Student presentation, anaesthesiology department, Usmanu Danfodiyo University Sokoto

1. By
ABIOLA MUBARAK MOHAMMED

2. OUTLINE
• INTRODUCTION
• HISTORY &EVOLUTION OF CPR
• CARDIAC ARREST
• INDICATIONS
• CONTRAINDICATIONS
• EQUIPMENTS/TECHNIQUES
• GUIDELINES
• MONITORING
• PRECAUTIONS
• COMPLICATIONS
• REFERENCES03-Jul-18 Weirdmaskman Slides 2

3. INTRODUCTION
• CardiopulmonaryResuscitation (CPR) is a life
saving technique/emergency procedure that
combine chest compression often with
artificial ventilation in an effort to manually
maintain circulatory flow and oxygenation
until further measures are taken to restore
spontaneousblood and breathing in a patient
who is in cardiac arrest
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4. HISTORY & EVOLUTION
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• Over many centuries various techniques have been
tried in order to restorelife. The use of heat, smoke,
cold water, and beating were some of the earlier
attempted technique.
• Use of bellows via mouth and nose, attributed to
Paracelsus in 1500s
• Kite introduced the use of artificial ventilation via
tracheal tubes in 1700s
• Postural technique – compressing the chest wall and
the abdomen from back as the victim is placed prone.
Moving the arms or using …. In 1850s

5. HISTORY & EVOLUTION
• Expire air ventilation although reported earlier
was developed in 1700s
• Cardiac massage – both internal and external
cardiac massage was 1st attempted in 1800s but
the popularization of external cardiac massage
was in 1960s
• Defibrillation – 1700/1800 - investigated in
animals. Internal defibrillation in man was
performed in 1940s while external defibrillation
in 1950s
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6. HISTORY & EVOLUTION
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• FIRST- Dedicated conference on CPR 1966 recommended
thus
– All medical personnel
– All allied health workers
– Be trained on the technique of mouth to mouth resuscitation and
external chest compression(Basic life support)
• SECOND-Conference on CPR 1973 rec.
– General public be trained on the technique of Basic Life
Support (BLS)
– Standards for BLS proposed
– Defibrillation, drugs, definitive treatment introduced
i.e. Advanced life support (ALS)

