Sudden cardiac arrest is the most cause of sudden death in the world. Many cardiac arrest victims are saving or can be saved if people around the victim conducted immediate action while cardiac in fibrillate status (VF). But if cardiac rhythm is change to arrest/asystole, the fail probability is high.
Chain of survival as a universal chain that already implemented are consist of :
- Immediate recognition of cardiac arrest and activate of emergency response system.
- Early CPR that emphazise chest compressions (new guidelines AHA 20120).
- Rapid defibrilation if indicated.
- Effective advanced life support.
- Integrated post-cardiac arrest care.
When these chain are implemented in an affective way, survival rate can approach 50% following witnessed out-hospital ventricular fibrilation (VF) arrest (fibrilation of the heart).
To minimize the time of that chain to make effective, it should be immediate action in the first chain. The witnesses should fast in recognition, activate EMS and conduct CPR as soonest. So many people should know at least know how to conduct the correct CPR before health proffesional’s coming.
Immediate recognition and activation, early CPR, and rapid defibrillation (when appropriate) are the first BLS links in the adult Chain of Survival. So many people know how to conduct corect CPR, it will improve save victim with cardiac arrest.
Key changes and continuesd point of emphasis from 2005 BLS Guidelines include the following:
- Immediate recognition of Sudden Cardiac Arrest based on assessing unresponsiveness and absence of normal brething (victim is no breathing or only gasping).
- Look, Listen, and Feel removed from the BLS algorthm.
- Encouraging Hands-Only (chest compression only) CPR for untrainedlay-rescuer (continous chest compression over of the middle of the chest).
- Sequence change to chest compression before rescue breaths (CAB rather than ABC)
- Health care providers continue effective chest compression/CPR until return of spontaneous circulation (ROSC) or termination of resuscitative efforts.
- Increase focus on methods to ensure that high quality CPR (compression of adequate rate and depth, allowing full chest recoil between compressions, minimizing interruptions in chest comperrassion and avoiding excessive ventilation) is performed.
- Continued de-emphasis on pulse check for health care providers.
- A simplified adult BLS algorithm is introduced with the revised traditional algorithm.
- Recommendation of simultaneous, choreographed approach for chest compression, airway management, rescue breathing, rhythm detection, and shocks (if appropriate) by an integrated team of highly-trained rescuers in appropriate settings.
Chest compressions consist of forceful rhythmic applications of pressure over the lower half of the sternum. These compressions create blood flow by increasing intrathoracic pressure and directly compressing the heart. This generates blood flow and oxygen delivery to the myocardium and brain.
- Effective chest compressions are essential for providing blood flow during CPR. For this reason all patients in cardiac arrest should receive chest compressions.
- To provide effective chest compressions, push hard and push fast. It is reasonable for laypersons and healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute with a compression depth of at least 2 inches/5 cm. Rescuers should allow complete recoil of the chest after each compression, to allow the heart to fill completely before the next compression.
- Rescuers should attempt to minimize the frequency and duration of interruptions in compressions to maximize the number of compressions delivered per minute. A compression-ventilation ratio of 30:2 is recommended.
- Journal of The America Heart Association, Circulation, 2010.
- http://www.medscape.com/viewarticle/730866, 2010 AHA Guidelines: The ABCs of CPR Rearranged to “CAB”.