2001 science behind bls guide

8/6/2019 2001 Science Behind BLS Guide

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The Science BehindThe Science Behind

the BLS Guidelinesthe BLS Guidelines

2001 American Heart Association

Part I: Adult

Part II: Infant and Child


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Lecture ObjectivesLecture ObjectivesAt the end of this lecture, the instructorAt the end of this lecture, the instructor

candidates will be able tocandidates will be able to

Discuss the science supporting the newDiscuss the science supporting the newBLS Guidelines recommendationsBLS Guidelines recommendations

Discuss how these recommendationsDiscuss how these recommendationscan be applied to CPR scenarios andcan be applied to CPR scenarios and

practicepractice Answer questions that may arise duringAnswer questions that may arise during

CPR coursesCPR courses


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International GuidelinesInternational Guidelines

Development ProcessDevelopment Process

Recommendations were developedRecommendations were developedduring 2 international conferencesduring 2 international conferences

Involved more than 500 experts from 30Involved more than 500 experts from 30countriescountries

Experts reviewed over 25,000 manuscriptsExperts reviewed over 25,000 manuscripts

Recommendations then were reviewedRecommendations then were reviewed

and revised by internationaland revised by internationalsubcommittee and 2 editorial groupssubcommittee and 2 editorial groups

Final recommendations were endorsedFinal recommendations were endorsedby 6 international resuscitation councilsby 6 international resuscitation councils


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Part I: AdultPart I: Adult


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Prearrest BLS EmergenciesPrearrest BLS Emergencies

Acute Coronary SyndromesAcute Coronary Syndromes Acute Coronary Syndromes (ACS) developAcute Coronary Syndromes (ACS) develop

when an artery in the heart is blocked andwhen an artery in the heart is blocked and

heart muscle does not receive enough oxygenheart muscle does not receive enough oxygen

ACS can cause chest pain or a heart attackACS can cause chest pain or a heart attack

and may causeand may cause ventricular fibrillationventricular fibrillation (the(the

heart quivers and cant pump blood) withheart quivers and cant pump blood) with

cardiac arrestcardiac arrest New treatments can open the blocked artery,New treatments can open the blocked artery,

but are most effective if started within hoursbut are most effective if started within hours


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Acute Coronary Syndromes:Acute Coronary Syndromes:

Early Call to EMSImportantEarly Call to EMSImportant

Most deaths occur in the firstMost deaths occur in the first hourhourafteraftersymptoms startsymptoms start

Many patients (eg, the elderly, women,Many patients (eg, the elderly, women,diabetics, and those with known heartdiabetics, and those with known heartdisease) havedisease) have vaguevague signs; some denysigns; some denysignssigns

Phone 911 to be sure victim is deliveredPhone 911 to be sure victim is deliveredto the hospital by EMS personnelto the hospital by EMS personnelprepared to deal with emergenciesprepared to deal with emergencies


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Prearrest BLS EmergenciesPrearrest BLS Emergencies

Acute Ischemic StrokeAcute Ischemic Stroke A stroke results from a blocked artery inA stroke results from a blocked artery in

the brain or bleeding into the brainthe brain or bleeding into the brain

If the stroke is caused by a clot, clotIf the stroke is caused by a clot, clot--busting drugs can limit brain damagebusting drugs can limit brain damageand improve recoveryand improve recovery ififgiven within 3given within 3hours of the onset of stroke signshours of the onset of stroke signs

Stroke victims may not understand theirStroke victims may not understand theirsymptoms or may deny them, delayingsymptoms or may deny them, delayingcall to EMS and delaying treatmentcall to EMS and delaying treatment


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Acute Coronary SyndromesAcute Coronary Syndromes

and Stroke: Lay Rescuer Actionsand Stroke: Lay Rescuer Actions Recognize signs and symptomsRecognize signs and symptoms

Phone EMS (911)Phone EMS (911)

If patient becomes unresponsive, begin stepsIf patient becomes unresponsive, begin stepsof CPRof CPR

Assess and support Airway, Breathing, andAssess and support Airway, Breathing, andCirculationCirculation

Use AED if neededUse AED if needed

If patient is breathing normally, place inIf patient is breathing normally, place inrecovery positionrecovery position


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The Recovery PositionThe Recovery Position

