phase of
CPR involving the use of adjunctive equipment
and special techniques and maintaining
effective ventilation and circulation.

 May require the use of oxygen, ECG monitoring,

arrythmia recognition, iv access, defribrillation,
drug administration, and finally critical
assessment and post resuscitation care which
may include prolonged intensive care.

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 CPR alone is unlikely to restart the heart; its
main purpose is to restore partial flow of
oxygenated blood to the brain and heart.

 The objective is to delay tissue death and to

extend the brief window of opportunity for a
successful resuscitation without permanent
brain damage

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 Defibrillation,
is usually needed in
order to restore a viable or "perfusing"
heart rhythm.

 It
is only effective for certain heart
rhythms:
 ventricular fibrillation or pulseless
ventricular tachycardia
 rather than asystole or pulseless
electrical activity.

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 CPR may succeed in inducing a heart
rhythm which may be shockable.

 CPR is generally continued until the

subject regains return of spontaneous
circulation (ROSC) or is declared dead.

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 There are 3 physical symptoms that indicate
the need for CPR to be performed immediately.
◦Unconsciousness/Unresponsiveness
◦Not breathing (lack of spontaneous
breathing)
◦No pulse detected
 Immediate help or CPR is needed when these
symptoms are found. TIME IS CRITICAL

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8 …we help you plan to save Lives!
 A few milestones in the development:

 Prophet Elisha’s use of mouth –to- mouth resuscitation

 Tossach in 1774- reported mouth-to-mouth

resuscitation

 -1960- Kouwen published a classic paper on closed

chest massage

 Peter Safar - ABC of resuscitation in 1957. In the U.S.,

it was first promoted as a technique for the public to
learn in the 1970s.

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 19th C- Silvester method
 Chest pressure, arm lift technique

 1911-Holger Nelson technique (reverse

Silvester)- famous till 1979
 Back pressure, arm lift technique

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 * Resuscitation Council (UK) guidance
provides evidence-based interventions that
are most likely to prevent cardiac arrest or
increase the chances of the successful
resuscitation (with full neurological
recovery) of an adult, child or newborn baby
in cardiac or respiratory arrest.

*Guidelines 2015 marks the 55th

anniversary of modern CPR

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 Cardiac arrest : ultimate medical
emergency the correct treatment must be
given immediately if the patient is to have
any chance of surviving.

 The interventions that contribute to a

successful outcome after a cardiac arrest
can be conceptualised as a chain
– the Chain of
Survival.

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 Cardiac Disease
 Circulatory causes
 Respiratory Causes
 Metabolic changes
 Drug Effects
 Miscellaneous causes

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 Warning signs of CA :
◦ Hypotension, tachycardia, chest pain,
dyspnoea, fever, restlessness or confusion
indicate that a patient is seriously ill.
◦ Hypoxaemia, hypovolaemia and sepsis may
progress to cardiac arrest unless rapidly
diagnosed and corrected.
◦ CPR for patients who are septic or
hypovolaemic usually fails.

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 ADULTS
 Sudden CA usually due to myocardial

ishaemia –hypertension,diabetes, obesity

 Hypoxaemia & Hypotension – slow

progressive deterioration in vital signs,

usually predictable
(Chances of survival poor )
- Early recognition is
important as prevention is better than cure

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 Primary CA uncommon
 Respiratory Problem is the commonest

resulting in hypoxaemia, bradycardia and

CA
 Haemorrhage leads to bradycardia and CA(

asystole)
 Commonly preceded by seizures
 Oxygen delivery is most important
 Results often poor following CA

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 Basic life support consists of the following sequence of
actions:
 1. Make sure the victim, any bystanders, and you
are safe.

 2. Check the victim for a response.

 Gently shake his shoulders and ask loudly, ‘Are you
all right?’

 3A. If he responds:
 Leave him in the position in which you find him
provided there is no further danger.
 Try to find out what is wrong with him and get help if
needed.
 Reassess him regularly.

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 In2010, the American heart
association (AHA) changed its
long held ABC to CAB
(Circulation, Airway, Breathing)
to help people remember the
order to perform the steps of
CPR.
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 Monitor in an area with facilities for
immediate resuscitation
 Regular re-evaluation of vital signs
 Appropriate training of all staff to recognise

at risk patients
 use of “Early Warning Score” will identify

in-patients at risk

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 Vital 3 2 1 0 1 2 3
Signs/Score

Heart rate <40 41-50 51-100 101-110 111-130 >130

Systolic BP <70 71-80 81-100 101-199 >200

Respiratory
rate <8 9-14 15-20 21-29 >30

Temperature <35 35.1-36.5

CNS A V P U

Urine output
last 4 hrs <1ml/kg <1.5ml/kg <2ml/kg >10ml/kg

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 By countries e.g. American Heart
Association
British Resuscitation Council,
South African Resuscitation Council
 Internationally: European Resuscitation

Council, International Liaison Committee on

Resuscitation (Brussels)

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If he is not breathing normally and unconscious:

 Call Ambulance/AED
 Start chest compressions:
 Sternal compressions 5-6cm deep
 Rate of 100-120/minute
 Give 2 rescue breaths lasting not more than 5 secs
after 30 compressions
 Continue with chest compressions and rescue
breaths in a ratio of 30:2.

