腹部CPR与海姆立克急救法

1、腹部CPR与海姆立克急救法陈彦海姆立克急救法1974年,亨利海姆立克发明了利用腹部冲击解除气道异物的急救方法。1975年10月，美国医学会以他的名字命名了该急救方法。世界名人录：海姆立克为世界上拯救生命最多的人”！ALife-SavingManeuvertoPreventFood-ChokingHentyJ.Hernlch.UD4cMbtallhliuMvtdualiinIbeUnited4UlmlawMBwiftdMtitkntMIrfhnula(AVvYwAFiiwiJMwMt.JimeIII.IW,p10)7heorliuluunwlrpnAnlily由hltfh(r.mWhw|MlWu

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5、皿laymanirwwmury.(nJuneIW.tFlirtedinVsfc2OJrrwNffulharJU4130gtfwZJAmMedAssoc.1975;234:398l01.HEIMLICHSManeuversMySeventyYearsofLifesavingInnovationHEZRYJ.HEIMLICH,MDPublished2014byPrometheusBookssaveaCHOKINGvictimHEIMLICHMANEUVERaquickupwardthrust.otherhandaitheivictimsatsintonwithFrombehind,wrapyour

6、armsaroundihcvictimswaist.MakealistandplacIhethumbsideofy-ourfistagainsi1hvictimsabdomen.beowttw心cageandabovethenavel.Graspyourfist-wllhyocirtcouldsaveyourlife!personcant的派ktxeaiheand仅2youehelpgw.*apt2victimsback.(Dkscouk)makematsecsworse.)“2Mrnaa3m2fCFW2e*ouWMKptvXi原理阻塞物膈用力的方向用力点异物导致气道梗阻冲击中上腹膈肌上抬肺内

7、残留气体形成气流气体冲出气道排出异物腹部CPR腹部提压心肺复苏仪MSB9CIUB纪AnnEmergMed.1983Mai;12(3):128-35.Improvedoxygendeliveryduringcardiopulmonaryresuscitationwithinterposedabdominalcompressions.AbstractThemethodutilizesstandardCPRtechniqueswiththeadditionofmanualabdominalcompressions(congruentto100mmHg)interposedbetweenchestco

8、mpressions,andistermedinterposedabdominalcompression-CPR(IAC-CPR).Ventricularfibrillationwasinducedelectricallyin10anesthetizeddogs.Ineachdog,trialsofIAC-CPRandstandardCPRwerealternatedeveryfiveminutesduringa30-minuteperiod.Arterialandcentralvenousbloodpressures,oxygenconsumption,andFickcardiacoutpu

9、tweremonitored.Theadditionofinterposedabdominalcompressionsigniflcantly(P0.01)increasedeachofthesehemodynamicindicators.Oxygendeliveryincreasedfrom4.12+/-0.39mlO2/kg/minduringstandardCPRto6.37+/-0.35mlO2/kg/minduringIAC-CPR.Arterialsystolicbloodpressureincreasedfrom67+/-5mmHgto90+/-5mmHg,whilediasto

10、licarterialbloodpressurerosefrom15+/-2mmHgto33+/-3mmHg.Cardiacoutputincreasedfrom19.9+/-2.6ml/min/kgto37.5+/-2.7ml/min/kg.Resuscitation.2003Oct：59(1):71-82.InterposedabdominalcompressionCPR:acomprehensiveevidencebasedreview.AbstractIAC-CPRincludesallstepsofstandardexternalCPRwiththeadditionofmanualm

11、idabdominalcompressionsincounterpointtotherhythmofchestcompressions.IAC-CPRcanincreasebloodflowduringCPRabout2-foldcomparedwithstandardCPRwithoutIAC,asshownbysixofsixstudiesincomputermodelsand19of20studiesinvariousanimalmodels.TheadditionofIAChasclinicalbenefitinhumans,asindicatedin10of12smalltomedi

12、umsizedclinicalstudies.Thetechniqueincreasesthefrequencyofimmediatereturnofspontaneouscirculationforin-hospitalresuscitationsfromroughly25to50%.Possibleharmfromabdominalcompressionisminimalonthebasisof426humans,151dogsand14pigsthatreceivedIACinpublishedreports.ThecomplexityofperformingIACissimilarto

13、thatofopeningtheairwayandislessthanthatofotherbasiclifesupportmaneuvers.TheaggregateevidencesuggeststhatIAC-CPRisasafeandeffectivemeanstoincreaseorganperfusionandsurvival,whenperformedbyprofessionallytrainedrespondersinahospitalandwheninitiatedearlyintheresuscitationprotocol.Costandlogisticalconside

14、rationsdiscourageuseofIAC-CPRoutsideofhospitals.DatabasecompositionbylevelofevidenceLevelCapsuledescriptionoflevel#ofpapers TOC o 1-5 h z Largerrandomizedclinicaltrials3Smallerrandomizedclinicaltrials1Prospective,non-randomizedcohortstudies2Historic,non-randomizedcohortstudies3Humancaseseries3Animal

15、ormechanicalmodelstudies25Rationalextrapolationsorquasi-experimentaldesigns1Commonsense,etc.0PerformancesitesforreviewedstudiesincludedUSA28studies,UK2,Israel2,Canada2,Japan1,Germany1,Netherlands1,Spain1,andItaly1(somestudieshadmultiplesites).Broadsummaryofresearchon1AC-CPKinthreeclassesofexperiment

16、almodelsModel classMathematical, computer and mechanical modelsAnimal models (dogs and pigs)Clinical modelsSubtypesPaperandpencil22Analog17,19Digital18,20Digitalspreadsheet21Bloodflow14-16,27-29,53-55Bloodpressure10,11,23,56Oxygenuptake26CO：excretion/bloodgasses57Survivalandcomplications25,30,3143刈P

17、ediatricanesthesiaoverdose9|Acutehemodynamics(BP,ETCO2crossover)32-34,46,59-61Allarrests(mostlyVF)1,45Difficultarrests(EMD.asystole,prolonged)35.36Formostendpointsresultsfor1AC-CPRwerebetween1.5and2.0timesthoseforcomparablestandardCPRwithoutabdominalcompression.EMUelectromechanicaldissociation;ETCO.

