国际心肺复苏指南

Guidelines Writing Group Chairs Michael R. Sayre, MD,贵阳医学院附院麻醉科 曾庆繁,2010年AHA 心肺复苏指南介绍,1960-2010 Kouwenhoven,2010心肺复苏50周年,356 位专家来自29 个国家 历时36个月讨论,2010 International Consensus Conference,Robert A. Berg University of PennsylvaniaProfessor of Anesthesiology and Critical Care Medicine, DivisionChief, Pediatric Critical Care,Cardiac arrest can be caused by,室颤 VF室速(无脉)VT 无脉性电活动PEA心博停止asystole.无脉性心动过缓Pulseless bradycardia,4 rhythms,室颤 无脉性室速 VF/Pulseless VTchest compressions (CC)early Defibrillation (DF),Early recognition cardiac arrest,及早识别心跳骤停,外行急救lay rescuer,1.突然晕倒 suddenly collapse 2.意识消失 Unresponsive 3.无呼吸或无正常呼吸 not breathing 4.Seizure (not normally,gasping). cardiac arrest降低脉搏检查的重要性Minimize the importance of pulse checks,不检查脉搏Not check for a pulse,2005 (Old): “Look, listen, and feel”,2010 (New): NO: “Look, Listen, Feel for Breathing”* 30 compressions 2 breaths,NO: “Look, Listen, Feel for Breathing”*,不看 不听 不觉,A Change From A-B-C to C-A-B,“Adults” Childreninfants (excluding thenewly born),复苏步骤,What about Oxygen?,VF-CA: 中心血液中富含氧 Experimental work has shown Arterial Sats remain acceptable for up to 10 min of CCC呼吸停- 通气! Respiratory Arrest-Different !Ventilation crucial to replace Oxygen,关键:CCC,心 脑,C-A-B,chest compressions initiated sooner,及早按压,Forget CPR, Give CCR Instead,心脑复苏新概念Cardiocerebral Resuscitation,忘了CPR,代之CCR,Standard CPR: 30:2,Continuous Chest Compressions,心脑复苏概念Cardiocerebral Resuscitation,200 chestcompressions,200 chestcompressions,Single shockwithout pulse Check or rhythm analysis,BVM or PassiveInsuflation 100% FIO2Begin IV,Analysis,200 chestcompressions,Single shock if Indicated without pulse check orrhythm analysis,Analysis,Single shock if Indicated without pulse check orrhythm analysis,Resume Standard ACLSConsider Endotracheal Intubation,200 chestcompressions,CCOnly,EMSarrival,Administer 1 mg IV Epinephrine,Analysis,If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analysis,Three-Phase Model of Resuscitation,0,2,4,6,8,10,12,14,16,18,20,Arrest Time (min),0,100%,Myocardial ATP,Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8,rapid defibrillation,good chest compressions,little we can do,外行成人CPR,简化成人基本生命支持,:CCC+DF,Chest Compressions*,2010 (New): Hands-Only “push hard and fast” on the center of the chest动手不动口30 compressions to 2 breaths,Chest Compression Rate: At Least 100 per Minute*,2010 (New): chest compressions at a rate of at least 100/min.(快 ! 不间断)2005 (Old): Compress at a rate of about 100/min.,Chest Compression Depth*,2010 (New): hard !The adult sternum should be depressed at least 2 inches (5 cm).2005 (Old): approximately 1,1/2 to 2 inches (approximately 4 to 5 cm).,C A B,电击治疗ELECTRICAL THERAPIES,AED Use in Children Now Includes Infants2010 (New):1 year of age.2005 (Old):Not use of AEDs for infants 1 year of age.,先除颤 VS 先CPR ?,CPR 3minDefibrillationHowever, in monitored patients, the time from VF to shock delivery should be under 3 minutes,1次除颤 vs 3连续除颤?,2010 (No Change From 2005): 一次电击后 立即CPR,200 chestcompressions,200 chestcompressions,Single shockwithout pulse Check or rhythm analysis,BVM or PassiveInsuflation 100% FIO2Begin IV,Analysis,200 chestcompressions,Single shock if Indicated without pulse check orrhythm analysis,Analysis,Single shock if Indicated without pulse check orrhythm analysis,Resume Standard ACLSConsider Endotracheal Intubation,200 chestcompressions,CCOnly,EMSarrival,Administer 1 mg IV Epinephrine,Analysis,If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analysis,CC200 -shockcc200(不检查脉搏/心律分析),电极放置Electrode Placement,2010 (Modification of Previous Recommendation): AED electrode pads positions : lateral posterior Anterior left infra scapular right infrascapular,胸骨旁(锁骨下),2005 (Old):,conventional sternal-apical (anteriorlateral) position. Right pad left pad Sternal apical胸骨旁(锁骨下) 心尖right or left upper back.,ADVANCED CARDIOVASCULAR LIFE SUPPORT,监测PETCO2 :,1.确定气管导管位置 confirming tracheal tube placement 2.监测CPR有效性 monitoring CPR quality3.检查心跳恢复 detecting ROSC,CPR质量,药物New Medication Protocols,2010 (New): 阿托品不常规用于PEA/asystoleAtropine not routine use for PEA/asystole,2005 (Old):,阿托品用于高级心血管生命支持 Atropine included in the ACLS 心搏停止 asystole or slow PEA 可用阿托品Atropincould be considered.,心动过速tachycardia,规律的Regular单型monomorphic宽QRS 心动过速wide-complex tachycardia 腺苷Adenosine(rhythm is regular),2010 (New),adenosine只用于规则的窄QRS 的折返性室上速only for suspected regular narrow-complexreentry supraventricular tachycardia,2005 (Old):,不规律的宽QRS 心动过速irregular wide-complex tachycardias不用腺苷Adenosine should not be used(may cause degeneration of the rhythm to VF),心动过缓Bradycardia,症状性不稳定心动过缓symptomatic unstable Bradycardia变时性药物输注chronotropic drug infusions (an alternative to pacing),atropine while awaiting