心跳骤停与心肺复苏.pptVIP

Studies have shown that the most important factor in attaining survival from sudden cardiac arrest (SCA) is CPR that generates good blood pressure through the coronary arteries – or coronary perfusion pressure (CPP). In this 1988 study by Kern, Ewy, and others, pigs that had good CPP during CPR had high rates of survival, and those that had poor CPP could not be resuscitated. Further, survival was not related to pH or oxygen content. These studies speak to focusing cardiac arrest care on excellent compressions and not on correcting pH with sodium bicarbonate or hyperoxygenation. The best way to improve an acidotic pH is to better perfuse the tissues with adequate chest compressions. * * When the rates of chest compression are plotted for the patients in whom ROSC was attained (green) and for those patients that did not attain ROSC (black), it is clear that most survivors received the faster chest compressions. The mean rate of chest compressions in all patients that attained ROSC was 90, compared with a mean rate of 79 compressions/ minute in the patients that did not attain ROSC. So we need to PUSH FASTER, but it is probably possible to push too fast. A target of 100-120 compressions/minute is probably ideal. * Additionally, the depth of compressions is important. The 2010 AHA guidelines call for compression depth of AT LEAST 2 inches in adults. [Historical note: the 2005 guidelines suggested a compression depth of 1.5 to 2 inches in an adult.] In this study from the ICCM, the coronary perfusion pressure and survival were both significantly better with 2 inch compressions versus 1.5 inch compressions. So we need to PUSH DEEPER. * In addition to better CPP with deep compressions, Edelson showed that the success of a defibrillation shock is much higher if the compressions are deeper. * In 2007, Dr. Ewy demonstrated the effect of a compression to ventilation ratio of 30:2 on the coronary perfusion pressure (CPP) and cerebral perfusion pressure in pigs. This graph sho