1. Things we knew, things we did… Things we have learnt, things we should do

2. 2 Advanced Cardiac Life Support New Approachs Introduction The fact: Unchanged results The causes: Education failure (public, health professionals) Limited and underpowered clinical trials Changes are required

3. 3 The fact: Unchanged results The causes: Education failure (public, health professionals) Limited and underpowered clinical trials Changes are required Advanced Cardiac Life Support New Approachs

4. 4 Morrison LJ et al NEJM 2006 Gueugniaud PY et al NEJM 1998

5. 5 Advanced Cardiac Life Support New Approachs The fact: Unchanged results The causes: Education failure (public, health professionals) Limited and underpowered clinical trials Changes are required

6. 6 Doctors should be trained in advanced life support before students Michelle C White BMJ 2001 Price CSG Resuscitation 2006

7. 7 CPR: Public knowledge Reactions in an emergency No of subjects (n=1011) Checking breathing Keeping the airway clear Taking pulse Mouth-to-mouth 642 (64%) 608 (60%) 463 (46%) 312 (31%) Chest compression217 (21%) Donohoe RT et al Resuscitation 2001

8. 8 The fact: Unchanged results The causes: Education failure (public, health professionals) Limited and underpowered clinical trials Changes are required Advanced Cardiac Life Support New Approachs

9. 9 Berg RA et al CPP mmHg Coronary perfusion pressure (CPP) during CPR CPP = Ao diastolic pressure – Right atrial pressure ventilationcompression

10. 10 Yannopoulos D et al * * *

11. 11 Berg RA et al Coronary perfusion pressure during continuous chest compression CRP

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13. 13 NEJM 2000

14. 14 Advanced Cardiac Life Support New Approachs The fact: Unchanged results The causes: Education failure (public, health professionals) Limited and underpowered clinical trials Changes are required

15. 15 1. Push hard and fast (100/min) 2. Minimize interruption in chest compression 3. One cycle of CPR 30:2 ratio 4. One shock with maximal power from the beginning 5. Resume CC immediately after shock 6. Check rhythm and rotate CC every 2 min. 7. Avoid hyperventilation (<12 breaths/min). 8. … Advanced Cardiac Life Support New Approachs

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