Hands On(ly) CPR

Hands-ON(LY) CPR

Nelson Santos Hosp. Prof. Dr. Fernando da Fonseca, EPE

Enf. UCIP HFF Esp. Enfermagem Médico-Cirúrgica Mestre Enfermagem Pessoa Situação Crítica Instrutor BLS e ACLS AHA Faculty American Heart Association

Hands-ON(LY) CPR | Nelson Santos

1992 ILCOR SBV | 2 Ventilações + 15:2 | 80/min | 4-5cm FV/TVsP | 3 Desf. | Analisar Ritmo Após Desf. | Ciclo de 1min ASY/AEsP | Ciclo de 3min Hands-ON(LY) CPR | Nelson Santos

1992

2000 SBV | 2 Ventilações + 15:2 | 100/min | 4cm PDAE


1992

2000

2005 SBV | 30:2 sem ventilações iniciais

SAV | 1 Desfibrilhação | Não Analisar Ritmo Após Desf. | Ciclos de 2min


1992

2000

2005

2010

High Quality CPR - Monitorização de RCP SAV | Compressões Durante Carga para Desfibrilhar


1992

2000

2005

2010

2015

SBV | 100-120/min | 5-6cm | Recoil Downgrade na Evidência em SAV – VAA / Adrenalina / TTM


1992

2000

2005

2010

UPDATE 2017 - SBV


2015

2017


Chest Compression Fraction > 60%


SBV 4’

2’

Tempo de PCR – 10’ SBV (30:2) + SAV (30:2) = 50 ciclos • Ventilar 4’’ x 50 ciclos = 200’’ • Análise de Ritmo 10’’ x 3 = 30’’ • Tempo Total de Pausa 230’’ • CCF = 61% (+10’’) Hands-ON(LY) CPR | Nelson Santos

SAV 2’

2’

RCE

PCR

Chest Compression Fraction > 60%

1. 2. 3. 4. 5. 6. 7.

Dispatcher-Assisted CPR: NO, NO, GO PDAE High QualityCPR Auxiliares de RCP TTM ICP ECMO


1. 2. 3. 4. 5. 6. 7.

Dispatcher-Assisted CPR: NO, NO, GO PDAE High QualityCPR Auxiliares de RCP TTM ICP ECMO




30:2

100:10 VAB Hands-ON(LY) CPR | Nelson Santos




Mean Chest Compression Fraction: •BLS 75% •ALS 58%

Fig. 1 Changes in chest compression fraction during transition of care from basic life support (BLS) to advanced life support (ALS) phases.





Analysis During Compressions with Fast Reconfirmation (ADC-FR) 1. Análise Auto + Carga com Compressões 2. Reconfirmação Auto sem Compressões


-5’’


-4,5’’

A - Hands-Off: 6,6’’

B - Hands-Off: 5,1’’ Difference: 1,5 s (95% confidence interval 0.4–2.5)



5,6’’

3,9’’


67 Cardioversões em 49 pessoas •Multifunções Antero-Lateral •Luvas de Proteção Elétrica Classe 1 – 7500V •Mãos no Tórax – simulando 20kg de força •Zona de Contacto Extra



500 Desfibrilhações com Protecção •50% a 360J •50% Fake





TeamECR – Treino de Equipas na Emerg. Cardiorrespiratória (2011) • Formação Semestral • Treino com carro de urgência e desfibrilhador do serviço

Internamento


Cuidados Intensivos

RCP HANDS-ON – Chest Compression Fraction • SBV – NO NO GO • SBV – Compression-Only / 30:2 / 100:10 • Carregar Energia Antes da Análise de Ritmo • Compressores Automáticos Externos ON para Desfibrilhar

RCP HANDS-ONLY – Guidelines 2020?!? • Filtros de ECG • Desfibrilhação Hands-ON

PIT CREW CPR Hands-ON(LY) CPR | Nelson Santos


1.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27.

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Educational training with the TrueCPR® feedback device significantly improves chest compression quality in lay rescuers, 2016. Wampler, D., Kharod, C., Bolleter, S., Burkett, A., Gabehart, C., & Manifold, C. (2016). A randomized control hands-on defibrillation study - Barrier use evaluation. Resuscitation, 103, 37–40. http://doi.org/10.1016/j.resuscitation.2016.03.019


Obrigado kjg

Keep Your Hands-ON(LY) Nelson Santos [email protected] [email protected]