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Is a series of life saving actions that increase the chance of survival after cardiac arrest; although the optimal approach to CPR may varies depending on the rescuer, the patient and the available resources, the fundamental challenge remain how to achieve early and effective CPR.

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CPR consists of these main components

Chest compressions

Airway

Breathing

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Start compressions within 10 seconds of recognition of cardiac arrest.

Push hard, push fast: Compress at a rate of 100 to 120/min with a depth of

At least 2 inches (5 cm) for adults

At least one third the depth of the chest, about 2 inches (5 cm), for children

At least one third the depth of the chest, about 1½ inches (4 cm), for infants

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Allow complete chest recoil after each compression.

Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds).

Give effective breaths that make the chest rise.

Avoid excessive ventilation.

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For any victim recognized to be in cardiac arrest he/she guarantee for CPR. Consider the following examples:

Hands-Only CPR. A single rescuer with little training and limited equipment who witnesses a cardiac arrest in a middle-aged man might provide only chest compressions until help arrives.

30: 2 CPR. A lifeguard who rescues a drowning young child or an adult in cardiac arrest will provide both chest compressions and breaths, using a ratio of 30:2.

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Teamwork. Emergency responders who are called to a scene to care for a cardiac arrest victim will perform multirescuer coordinated CPR: one rescuer performs chest compressions, a second rescuer gives breaths with a bag-mask device, and a third rescuer uses the defibrillator. With a team approach, several lifesaving actions are performed at the same time.

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5H’s

5T’s

Hypoxia.

Toxins.

Hypoglycemia/Hyperglycemia.

Tension pneumothorax.

Hypokalemia/Hyperkalemia.

Thrombosis pulmonary.

Hydrogen ions/Acidosis

Thrombosis coronary.

Hypovolemia.

Tamponade cardiac.

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If the victim is not breathing normally or is only gasping and has no pulse, immediately do the following:

One rescuer begins high-quality CPR, starting with chest compressions. Remove or move the clothing covering the victim’s chest so that you can locate appropriate hand placement for compression. This will also allow placement of the AED pads when the AED arrives.

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Once the second rescuer returns and 2-rescuer CPR is provided, rescuers should switch compressors frequently (about every 2 minutes or 5 cycles, typically when the AED is analyzing the rhythm) so that CPR quality is not reduced because of fatigue.

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The universal rate for compressions in all cardiac arrest victims is 100 to 120/min. The compression-to-ventilation ratio for single rescuers is the same (30:2) in adults, children, and infants.

If 2 rescuers are present for the resuscitation attempt of an infant or child, use a compression-to-ventilation ratio of 15:2.

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For most children, either 1 or 2 hands can be used to compress the chest. For most children, the compression technique will be the same as for an adult: 2 hands (heel of one hand with heel of other hand on top of the first hand). For a very small child, 1-handed compressions may be adequate to achieve the desired compression depth.

Compress the chest at least one third the anteroposterior (AP) diameter of the chest (about 2 inches, or 5 cm) with each compression.

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For infants, single rescuers should use the 2-finger technique. If multiple rescuers are present, the 2 thumb–encircling hands technique is preferred.

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Do not delay providing chest compressions for a pregnant woman in cardiac arrest. High quality CPR including respiratory support and early medication intervention can increase the mothers and infants chance of survival. If you do not perform CPR on a pregnant women when needed, the lives of both women and infant are at risk.

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Be aware that when a visibly pregnant women(approximately 20 weeks) is lying flat on her back, the uterus compresses the large blood vessels in the abdomen. This pressure can interfere with blood flow to the heart generated by chest compression. Manual lateral uterus displacement( LUD).

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Optimize ventilation and oxygenation: Ensure an adequate airway and support breathing immediately after ROSC.

Use continuous quantitative waveform capnography to confirm and monitor placement of ETT.

Use the lowest inspired oxygen concentration that will maintain arterial oxyhemoglobin saturation 92-98%.

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Avoid excessive ventilation of the patient(Do not ventilate too fast or too much)

Treat Hypotension. If SBP is less than 90mmHg, Treat hypotension as follows;

Iv bolus 1 to 2L Normal lactate or R/L.

Norepinephrine 0.1-0.5mcg/kg/min.

Epinephrine 2-10mcg/kg/min as an infusion to achieve SBP greater than 90mmHg.

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Dopamine: 5-20mcg/kg/min iv infusion to target minimum SBP of greater than 90mmHg.

Targeted Temperature Management: TTM is the only intervention demonstrated to improve neurological recovery after cardiac arrest. The optimal temperature of 32 to 36 degree should be maintained at least 24hrs.

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Glucose management: It should range 150-180mg/dl.

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