2010 년 AHA 심폐소생술 가이드라인 설명회 Chest compression & BLS algorithm 연세대학교 강남세브란스병원 응급의학과 정성필

대한심폐소생협회 Compression first  CAB rather than ABC - Layperson should be encouraged to provide chest compressions for anyone with a presumed cardiac arrest (Class I,B) - Growing evidences of the importance of chest compression - Setting up airway equipment takes time  Let’s change ABC mindset - ABC mindset may reinforce the idea that compressions should wait - Even when more than 1 rescuer is present

대한심폐소생협회 Hands-only CPR  Pros - No bystander CPR < Hands only CPR - C onventional CPR = Hands only CPR - Reluctance to perform mouth to mouth ventilation - May help overcome panic and hesitation to act  Why effective? - Ventilation is not important for first several minutes after arrest - If the airway is open, gasping and passive chest recoil can provide some air exchange

대한심폐소생협회 Hands-only CPR  Rescue breathing is important to non-cardiac origin - Pediatric arrests - Asphyxial cardiac arrest - Prolonged cardiac arrest - Conventional CPR is recommended for those specific situations (when capable of giving CPR with ventilations) (IIa, C)  Hands-only CPR is recommended to - Untrained layperson (dispatcher assisted CPR) - Trained but incapable of airway and breathing

대한심폐소생협회 AHA BLS algorithm

대한심폐소생협회 BLS HCP algorithm 1/2 No pulse Definite Pulse Deleted from 2005

대한심폐소생협회 BLS HCP algorithm 2/2 Shockable Not Shockable

대한심폐소생협회 Simplified Adult BLS algorithm

대한심폐소생협회 ERC Adult BLS algorithm A C B Same as 2005

대한심폐소생협회 Patient position  Supine on a firm surface  Use of backboard - Traditionally recommended despite insufficient evidence - Care should be taken - to avoid delays in initiation of CPR - to minimize interruptions in CPR - to avoid line/tube displacement  Air-filled mattress - Should be deflated when performing CPR

대한심폐소생협회 Chest compression technique  Hand position - Lower half of the sternum (IIa,B) - “Place the heel of your hand in the center of the chest with the other hand on top” - Internipple line as a landmark is not reliable  Compression rate (speed) - At least 100 compressions per minute (IIa,B) - Compression pause should be minimized - Not exceeding 120 /min (ERC)  Compression depth - At least 5 cm (IIa,B) - Not exceeding 6 cm (ERC)

대한심폐소생협회 Compression ventilation ratio  30:2 - Based on consensus among experts (IIb, B) - Further validation of this guideline is needed  Once an advanced airway is in place - Continuous chest compressions without pauses for ventilation (IIa, B) - Provide ventilation every 6~8 seconds  Minimize interruption of chest compressions throughout the entire resuscitation (IIa, B) -

대한심폐소생협회 Decompression (chest recoil)  Complete chest wall recoil (IIa,B) - Incomplete recoil is common particularly when rescuers were fatigued  Adverse effect of incomplete recoil ↑intrathoracic pressure ↓coronary & cerebral perfusion ↓cardiac index, myocardial blood flow  Can be improved by - Electronic recording devices with real-time feedback - Lifting the heel of the hand slightly, but completely, off the chest

대한심폐소생협회 Duty cycle  Time spent compressing the chest  Duty cycle of 50% is recommended (IIb,C) - Reduced coronary perfusion is associated with a duty cycle of >50% - Duty cycles ranging between 20~50% can result in adequate coronary and cerebral perfusion - 50% is easy to achieve with practice  Compression relaxation times - Approximately equal (IIb,C)

대한심폐소생협회 Switching compressors  Fatigue and shallow compressions are common after 1 min of CPR - Rescuers may not recognize that fatigue is present for 5 min  Switch chest compressors approximately every 2 min (IIa, B) - Consider switching compressors during any intervention in 5 sec

대한심폐소생협회 Interruption of compression  Lay rescuers - Should not interrupt chest compressions to palpate pulses or check for ROSC (IIa, C) - Should continue CPR until an AED arrives, the victim wakes up, or EMS personnel take over CPR (IIa, B)  Healthcare providers - Should interrupt chest compressions as infrequently as possible and try to limit interruptions to no longer than 10 seconds (IIa, C) - Because of difficulties with pulse assessments, interruptions in chest compressions should be minimized

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