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1、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 Pennsylvania Professor of Anesthesiology and Critical Care Medicine, Division Chief,
2、 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 VT chest 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
3、 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
4、, Feel for Breathing”*,不看 不听 不觉,A Change From A-B-C to C-A-B,“Adults” Children infants (excluding the newly 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
5、 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 chest compressions,200 chest compressions,Single shock with
6、out pulse Check or rhythm analysis,BVM or Passive Insuflation 100% FIO2 Begin IV,Analysis,200 chest compressions,Single shock if Indicated without pulse check or rhythm analysis,Analysis,Single shock if Indicated without pulse check or rhythm analysis,Resume Standard ACLS Consider Endotracheal Intub
7、ation,200 chest compressions,CC Only,EMS arrival,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,Weisf
8、eldt 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
9、 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
10、 5 cm).,C A B,电击治疗ELECTRICAL THERAPIES,AED Use in Children Now Includes Infants 2010 (New): 1 year of age. 2005 (Old): Not use of AEDs for infants 1 year of age.,先除颤 VS 先CPR ?,CPR 3min Defibrillation However, in monitored patients, the time from VF to shock delivery should be under 3 minutes,1次除颤 vs
11、 3连续除颤?,2010 (No Change From 2005): 一次电击后 立即CPR,200 chest compressions,200 chest compressions,Single shock without pulse Check or rhythm analysis,BVM or Passive Insuflation 100% FIO2 Begin IV,Analysis,200 chest compressions,Single shock if Indicated without pulse check or rhythm analysis,Analysis,Si
12、ngle shock if Indicated without pulse check or rhythm analysis,Resume Standard ACLS Consider Endotracheal Intubation,200 chest compressions,CC Only,EMS arrival,Administer 1 mg IV Epinephrine,Analysis,If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analys
13、is,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
14、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 quality 3.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/asystole Atropine not routine use for
15、 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-complex reentry 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