18、endtidalcarbondioxideconcentration;VF,ventricularfibrillation.按压位置相同：中上腹，剑突与肚脐之间按压频率不同：海姆立克急救法无特殊要求腹部CPR按压频率同普通的CPR腹部按压二调整频率的海姆立克急救法!海姆立克急救法与腹部CPR海姆立克急救法有助于缩短按压中断时间海姆立克急救法有助于开放气道海姆立克急救法有助于缩短除颤准备时间01OPTION j心缩短按压中断时间2015 AHA CPR指南尽可能减少按压的中断，其判断标准是：根据胸外按压在整体心肺复苏中所占比例确定，对于无高级气道接受cPR患者,要求按压目标比例260%。C要求：

19、按压中断时间限制在10秒以内2015AmericanHeartAssociationGuidelinesUpdateforCardiopulmonaryResuscitationandEmergencyCardiovascularCare.Circulation.2015;132:S315-573.AcadEme里Med.2016Apr;23(4):448-54.AComparisonoftheEffectofInterposedAbdominalCompressionCardiopulmonaryResuscitationandStandardCardiopulmonaryResuscita

20、tionMethodsonEnd-tidalCO2andtheReturnofSpontaneousCirculationFollowingCardiacArrest:AClinicalTrial.METHODS:AftercardiacarrestwasconfirmedinapatientatMashhadGhaemHospital,80caseswererandomlyassignedtooneofthetwomethodsofresuscitation,eitherIAC-CPRorSTD-CPR,respectively.TheIAC-CPRgroupreceivedSTD-CPRp

21、lusIAC-CPRandtheSTD-CPRgroupreceivedSTD-CPRonly.InIAC-CPRgroup,abdominalcompressionwasperformedwithopenhands,fusedtogetherillcenterofabdomenbetweenthexiphoidandtheumbilicusduringtherelaxationphaseofchestcompression.Depth,rhythm,andrateofabdominalcompressionsweresimilartochestcompressionsandforceonth

22、eabdomenwasmaintaineduntilthebeginningofnextchestcompression.RESULTS:TherewasasignificantdifferencebetweenthetwogroupsinETCO2(p0.50).CONCLUSION：TheincreaseintheETCO2duringIAC-CPRisanindicatoroftheincreaseincardiacoutputfollowingtheuseofthismethodofCPR.揶开放窒息是心跳呼吸骤停的重要原因之一腹部按压有利于气道异物排出，解除气道梗阻，保持气道通畅。R

23、esuscitation.2008Dec;79(3):460-7.RhythmicabdominalcompressionCPRventilateswithoutsupplementalbreathsandprovideseffectivebloodcirculation.METHODS:Twelveswinewereanesthetized,intubatedandallowedtobreathespontaneously.Physiologicdeadspace,restingtidalvolume,compression-inducedlungairflow,andbloodpressu

24、reswererecorded.VentricularfibrillationwaselectricallyinducedandsubjectsweretreatedwitheitherstandardCPRorOAC-CPRatvariousforceandratesettings.Minutealveolarventilation(MAV)andmeancoronaryperfusionpressure(CPP)werecompared.RESULTS:ForOAC-CPR,ventilationpercompressiontendedtoincreasewithincreasingfor

25、ceanddecreasingrate.ChestonlycompressionsproducednoMAV,whileOAC-CPRat80cycles/minorless,matchedtheMAVforspontaneousrespiration.Forallrates,abdominalcompressionsmet,orexceeded,theCPPofchestcompressionsperformedatlOOlbs.CONCLUSIONS：OAC-CPRgeneratedventilatoryvolumessignificantlygreaterthanthedeadspace

26、andproducedequivalent,orlarger,CPPthanwithchestcompressions.Thus,OAC-CPRventilatesasubject,eliminatingtheneedformouth-to-mouthbreathing,andeffectivelycirculatesbloodduringVFwithoutbreakingribs.Furthermore,thistechniqueissimpletoperform,canbeadministeredbyasinglerescuer,andshouldreducebystanderreluct

27、ancetoadministerCPR.缩短除颤准备时间2015AHACPR指南可以立即取得AED时，对于有目击的成人心脏骤停，应尽快使用除颤器。若无法立即取得AED,或无人目击，应在他人获取及准备AED时开始心肺复苏，并且视患者情况，在设备可供使用后尽快尝试进行除颤。2015AmericanHeartAssociationGuidelinesUpdateforCardiopulmonaryResuscitationandEmergencyCardiovascularCare.Circulation.2015;132:S315-573.除颤前准备:暴露胸部贴电极片清洁皮肤耗费时间影响按压石展了 CPR的应用范合并胸肋骨骨折、胸廓