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 Restore blood circulation with chest
compression
• Put the person on his back on a firm surface.

• Kneel next to the person’s neck and shoulder

• Place a heel of one hand over the centre of the

person’s chest

• Place your other hand on top of the first hand

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 Keep your elbow straight and position your
shoulder directly above your hands.
 Use your upper body weight and press

down at least 2 inch (5 -6cm). At a rate of

100 -120 compressions/min

 NB: Pivot from the hip

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 30

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 Clear the airway
 If you have done up to 30 chest

compressions, you can now open the

person’s airway using the Head-tilt, Chin-
lift maneuver.

 Place your palm on the person’s forehead

and gently lift the chin forward to open the
airway

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 Breath for the person

• Rescue breath can be mouth-mouth or

mouth-nose (if the mouth is seriously injured
or cant open).

• With the airway opened using the head-tilt,

chin lift maneuver, pinch the nose shut (for
mouth-mouth) and cover the persons mouth
with your mouth, making a seal

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 Give 2 rescue breaths. Give the first lasting
1 sec and watch to see if the chest rises.
 If it does rise give the second breath.
 If it doesn’t rise repeat the head-tilt, chin-

lift maneuver and give the second breath

 NB: 30 chest compressions + 2 rescue

breath = 1 cycle

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 Do not stop unless:
 Emergency help arrives and takes over.
 The casualty breathes normally or
 You becomes exhausted that you cannot

carry on OR
 If two rescuers with knowledge of CPR are

available, change every two minutes with

minimal disruption.

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 Continue resuscitation until:
 qualified help arrives and takes over,
 the victim starts to show signs of
regaining consciousness, such as
◦ coughing, opening his eyes, speaking, or moving
purposefully AND starts to
◦ breathe normally, OR
 you become exhausted

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 CPR LECTURE 12/02/24
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Do not stop to check the victim or
discontinue CPR unless the victim starts to
show signs of regaining consciousness, such
as coughing, opening his eyes, speaking, or
moving purposefully AND starts to breathe
normally.
 Teach CPR to lay people with an emphasis

on chest compression, but include

ventilation as the standard, particularly for
those with a duty of care.

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 Minimal interruption high quality chest
compression emphasized throughout any ALS
intervention.
 Chest compressions are now continued while a
defibrillator is charged – this will minimise the
pre-shock pause.

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 Establish the safety of the victim and potential rescuer
 Confirm the diagnosis of an arrest
 Send for help/AED
 Establish BLS
 Aim for early and frequent defribrillation if indicated
with regular doses of adrenaline and CPR
 If there is any doubt about the rhythm, or no ECG
monitor available, treat adults as being in VF
 Minimise interruptions of external chest compressions
 Give drugs IV. Use a 20-50ml 0.9% saline flush with
the peripheral route
 Consider and treat underlying causes

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 Two thirds of those dying after admission to
ICU following out-of-hospital cardiac arrest
die from neurological injury.
 A quarter of those dying after admission to

ICU following in-hospital cardiac arrest die

from neurological injury.
 A means of predicting neurological outcome

that can be applied to individual patients

immediately after ROSC is required

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 No definite tests yet to determine prognosis
 There is wide variation in patient survival rates
among hospitals caring for patients after
resuscitation from cardiac arrest.

 Treatment outcomes –
i. Recovery without any brain damage.
ii. Recovery with residual minor brain damage
iii. Vegetative state(social death)
iv. Recovery with brain death. There is
irreversible necrosis of the brain with flat EEG

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• CPR is an emergency life saving measure

• Combination of rescue breathing and chest

compressions

• Done on unconscious/non-breathing
patient

• Also for near

drowning/asphyxiation/trauma cases

• CPR conducts defibrillation

• Support heart pumping for a short time

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• Buy time till help arrives.

• More effective when done as early as possible.

• All victims in cardiac arrest need chest
compressions.
• In the first few minutes of a cardiac arrest,
victims will have oxygen remaining in their
lungs and blood stream.

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 The currently dismal outcomes of “sudden
death” victims in our environment may be
improved upon by the teaching and
practice of both BLS and ALS at all levels of
our health care system.

 Community Educational programs and

Emergency Medical facilities will go a long
way in ensuring the success of CPR in our
environment.

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THANK YOU

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