Used for unresponsive victims withUsed for unresponsive victims with

normal breathing and no signs of injurynormal breathing and no signs of injury

Helps maintain an open airway andHelps maintain an open airway and

reduces risk of aspirationreduces risk of aspiration

Several versions are acceptableSeveral versions are acceptable

Rotate victim to opposite side afterRotate victim to opposite side after

30 minutes30 minutes


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The Sequence of Actions forThe Sequence of Actions for

the Lone Rescuerthe Lone Rescuer Phone firstPhone firstfor unresponsive adultsfor unresponsive adults

Phone fastPhone fast(CPR first) for unresponsive(CPR first) for unresponsive

infants and childreninfants and children Exceptions:Exceptions: Phone fastPhone fast(provide CPR(provide CPR

first) forfirst) forallallvictims ofvictims of Submersion/nearSubmersion/near--drowningdrowning

InjuryInjury Drug overdoseDrug overdose

Phone firstPhone firstif any infant or child withif any infant or child withheart disease collapses suddenlyheart disease collapses suddenly


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Rescue BreathingRescue Breathing Provides oxygen and removes carbonProvides oxygen and removes carbon

dioxidedioxide

Avoid rescue breathing that is tooAvoid rescue breathing that is tooforceful or too rapidforceful or too rapid

May cause gastric inflation (air in theMay cause gastric inflation (air in thestomach), with possible complications:stomach), with possible complications:

Resistance to effective rescue breathsResistance to effective rescue breaths

VomitingVomiting

Aspiration of stomach contentsAspiration of stomach contents

PneumoniaPneumonia


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Rescue Breathing:Rescue Breathing:

Without Supplementary OxygenWithout Supplementary Oxygen

MouthMouth--toto--mouth or mouthmouth or mouth--toto--maskmask

ventilation (without supplementaryventilation (without supplementary

oxygen):oxygen):

Deliver breath until you seeDeliver breath until you see obviousobvious

chest risechest rise

Deliver over 2 secondsDeliver over 2 seconds


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Rescue Breathing: WithRescue Breathing: With

Supplementary OxygenSupplementary Oxygen

Some mouthSome mouth--toto--mask devices can providemask devices can provide

supplementary oxygen during rescuesupplementary oxygen during rescue

breathing. This will allow you to supportbreathing. This will allow you to supportthe victims oxygenation with smallerthe victims oxygenation with smaller

breaths:breaths:

Deliver breaths until the chestDeliver breaths until the chest begins to risebegins to rise

Deliver over 1 to 2 secondsDeliver over 1 to 2 seconds


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Pulse Check not RecommendedPulse Check not Recommended

for Lay Rescuersfor Lay Rescuers

Pulse check requires too much timePulse check requires too much time

Rescuers are wrong about a pulse checkRescuers are wrong about a pulse check

35% of the time35% of the time

Some victims of cardiac arrest areSome victims of cardiac arrest aremissed because rescuers think a pulsemissed because rescuers think a pulseis present when it isntis present when it isnt

Lay rescuers should check for signs ofLay rescuers should check for signs ofcirculation (normal breathing, coughing,circulation (normal breathing, coughing,or movement after 2 breaths)or movement after 2 breaths)


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Adult Chest CompressionAdult Chest Compression

Rate and RatioRate and Ratio

When chest compression rates are aboveWhen chest compression rates are above

80/min, blood flow to the heart muscle is80/min, blood flow to the heart muscle is

improved during CPRimproved during CPR

Rescuers often compress at a slow rate ofRescuers often compress at a slow rate of

compressionscompressions

A large series of uninterrupted compressionsA large series of uninterrupted compressionswill increase the blood flow to the heart andwill increase the blood flow to the heart and

improve survival from cardiac arrestimprove survival from cardiac arrest


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Coronary Artery Perfusion PressureCoronary Artery Perfusion Pressure

Improves With Longer Series of ChestImproves With Longer Series of Chest

Compressions in Adult VictimsCompressions in Adult VictimsCoronary Artery Pressure at 5:1 ratioCoronary Artery Pressure at 5:1 ratio

Pressure at 15:2 ratioPressure at 15:2 ratio


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Adult Chest Compression RateAdult Chest Compression Rate

and Ratio: Conclusionsand Ratio: Conclusions Provide chest compressions at a rate ofProvide chest compressions at a rate of

