CPR思考

nullCPRCPRFrom guidelines to clinical practice ----- does one size fit all ? 心肺复苏预后统计 (< 4 min) 心肺复苏预后统计 (< 4 min)Cardiac arrestROSC 25%No ROSC 75%Recovery 7%PRS 18%Alive 3%Dead 15%WHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?Despite more than 40 years of “improvements” & updates of guidelines the essential is unchanged and survival has been dismal: “CPR” or “Shock” first? Does Cardiac arrest victims have normal oxygenation and Mouth-Mouth is necessary? Is intubation the earlier the better No improvements evident based on science with drugs to improve outcome Is it really important for compression rate? What can we do for “Post-resuscitation Syndrome” The othersPathophysiology of V-Fib ArrestPathophysiology of V-Fib ArrestWHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?“CPR” or “Shock” first?“CPR” or “Shock” first?Primary treatment for V-fib at 3 minutes and under Should be delayed until good CPR are done for 2 minutes if down time is over 3 minutes Should always be one shock at max energy AEDs are good in the first 3 minutes, but bad after that One shock only with no pulse checks afterward WHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?Despite more than 40 years of “improvements” & updates of guidelines the essential is unchanged and survival has been dismal: “CPR” or “Shock” first? Does Cardiac arrest victims have normal oxygenation and Mouth-Mouth is necessary? Is intubation the earlier the better No improvements evident based on science with drugs to improve outcome Is it really important for compression rate? What can we do for “Post-resuscitation Syndrome” The othersWHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?“CPR” evolved as a single treatment for two totally different disease processes: Respiratory and Cardiac arrests They differ dramatically in how much oxygen exists in their blood at the onset of arrest Drowning or choking victims use up all available oxygen before arresting. They DO need early ventilation Cardiac arrest victims have normal oxygenation Initially they do NOT need additional oxygen Instead they need existing O2 pumped to the two organs that determine survival – the heart and brainnullPausing Chest Compressions to breathe reduces Coronary Perfusion PressureIs intubation the earlier the betterIs intubation the earlier the betterIn first 4 minutes, not a priority (V-fib) Understand that positive pressure breaths decrease cardiac output. There is some air exchange from chest compressions plus gasping. Once intubated 1 second breaths. 6-8 per minute. About once every 10 seconds. NO MORE.Some people think……Some people think……Chest compressions are the single most important intervention !!!! Optimal QUALITY is essential Interruptions are deadly → continuous Ventilation can be deadly Don’t do when not needed Do it without error when needed Interventions MUST be prioritized. Learn What to do it When to do it How to do it as well as possibleWHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?Despite more than 40 years of “improvements” & updates of guidelines the essential is unchanged and survival has been dismal: “CPR” or “Shock” first? Does Cardiac arrest victims have normal oxygenation and Mouth-Mouth is necessary? Is intubation the earlier the better Is it really important for compression rate? No improvements evident based on science with drugs to improve outcome What can we do for “Post-resuscitation Syndrome” The othersChest compressionChest compressionPush hard and push fast (100/minute) Longer uninterrupted chest compression Compression : Breath (30:2) Question: how we got the number 100 bpm Should it is a interval or a number Can it affect the prognosis WHY WE BOTHER WITH CPR?WHY WE BOTHER WITH CPR?Despite more than 40 years of “improvements” & updates of guidelines the essential is unchanged and survival has been dismal: “CPR” or “Shock” first? Does Cardiac arrest victims have normal oxygenation and Mouth-Mouth is necessary? Is intubation the earlier the better Is it really important for compression rate? No improvements evident based on science with drugs to improve outcome What can we do for “Post-resuscitation Syndrome” The othersPharmacologyPharmacologyPharmacists should be able to identify: Why? … we use an agent When? … to use an agent How? … to use an agent What? ... to watch for PharmacologyPharmacologyNo improvements evident based on science with drugs to improve outcome Epinephrine every 5 minutes Vasopressin OK but use early and with epinephrine. Use of anti-arrhythmic is important If we want new drugs what’s the direction?Post-resuscitation SyndromePost-resuscitation SyndromePersisting coma after discontinuation of sedatives No signs of breathing Absence of pupillary light reflexes, corneal reflexes … Seizures No motor responce to pain Who, What, when and how to do?Post-resuscitation SyndromePost-resuscitation Syndromestandardized, goal-directed , intensive care treatment with focus on optimal vital organ perfusion! get the patient to the right place with the right people and a standardized post resuscitation care protocol! Then the more? CPR IS Still A Challenge CPR IS Still A Challenge I’ve done it a thousand times, what could possibly go wrong?Who will face the challenge?Who will face the challenge? “You’re the one.” “You are the man!” You are the architects of the CPR guideline of tomorrow!How do you think about the CPR guidelines-- Bible or Trouble？How do you think about the CPR guidelines-- Bible or Trouble？Reading understanding seeing thinking practicing and changingYou must understand guidelines can´t, unfortunately, solve everything....You must understand guidelines can´t, unfortunately, solve everything.... Because Doing the Same Things in the same way can get Different Results. But we must never surrender nullnullThank you now and in the Future