7. HISTORY & EVOLUTION
• THIRD - Conference on CPR 1979
– Many new information collected, changes in ‘standards’
techniques necessary.
• Recommendation: change ‘standards’to
‘Guidelines and standards’
– This indicates that even the ‘Guidelines and standards’
were not the only legally acceptable approach but the
one with best likelihood of success.
• FOURTH- Conference on CPR 1985
– Approved ‘Guidelines and standards for pediatrics and
adult Advance Cardiac Life Support (ACLS)
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8. HISTORY & EVOLUTION
• FIFTH - Conference on CPR 1991
• Causes of cardiac arrest better understood
• Regional councils established to supervise and update the
guidelines and standards e.g.
» European resuscitation council (REC)
» American heart association (AHA)
» International liaison committee on resuscitation
(ILCOR)
• Review dates back to 2015
• Result is now the consensus view of the regional association
on CPR.
• Mouth to mouth
• Closed chest cardiac massage
• Defibrillations
• Vasopressors
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9. WHAT OFTEN PROVOKES CPR?
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10. CARDIAC ARREST
It is the sudden cessation of a demonstrable
heart beat with no clinical cardiac output in a
patient not expected to die. The sooner the
patient is resuscitated the better the chances
of a full recovery
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11. • Brain death occurs when the brain undergoes
irreversible damage from oxygen deprivation
after cardiac arrest. It occurs 4-6 minutes after
an arrest and in such an instance,
resuscitation is fruitless.
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12. CAUSESOF CARDIACARREST
• The commonest cause of cardiac arrest in the
immediate post operative period is tissue
hypoxia which may result from
• Respiratory obstruction
• Severe haemorrhage leading to hypovolaemia
• Shock
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13. OTHER CAUSES
• Myocardial infarction
• Massive transfusion
• Acidosis
• Hypothermia
• Pulmonary embolism
• Cardiac temponade
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14. INDICATION FOR CPR
• Loss of consciousness
• Pulselessness
• Heart attack
• Drowning
• Excessive bleeding
• Drug overdose (anaesthetics)
• Other conditions where breathing or pulse are
absent e.g ventricular fibrillation, pulseless ventriculartachycardia,
asystole,pulselesselectrical activity, pulseless bradycardia etc.
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15. INDICATION FOR CPR
NOTE – not all dying patient should have
CPR
– The arrest must be sudden, unexpected,
witnessed or monitored
– Patient must not be in terminal stage of
malignant or other chronic disease
– Ensure there is no DNR request
– There should be possibility of return to a
functional existence
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16. CONTRAINDICATION
• Absolute
– Do-Not-Resuscitate order (DNR)
• The only absolute contraindication to CPR
• Relative contraindications
– Trauma to the chest wall (in the way of ECPR)
– Dead body
– Spontaneous breathing or recovery
– Clinical justification against CPR
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17. EQUIPMENTS
• CPR, in the most basic form can be performed
anywhere without the need for specialized
equipment
• Universal precautions
– Gloves
– Mask (face shield or mask)
– Gown
• Others for advanced cardiac life support
– Defibrillators
– Endotracheal tubes
– Vasopressors
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18. TECHNIQUES
• There are three steps in CPR; performed in order
(CAB) in accordance with the American Heart
Association (AHA) guidelines for healthcare
providers
– Chest compression
– Airway
– Breathing
NB: Artificial respirations are no longer
recommended for bystander rescuers; thus
perform compression-only CPR (COCPR)
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19. Cont’d
• Basic cardiac life support (BCLS)
– CAM
• Advanced cardiac life support (ACLS)
– In-hospital
– More robust e.g drugs, ECG monitoring,
defibrillation, invasive airway procedures
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20. CHESTCOMPRESSION
• Patient should be in
supine position
• On a relatively hard
surface to allow effective
compression of the
sternum (not on Cushing)
• The person giving
compression should be
positioned high enough
above the patient to
achieve sufficient
leverage
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21. • The heel of the palm of one hand is place on
patient sternum
• The other hand on top of the first with the fingers
interlaced
• Extend the elbows and the provider leans directly
over the patient
• Press down on the chest at least 2 inches
4-6cm in adults, 2-4cm in children and 1-2cm for infants using the middle and
ring fingers on sternum at a position two finger breath below the nipple line.
• Release the chest and allow it to recoil
completely
• Compression rate of about 100/min
– Chest compression provider swap every 2-3 min to
prevent fatigue
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22. AIRWAY
• Perform head tilt chin lift maneuver to open
the airway
• Before starting
ventilation, look in the
patient mouth for any
foreign body and remove
• Ensure ventilation
access
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23. MOUTH TO MOUTH TECHNIQUE
• Pinch the patient nostril closed to
assist with an air tight
• Put the mouth completely over the
patient mouth
• After 30 compression, give 2 breath
• Each breath should be giving for
approximately 1 second with each
force to make the patient chest rise
• Failure to observe chest rise indicates
an inadequate mouth seal or airway
occlusion03-Jul-18 Weirdmaskman Slides 23

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Note the
overlapping
hands
placed on
the centre
of sternum,
with the
rescuer’s
arms
extended

25. PRECAUTIONS
• Do not leave patient alone
• Do not give chest compression if the victim has a
pulse
• Do not give the victim anything to eat or drink
• Avoid moving the victim head and neck if spinal
injury is a possibility
• Do not place pillow under the victims head
• Do not put hand directly in mouth to remove
foreign body
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26. MONITORING
International guidelines 2000 conference
recommended that rescuer should not
depend on the unreliable pulse assessment as
an indicationfor perfusion but instead on
signs of life such as breathing, movement and
cough. This is based on Cummins and
colleagues’ findings that only 15% lay rescuer
can assess pulse within 10sec and 45.5%
report no pulse when pulse was present
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27. MONITORING OF CPR
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• If the heart is not restarted in 1hr,
resuscitation should be abandoned
• The important parameters during
resuscitation include:
– State of the pupils
– Carotid or femoral pulsation
– Spontaneous respiratory effort
– Level of consciousness

28. MONITORING
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• Cerebral death is indicated by
– Widely dilated pupils which do not respond to
light
– Deep unconsciousness
– Absence of respiratory effort
If these persist for 1 hr, then death has occurred
If rescuer wasn’t there when patient collapsed,
rescue can be called off after 30 min

29. CHAINOF SURVIVAL
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31. COMPLICATIONS OF CPR
• Rib fractures
• Sternal fracture
• Bleeding in the anterior mediastinum
• Heart contusion
• Haemopericardium
• Pneumothorax
• Haemothorax
• Lung contusion
• Regurgitation / aspiration
– Gastric insufflation
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32. CONCLUSION
• CPR is a life saving technique that prevents
cessation of blood flow to vital organs
dependent on oxygen supply for life support
• Survival rates and neurological outcomes are
poor in patients with cardiac arrest, though
early appropriateresuscitation involving BCLS
and ACLS techniques leads to improved
survival and better outcome
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34. REFERENCE
• Cardiac Arrest and CPR
Lecture note by DR Abdullahi;
consultant anaesthetist, UDUTH
• Medscape online Medical Reference
– www.emedicine.medscape.com/article/1344081-
overview
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