100/min (with pauses for 2 breaths you will100/min (with pauses for 2 breaths you will

actually deliver fewer than 100/min)actually deliver fewer than 100/min) Perform 1Perform 1-- and 2and 2--rescuer CPR at a 15:2rescuer CPR at a 15:2

compressioncompression--toto--ventilation ratioventilation ratio

The time for compression (push on theThe time for compression (push on the

breastbone) should approximately equalbreastbone) should approximately equalthe relaxation timethe relaxation time


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CompressionCompression--Only CPROnly CPR

for Adult Victimsfor Adult Victims Some rescuers are reluctant to give mouthSome rescuers are reluctant to give mouth--toto--

mouth breaths to strangersmouth breaths to strangers

Something (chest compressions alone) isSomething (chest compressions alone) isbetter than nothingbetter than nothing

In some studies ofIn some studies ofadultadultcardiac arrest for shortcardiac arrest for shortperiods, compressions only may be effectiveperiods, compressions only may be effective

CompressionCompression--only is recommended foronly is recommended fordispatcherdispatcher--assisted CPR or when the rescuerassisted CPR or when the rescueris unable or unwilling to perform rescueis unable or unwilling to perform rescuebreathingbreathing


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Relief of ForeignRelief of Foreign--Body AirwayBody Airway

Obstruction in UnresponsiveObstruction in UnresponsiveVictimVictim

Previous guidelines included a complex setPrevious guidelines included a complex set

of skills to relieve foreignof skills to relieve foreign--body airwaybody airwayobstruction (FBAO) in an unresponsiveobstruction (FBAO) in an unresponsivevictimvictim

The skills were difficult to teach, learn, andThe skills were difficult to teach, learn, and

rememberremember Inclusion of complex skills in CPR coursesInclusion of complex skills in CPR courses

reduced retention of all skillsreduced retention of all skills

The recommendations have been simplifiedThe recommendations have been simplified


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Lay Rescuer Relief of FBAO inLay Rescuer Relief of FBAO inUnresponsive Adult VictimUnresponsive Adult Victim

Lay rescuer is much more likely to treat aLay rescuer is much more likely to treat avictim unresponsive fromvictim unresponsive from cardiac arrestcardiac arrestthan a victim unresponsive from FBAOthan a victim unresponsive from FBAO

Sudden cardiac arrestSudden cardiac arrest 250,000 deaths/yr250,000 deaths/yr FBAOFBAO 3,200 deaths/yr3,200 deaths/yr

Chest compressions may relieve FBAOChest compressions may relieve FBAO

If adult choking victim becomesIf adult choking victim becomes

unresponsive:unresponsive: Contact EMSContact EMS

Begin steps of CPRBegin steps of CPR

Look for (and remove) obstructing objectLook for (and remove) obstructing object


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Percentsurvi

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Cummins, 1989Cummins, 1989

Effect of Time to Defibrillation onEffect of Time to Defibrillation on

Survival From Witnessed VF ArrestSurvival From Witnessed VF ArrestWithout CPRWithout CPR


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1 MIN 2 MIN 3 MIN 4 MIN 5 MIN 6 MIN 7 MIN 8 MIN 9 MIN 10

MIN

EMS PROVIDERSEMS PROVIDERS

ARRIVEARRIVE

Cummins, 1989

Survival From VF Cardiac ArrestSurvival From VF Cardiac Arrest

With EMS Defibrillation (6+ min)With EMS Defibrillation (6+ min)


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Public Access to DefibrillationPublic Access to Defibrillation

(PAD) Initiative(PAD) Initiative

GoalGoal:: Improve survival by reducing timeImprove survival by reducing time

to defibrillation for victims of outto defibrillation for victims of out--ofof--

hospital cardiac arresthospital cardiac arrest

Plan:Plan: Develop PAD programs that placeDevelop PAD programs that place

defibrillators and trained rescuersdefibrillators and trained rescuers

throughout the communitythroughout the community


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Keys to Successful PublicKeys to Successful Public

Access Defibrillation ProgramsAccess Defibrillation Programs

Automated External DefibrillatorsAutomated External Defibrillators

(AEDs)(AEDs)

Trained rescuers (CPR plus use of AED)Trained rescuers (CPR plus use of AED)

Medical oversight and quality assuranceMedical oversight and quality assurance

Appropriate AED

maintenanceAppropriate AED

maintenance Link with EMS systemLink with EMS system


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Successful Public AccessSuccessful Public Access

Defibrillation ProgramsDefibrillation Programs

Police and EMS PAD program inPolice and EMS PAD program in

Rochester, MN: 49% survivalRochester, MN: 49% survival Security guards in casinos in Las Vegas:Security guards in casinos in Las Vegas:

