- Cardiopulmonary resuscitation and emergency
cardiac care should be considered any time an individual cannot
adequately oxygenate or perfuse vital organs—not only following
cardiac or respiratory arrest.
- Regardless of which transtracheal jet ventilation
system is chosen, it must be readily available, use low-compliance
tubing, and have secure connections.
- Ventilation (and chest compressions) should not
be delayed for intubation if a patent airway is established by a
- Attempts at intubation should not interrupt ventilation
for more than 30 s.
- Chest compressions should be immediately initiated
in the pulseless patient.
- Whether adult resuscitation is performed by a
single rescuer or by two rescuers, two breaths are administered
every 15 compressions (15:2), allowing 2 s for each breath. The
cardiac compression rate should be 100/min regardless of
the number of rescuers.
- Health care personnel working in hospitals and
ambulatory care facilities must be able to provide early defibrillation
to collapsed patients with ventricular fibrillation as soon as possible.
Shock should be delivered within 3 min (± 1 min) of arrest.
- Lidocaine, epinephrine, atropine, and vasopressin
but not sodium bicarbonate can be delivered down a catheter whose
tip extends past the tracheal tube. Dosages 2–2½
times higher than recommended for intravenous use, diluted in 10
mL of normal saline or distilled water, are recommended for adult
- If intravenous cannulation is difficult, an intraosseous
infusion can provide emergency vascular access in children.
- Because carbon dioxide, but not bicarbonate,
readily crosses cell membranes and the blood–brain barrier,
the resulting arterial hypercapnia will cause intracellular tissue
- A wide QRS complex following a pacing spike
signals electrical capture, but mechanical (ventricular) capture must
be confirmed by an improving pulse or blood pressure.
One goal of anesthesiology is to maintain the function of vital
organ systems during surgery. It is not surprising, therefore, that
anesthesiologists have played a major role in the development of cardiopulmonary
resuscitation techniques outside the operating room. Cardiopulmonary
resuscitation and emergency cardiac care (CPR-ECC) should be considered
any time an individual cannot adequately oxygenate or perfuse vital
organs–not only following cardiac or respiratory arrest.
This chapter presents an overview of the American Heart Association
and the International Liaison Committee on Resuscitation (ILCOR)
Year 2000 recommendations for establishing and maintaining the ABCDs
of cardiopulmonary resuscitation: Airway, Breathing, Circulation,
and Defibrillation. The best outcomes,
however, come from instituting ECC (Table 47–1, Figures 47–1 and 47–2). The guidelines
have been updated for 2000 with new guidelines planned for 2006,
and they are now more than ever evidence based and international.
Major changes for the layperson are that the pulse should not be
checked, and chest compression without ventilation may be as effective
as compression with ventilation for the first several minutes. If
a lay-bystander is unwilling to perform mouth-to-mouth ventilation,
chest compressions alone are preferred to doing nothing. For the
health care provider, defibrillation using biphasic electrical current
works best, tracheal tube (TT) placement should be confirmed with
a qualitative end-tidal CO2...