HISTORICAL REVIEW

5000 - first artificial mouth to mouth

CARDIOPULMONARY 3000 BC ventilation
1780 first attempt of newborn
resuscitation by blowing
RESUSCITATION 1874 first experimental direct cardiac
massage
1901 first successful direct cardiac massage
in man
1946 first experimental indirect cardiac
massage and defibrillation
1960 indirect cardiac massage
1980 development of cardiopulmonary
resuscitation due to the works of Peter
Safar

1 2

all cases accompanied

with hypoxia Causes of circulation arrest
extracardiac Cardiac Extracardiac
Ischemic heart disease airway obstruction
(myocardial infarction,
stenocardia) acute respiratory failure
Arrhythmias of different
Causes of cardiac origin and character
shock

arrest Electrolytic disorders reflector cardiac arrest

Valvular disease embolisms of different
Cardiac tamponade origin
Pulmonary artery drug overdose
cardiac thromboembolism
Ruptured aneurysm of electrocution
Primary lesion of cardiac muscle leading to the aorta poisoning
progressive decline of contractility, conductivity
disorders, mechanical factors 3 4

1
3 absence of pulse on carotid arteries a Sequence of operations
pathognomonic symptom
3 respiration arrest may be in 30 seconds after r Check responsiveness
cardiac arrest r Call for help
3 enlargement of pupils may be in 90 seconds after r Correctly place the victim and ensure
cardiac arrest the open airway
Symptoms of cardiac arrest r Check the presence of spontaneous
respiration
r Check pulse
r Start external cardiac massage and
artificial ventilation
5 6

In case of unconsciousness it Main stages of resuscitation

is necessary to estimate A (Airway) ensure open airway by preventing
quickly the falling back of tongue, tracheal
intubation if possible
B (Breathing) start artificial ventilation of
lungs
the open airway C (Circulation) restore the circulation by
external cardiac massage
respiration D (Differentiation, Drugs, Defibrilation)
quickly perform differential diagnosis of
hemodynamics cardiac arrest, use different medication and
electric defibrillation in case of ventricular
7 fibrillation 8

2
 A (Airway)
ensure open Open the airway using a head
airway tilt lifting of chin. Do not tilt the
head too far back

Check the pulse on

carotid artery using
fingers of the other hand

9 10

B (Breathing) Algorithm
for artificial ventilation

Tilt the head back mouth to mouth or mouth ventilation by a face mask and a
to nose respiration self-inflating bag with oxygen
and listen for. If
not breathing 2 initial subsequent breaths
normally, pinch
wait for the end of expiration
nose and cover
10-12 breaths per minute with a volume of app.
the mouth with
800 ml, each breath should take 1,5-2 seconds
yours and blow
until you see the Control over the ventilation

chest rise. check chest movements during ventilation

11 check the air return 12

3
 C. Circulation
Restore the circulation, that is 2 mechanisms explaining the
start external cardiac massage restoration of circulation by
external cardiac massage

Cardiac Thoracic
pump pump

13 14

Cardiac pump during the cardiac Thoracic pump at the cardiac massage
massage Blood circulation is
restored due to the change
Blood pumping is in intra thoracic pressure
assured by the and jugular and subclavian
compression of heart vein valves
between sternum and During the chest
spine compression blood is
directed from the
pulmonary circulation to
the systemic circulation.
Between
Cardiac valves function as
compressions
in normal cardiac cycle.
thoracic cage is
expanding and heart
is filled with blood15 16

4
ALGORITHM of Cardiopulmonary resuscitation VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA

2 breaths (durationa 1 1.5 sec.) Witnessed Unwitnessed

palpation of pulse on carotid arteries (5 10 sec.) Precordial thump

1 in case of absence of pulse initiate 2 Check pulse, if none:

person external cardiac massage persons
a Begin CPR
compression rate 80 100/min. compression rate 80 100/min
compression/breath = 15 : 2 compression/breath = 5 : 1 Defibrillate with 200 joules
2 breathsa in 4 7 sec. breath during 1 1.5 sec. after Defibrillate with 200-300 joules
each 5th compression
Establish IV access, intubate
4 cycles: 15 compression 10 cycles: 5 compression Adrenaline 1 mg push
and 2 breaths and 1 breath
Defibrillate with 360 joules
check the pulse on carotid arteries (5 sec)
Lidocaine 1 mg/kg IV, ET
in case of absence of pulse continue resuscitation
17 Defibrillate with 360 joules 18

Possible arrhythmias after Operations in case of asystole

cardiac defibrillation Asystole
Start CPR
ventricular tachycardia IV line
bradyarrythmia including Adrenaline:IV 1 mg, each 3-5 min.
electromechanical dissociation and -or
- intratracheal 2 - 2.5 mg
asystole - in the absence of effect increase
supraventricular arrhythmia the dose
accompanied with tachycardia -Atropine 1 mg push (repeated
once in 5 min)
supraventricular arrhythmia with
normal blood pressure and pulse Na Bicarbonate 1 Eq/kg IV
rate 19 Consider pacing 20

5
 Drugs used in CPR
Atropine can be injected bolus, max 3 mg to
block vagal tone, which plays significant role in
some cases of cardiac arrest
Adrenaline large doses have been
withdrawn from the algorithm. The
recommended dose is 1 mg in each 3-5 min.
Vasopresine in some cases 40 U can
replace adrenaline
Amiodarone - should be included in algorithm
Lidocaine should be used only in ventricular
fibrillation 21