- 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.
- Chest compressions and ventilation should not be delayed for intubation if a patent airway is established by a jaw-thrust maneuver.
- Attempts at intubation should not interrupt ventilation for more than 10 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 30 compressions (30:2), allowing 3-4 s for each two breaths. 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, naloxone, and vasopressin, but not sodium bicarbonate, can be delivered via 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 patients.
- 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 acidosis.
- 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 (AHA) and the International Liaison Committee on Resuscitation (ILCOR) Year 2010 recommendations for establishing and maintaining the ABCDs of cardiopulmonary resuscitation: Airway, Breathing, Circulation, and Defibrillation (Table 55-1, Figures 55-1 and 55-2). The 2010 CPR-ECC guidelines have been updated with new evidence-based recommendations. Still of import to 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 rescuer 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 and tracheal tube (TT) placement should be confirmed with a quantitative capnographic waveform analysis. More importantly, in the new guidelines, emphasis has been placed on the quality and adequacy of compressions, ...