← All decks
Anaesthesiology
Cardiopulmonary Resuscitation
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
17 sections · 199 slides
Overview
- Scope of this topic
- Road map of the topic
History and scale of the problem
- Early history of resuscitation
- Birth of modern cardiopulmonary resuscitation
- Burden of cardiac arrest
- Survival rates by setting
- Time to brain energy failure
- Determinants of success and time targets
- Perfusion falls when compressions stop
- Cost of interrupting compressions, and the casino experience
- Incidence of perioperative cardiac arrest
- Components of resuscitation
- Sequence of the ABCDE components
Airway management
- Airway obstruction by the tongue
- Airway adjuncts during resuscitation
- Front of neck access and sternal thrusts
- Foreign-body airway obstruction and thrust complications
- Recognising complete versus partial obstruction
- Back blows for choking
- Abdominal thrusts
Ventilation during resuscitation
- Rescue breathing methods
- Gas distribution between lung and stomach
- Consequences of gastric insufflation
- Tidal volume, timing and ventilation adjuncts
- Technique of mouth-to-mouth ventilation
- Mouth-to-nose ventilation and compression ratios
- Self-inflating resuscitation bag
- Ventilation with an advanced airway
Circulation during closed-chest compression
- Mechanisms of blood flow during compressions
- Cardiac pump versus thoracic pump
- Cardiac pump mechanism
- Cardiac pump implications and epinephrine effects
- Thoracic pump mechanism
- Why blood does not run backwards
- Flow below the diaphragm
- Factors that decide which mechanism dominates
- Distribution of blood flow during resuscitation
- Perfusion targets during resuscitation
- Carbon dioxide excretion during resuscitation
- Arterial and venous blood gases during resuscitation
- End-tidal carbon dioxide during low flow
Technique of closed-chest compression
- Recognising cardiac arrest
- Positioning, and the flow the heart muscle needs
- Hand placement for chest compressions
- Force and direction of compression
- Depth, rate and duty cycle
- Pauses and continuous compression strategies
Alternative methods of circulatory support
- Limits of standard resuscitation
- Load-distributing band device and waveform types
- Piston-type mechanical compression devices
- Impedance threshold device
- Open-chest massage and extracorporeal resuscitation
- Patient selection and timing for ECPR
Assessing the adequacy of circulation
- Limits of pulse palpation
- Coronary perfusion pressure
- Critical variables associated with successful resuscitation
- Invasive monitoring and the bicarbonate artefact
- End-tidal carbon dioxide as a CPR monitor
- Prognostic value of end-tidal carbon dioxide
Pharmacologic therapy
- Place of drugs in the resuscitation sequence
- Intravenous route during resuscitation
- Flushing boluses and the endotracheal route
- Adult advanced cardiac life support drugs and doses
- Adult advanced cardiac life support drugs and doses (continued)
- Adult advanced cardiac life support drugs and doses (continued)
- Intraosseous access
- Mechanism of action of vasopressors
- Adrenergic requirements for resuscitation
- Potentially harmful beta effects of epinephrine
- Comparative data and epinephrine dosing targets
- High-dose epinephrine trials
- Current epinephrine recommendations
- Vasopressin pharmacology
- Vasopressin evidence in cardiac arrest
- Larger vasopressin trials and current status
- Antiarrhythmic drugs and lidocaine
- Amiodarone pharmacology
- Amiodarone evidence and the priority of the shock
- Antiarrhythmic dosing in cardiac arrest
- Atropine in cardiac arrest
- Priorities in asystole, and bicarbonate harms
- Bicarbonate rationale and the paradoxical acidosis question
- Paradoxical acidosis from bicarbonate
- Indications for sodium bicarbonate
- Calcium in cardiac arrest
Electrical therapy
- Ventricular fibrillation and why its duration matters
- Fibrillatory waveform and prognosis
- Waveform analysis and epinephrine
- Defibrillator construction and impedance compensation
- Monophasic and biphasic waveforms
- Accuracy and limits of automated rhythm analysis
- Energy, current and impedance
- Chest impedance and body size effects on energy
- Transthoracic impedance values and determinants
- Adverse effects of high-energy shocks
- From stacked shocks to a single shock
- Biphasic energy selection
Putting it all together
- How resuscitation guidelines are made and standardised
- Process quality versus new interventions
- Respiratory arrest versus cardiac arrest
- Time-sensitive model of ventricular fibrillation
- Electrical phase and public-access defibrillation
- Delays to first shock and myocardial energy loss
- Hemodynamic phase priority and air exchange from compressions
- Barriers to bystander CPR
- Human and animal evidence on compression-only CPR
- Compression ratios and hands-only CPR guidance
- Public education programmes for compression-only CPR
- Compressions before ventilation in advanced life support
- Sources of interruption during advanced life support
- Minimising interruptions in practice
- Second rescuer roles and ventilation hazards
- Rhythm analysis timing and peri-arrest algorithms
- Single shock strategy and postshock pulse checks
- Rhythm after defibrillation, and reading the adult algorithm
- Outcome gains from minimal-interruption resuscitation
- Adult cardiac arrest circular algorithm
- Adult bradycardia algorithm
- Adult tachycardia with a pulse algorithm
Pediatric cardiopulmonary resuscitation
- Causes of cardiac arrest in children
- Starting sequence and infant ventilation
- Compression technique in infants and children
- Defibrillation and drug routes in children
- Pediatric cardiac arrest algorithm
- Pediatric bradycardia with a pulse algorithm
- Pediatric tachycardia with a pulse algorithm
- Using the pediatric medication table
- Pediatric resuscitation medications and doses
- Pediatric resuscitation medications and doses (continued)
- Pediatric resuscitation medications and doses (continued)
- Pediatric resuscitation medications and doses (continued)
- Pediatric resuscitation medications: administration remarks
- Pediatric resuscitation medications: administration remarks (continued)
- Pediatric resuscitation medications: administration remarks (continued)
Postresuscitation care and prognosis
- Determinants of mortality and where to treat after arrest
- Adult post-cardiac arrest algorithm
- Myocardial stunning and the timing of prognosis
- Neurologic outcomes and causes of death after arrest
- Stages of cerebral reperfusion
- Intracranial pressure and seizures after arrest
- Prognostication timing and brain-preserving drugs
- Ventilation and gas targets after arrest
- Blood pressure and glucose targets after arrest
- Targeted temperature management
- Temperature management recommendations and operating room data
- Confirmatory signs of poor neurologic outcome
Resuscitation in the operating room
- Features of operating room arrest and early deterioration
- Failure to rescue, and limits of standard algorithms
- Diagnoses requiring specific intervention
- Diagnostic challenges during anesthesia
- Local anesthetic systemic toxicity
- Crisis resource management and skill practice
Do-not-resuscitate orders in the operating room
- Ethical basis and the operating room conflict
- Why CPR needs an order to withhold it, and who needs the talk
- Professional guidance on perioperative DNR orders
- Palliative surgery and the principle of double effect
- Clarifying DNR scope and documenting limitations
- Sample language for management of a DNR policy in the perioperative period
Key points
- Key points on physiology
- Key points on treatment
- Key points on outcome and practice
References
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition