CPR Guidelines and Organizations American Academy of Science 1st Guidelines for CPR and ECC (1966) American Heart Association European Resuscitation C

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1 New CPR Guidelines 원주의대황성오

2 CPR Guidelines and Organizations American Academy of Science 1st Guidelines for CPR and ECC (1966) American Heart Association European Resuscitation Council AHA Guidelines for CPR and ECC, 1974, 1980, 1986, 1992 ERC Guidelines for CPR and ECC 1992, 1996, 1998 International Liaison Committee on Resuscitation (ILCOR) (1993) International Guidelines 2000 for CPR and ECC Korean Association of CPR (KACPR) (2004) International Guidelines 2005 for CPR and ECC Korean Guidelines for CPR and ECC 2006: Korean Association of CPR (KACPR) Korean Guidelines for CPR and ECC 2011: Korean Association of CPR (KACPR) International Guidelines 2010 for CPR and ECC

3 General Principle for New Guidelines Confirm the safety and effectiveness of G2005 and introduce new treatment Extension of Chain of Survival from prevention of cardiac arrest to post-resuscitation care Achievement of higher rate and quality of lay rescuer CPR and establishment of AED programs in the community

4 2011 한국심폐소생술지침의주요변경내용 기본소생술순서의변경 (C-A-B) 가슴압박방법의조정과가슴압박소생술도입 심정지확인과정과기본소생술및전문소생술의단순화 심정지후치료의중요성강조

5 생존사슬, Chain of Survival

6 Key changes in the New Guidelines 심폐소생술의단순화, Simplified BLS algorithm - Removal of look, listen, and feel - Immediate activation of EMS and starting chest compressions for any unresponsive adult victim with no breathing or no normal breathing (ie, only gasps) 가슴압박소생술도입 Encourage hands-only (compression only) CPR for untrained lay rescuer 심폐소생술순서변경, C-A-B rather than A-B-C - Beginning CPR with 30 compressions rather than 2 ventilations

7 Key changes in the New Guidelines Airway (A) Breathlessness Breathing (B) Circulation (C) G2006 A-B-C C A B G2011 C-A-B C H-CPR C-only

Hands-only CPR, Clinical studies Study Bossaert et al. 1989 Hallstrom et al.

2007 Outcome 14-day survival Discharge alive Discharge alive 1-month survival 1-year survival

71/443 (16)* - 32/240 (15) 29/278 (10) 26/429 (6) 6/41 (15)* 61/437 (14)* 63/2917 (2) 27/439

8 Hands-only CPR, Clinical studies Study Bossaert et al Hallstrom et al Waalewijn et al Nagao et al Iwami et al Bohm et al Outcome 14-day survival Discharge alive Discharge alive 1-month survival 1-year survival 1-month survival No bystander CPR (%) CC-only CPR (%) CC+RB CPR (%) 123/2,055 (6) 17/116 (15)* 71/443 (16)* - 32/240 (15) 29/278 (10) 26/429 (6) 6/41 (15)* 61/437 (14)* 63/2917 (2) 27/439 (6)* 30/712 (3) 70/2,817 (2.5) 19/441 (4.3)* 25/617 (4.1)* - 591/8,209 (7) 77/1,145 (7) * CC: chest compression, RB: rescue breathing

9 Annual Lay Bystander CPR Rates and Survival After Hands-only CPR 80 Survival Bystander CPR H-CPR Bobrow, B. J. et al. JAMA 2010;304:

10 C-A-B from A-B-C (Ventilation first vs. Compression first) AHA Guidelines 2005 ERC Guidelines 2005

11 C-A-B: Manikin simulation study Kobayashi M, et al. Resuscitation 2008;78:333-9

exceeding 120 /min, Korea, Europe) At least 5 cm in depth (not

12 Key changes in the New Guidelines Basic Life Support, 가슴압박방법의조정 C:V ratio=30:2 At least 100 compressions per minute (not exceeding 120 /min, Korea, Europe) At least 5 cm in depth (not exceeding 6 cm, Korea, Europe) Minimize pause less than 10 sec Complete recoil

13 기본소생술흐름도 ( 일반인 ) 반응이없는환자발견 무호흡또는비정상호흡 ( 심정지호흡 ) 119 신고및자동제세동기요청 예 심폐소생술을할수있습니까? 아니오 심폐소생술시작 ( 가슴압박 : 인공호흡 30:2 반복 ) 가슴압박소생술 자동제세동기도착 자동제세동기사용 제세동필요 심장리듬분석 제세동불필요 제세동 2 분간심폐소생술

14 기본소생술흐름도 ( 의료종사자 ) 반응이없는환자발견 무호흡또는비정상호흡 ( 심정지호흡 ) 구조요청및 ( 자동 ) 제세동기준비 맥박확인 (10 초이내 ) 심폐소생술시작 ( 가슴압박 : 인공호흡 =30:2 반복 ) ( 자동 ) 제세동기도착 ( 자동 ) 제세동기사용 제세동필요 심장리듬분석 제세동불필요 제세동 2 분간심폐소생술

15 Key changes in the New Guidelines 전문소생술, Advance Cardiovascular Life Support 호기말이산화탄소압측정장치의유용성강조 Use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement 심폐소생술중약물투여 Vasopressors, antiarrhythmic agents: unchanged Atropine is no longer recommended for routine use in the management of PEA/asystole Adenosine for undifferentiated, regular, wide QRS tachycardia 약물투여경로 : IV and IO, equally effective Intratracheal route: not recommended

16 전문심장소생술흐름도 ( 성인 ) 심정지환자발견 도움요청 / 전문소생술팀활성화심전도감시장치 / 제세동기요청심폐소생술시작 심전도감시장치 / 제세동기부착 심실세동 / 무맥성심실빈맥 심전도리듬분석 무수축 / 무맥성전기활동 제세동 자발순환회복 2분간심폐소생술 ( 전문 ) 기도확보와환기주사로확보후약물투여 심정지후통합치료 2분간심폐소생술 ( 전문 ) 기도확보와환기주사로확보후약물투여

17 Key changes in the New Guidelines 심정지후치료, Post-Cardiac Arrest Care 체온조절, Temperature control Therapeutic hypothermia (32-34 ) during first hours 급성관상동맥증후군의치료, Active intervention of acute coronary syndrome PCI for ST elevation on EKG after resuscitation 심폐기능및관류의정상화, Optimize cardiopulmonary function and vital organ perfusion including oxygenation and ventilation Avoid hyperoxia (SaO2 94~96%) and hypo- or hypercapnea (PaCO mm Hg) 혈당조절, Glucose control Conventional glycemic control ( mg/dl) 통합적심정지후치료체계도입, Comprehensive postcardiac arrest care system

18 Effect of Therapeutic Hypothermia by Cochrane Review For good neurologic outcome For survival Arrich J, et al. Cochrane Database Syst Rev 2009;7:CD004128

19 Immediate PCI and Survival in 714 OHCA PCI is a predictor of better prognosis (OR=2.06, ) Dumas F et al. Circ Cardiovasc Interv 2010;3:

20 Hyperoxia during post-resuscitation Kilgannon, J. H. et al. JAMA 2010;303:

21 Intensive (81-108) vs. conventional glucose control(<180 mg/dl) (NICE-SUGAR study, n=6,104) The NICE-SUGAR Investigators, N Engl J Med 2009; 360:

22 Comprehensive post-cardiac arrest care

/12- 유도심전도 / 원인질환교정수축기혈압 90 mm Hg 유지평균동맥압 65 mm Hg 유지 의식없음

23 소생후통합치료과정의흐름도 자발순환회복 환자평가 전문기도유지술 ( 기관내삽관 ) 로교체혈압, 호기말이산화탄소압, 산소포화도측정심전도감시, 혈액채취및검사 적절한환기와산소유지 산소포화도 94% 유지 혈역학적안정유지 약물투여 /12- 유도심전도 / 원인질환교정수축기혈압 90 mm Hg 유지평균동맥압 65 mm Hg 유지 의식없음 의식및반응확인 치료적저체온요법 ST 절상승급성심근경색 12- 유도심전도확인 관상동맥중재술 중환자실입원심정지후통합치료

24 Acknowledgement (52 contributing authors of Korean Guidelines 2011) 기본소생술 강형구 ( 한양의대 ), 류지호 ( 부산의대 ), 문중범 ( 강원의대 ), 서정열 ( 한림의대 ), 손유동 ( 한림의대 ), 손인아 ( 가천의과학대 ), 송근정 ( 성균관의대 ), 송소현 ( 대구보건대 ), 심민섭 ( 성균관의대 ), 이창희 ( 전주기전대 ), 장용수 ( 한림의대 ), 정성필 ( 연세의대 ), 조규종 ( 한림의대 ) 전문심장소생술 강구현 ( 한림의대 ), 강영준 ( 제주의대 ), 김기운 ( 아주의대 ), 김동빈 ( 가톨릭의대 ), 김준수 ( 성균관의대 ), 김진회 ( 국립공주대 ), 김찬웅 ( 중앙의대 ), 김현 ( 원주의대 ), 노태호 ( 가톨릭의대 ), 류현욱 ( 경북의대 ), 박규남 ( 가톨릭의대 ), 박현경 ( 경희의대 ), 박홍준 ( 가톨릭의대 ), 신종환 ( 서울의대 ), 양혁준 ( 가천의대 ), 염석란 ( 부산의대 ), 이미진 ( 건양의대 ), 임용수 ( 가천의대 ), 한상진 ( 한림의대 ) 소아소생술 김도균 ( 서울의대 ), 박준동 ( 서울의대 ), 신동민 ( 충주대 ), 이은경 ( 청암대 ), 장혜영 ( 순천향의대 ), 허준 ( 성균관의대 ) 신생아소생술 김애란 ( 울산의대 ), 김한석 ( 서울의대 ), 박문성 ( 아주의대 ), 손동우 ( 가천의대 ), 장윤실 ( 성균관의대 ), 전용훈 ( 인하의대 ) 교육지침 김명천 ( 경희의대 ), 김영민 ( 가톨릭의대 ), 나상훈 ( 서울의대 ), 이중의 ( 서울의대 ), 임태호 ( 한양의대 ), 임훈 ( 순천향의대 ), 최대해 ( 동국의대 ), 탁양주 ( 충주대 )

25 감사합니다

Microsoft PowerPoint Korean CPR guidelines.pptx

Microsoft PowerPoint Korean CPR guidelines.pptx 2015 Korean guidelines for CPR and ECC Sung Phil CHUNG, MD Emerg Med, Yonsei Univ, Korea Contributors to K2015 가이드라인개발총괄운영위원회 : 황성오 ( 위원장, 원주의대 ), 송근정 ( 성균관의대 ), 김현 ( 원주의대 ), 노태호 ( 가톨릭의대 ), 김영민 ( 가톨릭의대