59% survival59% survival

PAD

program at OHare and MidwayPAD

program at OHare and Midwayairports in Chicago: 75% survivalairports in Chicago: 75% survival


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Use of AEDs for Adult VictimsUse of AEDs for Adult Victims

of Cardiac Arrestof Cardiac Arrest

Early defibrillation (within 3 to 5Early defibrillation (within 3 to 5minutes) is a high priority goal in adultsminutes) is a high priority goal in adults

Use of AEDs in childrenUse of AEDs in children uu8 years of age8 years of ageis recommendedis recommended

Use of AEDs in childrenUse of AEDs in children


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Conclusion: Science BehindConclusion: Science Behindthe Adult BLS Guidelinesthe Adult BLS Guidelines

This concludes the overview of theThis concludes the overview of the

science behind the guidelines for adultscience behind the guidelines for adult

CPR and use of an AEDCPR and use of an AED

Are there any questions?Are there any questions?


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Part II: Infant and ChildPart II: Infant and Child


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AHA Chains Of SurvivalAHA Chains Of Survival

ADULTADULT

PEDIATRIC (for infants and children)PEDIATRIC (for infants and children)


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Prearrest Pediatric EmergenciesPrearrest Pediatric Emergencies

Respiratory Failure and ShockRespiratory Failure and Shock

Sudden cardiac arrest is uncommonSudden cardiac arrest is uncommon

Respiratory failure (breathing problems) andRespiratory failure (breathing problems) and

shock often precede cardiopulmonary arrestshock often precede cardiopulmonary arrest Respiratory arrest often developsRespiratory arrest often develops beforebefore

cardiac arrest (rescue breathing important)cardiac arrest (rescue breathing important)

If you detect breathing problems or you areIf you detect breathing problems or you are

concerned the child appears ill, phone 911concerned the child appears ill, phone 911


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The Sequence of Actions forThe Sequence of Actions for

the Lone Rescuerthe Lone Rescuer Phone firstPhone firstfor unresponsive adultsfor unresponsive adults

Phone fastPhone fastfor unresponsive infants andfor unresponsive infants and

childrenchildren Exceptions: Phone fast (provide CPRExceptions: Phone fast (provide CPR

first) forfirst) forallallvictims of:victims of: Submersion/near drowningSubmersion/near drowning

InjuryInjury Drug overdoseDrug overdose

PhonePhone firstfirst if any infant or child with if any infant or child withheart disease collapses suddenlyheart disease collapses suddenly


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Rescue Breathing forInfantsRescue Breathing forInfants

and Childrenand Children

Extremely important for infants andExtremely important for infants andchildrenchildren

Important to avoid rescue breathing thatImportant to avoid rescue breathing thatis too forceful or too rapidis too forceful or too rapid

May cause gastric inflation withMay cause gastric inflation withvomiting and aspirationvomiting and aspiration

Provide breaths that make the chestProvide breaths that make the chestvisibly risevisibly rise


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Compression Rate and Ratio:Compression Rate and Ratio:

Infants and ChildrenInfants and Children

Rate:Rate: at leastat least100 times/minute for infants,100 times/minute for infants,

about 100 times/minute for children andabout 100 times/minute for children and

adultsadults

Compression to breathing ratios (1 or 2Compression to breathing ratios (1 or 2rescuers): 5 to 1 for up to 8 years of agerescuers): 5 to 1 for up to 8 years of age

RationaleRationale

Respiratory problems more common thanRespiratory problems more common than

cardiac problemscardiac problems

Children need faster breathing rates thanChildren need faster breathing rates than

adultsadults


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Pediatric CompressionPediatric Compression--OnlyOnly

CPR Is Not RecommendedCPR Is Not Recommended

Reluctance to perform mouthReluctance to perform mouth--toto--mouthmouth

breathing hasbreathing has notnotbeen expressed bybeen expressed by

rescuers of infants and childrenrescuers of infants and children

Chest compression and rescueChest compression and rescue

breathing are optimalbreathing are optimal


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Conclusion: Science BehindConclusion: Science Behind

the Infant and Child BLSthe Infant and Child BLS

GuidelinesGuidelines This concludes the overview of theThis concludes the overview of the

science behind the guidelines for infantscience behind the guidelines for infantand child CPRand child CPR

Are there any questions?Are there any questions?

2001 science behind bls guide

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