Compliance And Safety Training

Advanced CPR Techniques (Beyond Basic CPR)




1. What is Advanced CPR?

  • Advanced CPR includes techniques and tools used by trained healthcare professionals to improve survival rates in cardiac arrest cases.
  • It incorporates basic life support (BLS) principles with additional interventions like airway management, advanced medications, and monitoring.

2. Key Components of Advanced CPR

A. Advanced Airway Management

  • Endotracheal Intubation:
    • Inserting a tube into the trachea to secure the airway and ensure effective oxygen delivery.
  • Supraglottic Airway Devices:
    • Tools like laryngeal mask airways (LMAs) used when intubation is not feasible.
  • Bag-Valve-Mask Ventilation (BVM):
    • Manual ventilation using a bag and mask to provide oxygen if the person is not breathing.

B. Defibrillation (Advanced Use of AED or Manual Defibrillators)

  • AED: Used in basic CPR to analyze and shock shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia).
  • Manual Defibrillators:
    • Used by trained professionals to deliver shocks at specific energy levels based on patient needs.
    • Requires interpretation of heart rhythms using electrocardiograms (ECGs).

C. Rhythm Recognition

  • Advanced CPR involves identifying and treating specific cardiac rhythms, including:
    • Shockable Rhythms:
    • Ventricular Fibrillation (VF).
    • Pulseless Ventricular Tachycardia (VT).
    • Non-Shockable Rhythms:
    • Asystole (flatline).
    • Pulseless Electrical Activity (PEA).
  • Treatment plans differ depending on the rhythm (e.g., defibrillation for VF/VT or medications for asystole/PEA).

D. Advanced Medications

  • Medications used during advanced CPR include:
    1. Epinephrine: Increases blood flow to the brain and heart by improving vasoconstriction.
    2. Amiodarone or Lidocaine: Used for shockable rhythms (VF/VT) that persist after defibrillation.
    3. Atropine: Sometimes used for bradycardia (slow heart rate) or asystole in specific cases.
    4. Bicarbonate: May be given for severe acidosis after prolonged resuscitation efforts.

E. High-Quality Chest Compressions with Monitoring

  • Use of advanced devices to ensure compressions meet the recommended depth (at least 2 inches), rate (100–120 beats per minute), and allow for full chest recoil.
  • Tools like CPR feedback devices provide real-time data on compression quality.

3. Specialized Techniques

A. Targeted Temperature Management (TTM)?

  • Post-resuscitation care involving controlled cooling of the body to reduce brain damage after cardiac arrest.

B. Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

  • Involves using a machine (ECMO - extracorporeal membrane oxygenation) to bypass the heart and lungs, providing oxygenated blood to the body during prolonged cardiac arrest.
  • Typically used in hospitals for patients who don’t respond to standard CPR.

C. Capnography Monitoring

  • Measures exhaled carbon dioxide (EtCO?) to evaluate the effectiveness of chest compressions and detect return of spontaneous circulation (ROSC).
  • Normal EtCO? levels: 10–20 mmHg during CPR; an increase indicates possible ROSC.

D. Reversible Causes of Cardiac Arrest (H’s and T’s)

  • Advanced CPR focuses on identifying and treating underlying causes:
    • H’s: Hypoxia, Hypovolemia, Hypothermia, Hyper/Hypokalemia, Hydrogen ion (acidosis).
    • T’s: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (cardiac or pulmonary).

4. Post-Resuscitation Care???

  • Once ROSC is achieved, advanced care focuses on stabilizing the patient:
    • Maintain airway and oxygenation.
    • Monitor blood pressure and circulation.
    • Use ECG to detect and treat underlying arrhythmias.
    • Assess brain function and prevent further organ damage.

5. Differences Between Basic and Advanced CPR

| Feature | Basic CPR (BLS) | Advanced CPR (ACLS) |
|-----------------------------|-----------------------------|------------------------------------|
| Airway Management | Head-tilt/chin-lift, rescue breaths. | Intubation, advanced airway devices. |
| Defibrillation | AED use. | Manual defibrillation with ECG monitoring. |
| Medications | None. | Epinephrine, Amiodarone, etc. |
| Rhythm Recognition | Not required. | Identification of VF, VT, asystole, PEA. |
| Post-Resuscitation Care | Limited. | Comprehensive care including TTM and organ support. |

6. When is Advanced CPR Performed?

  • Typically performed by healthcare professionals (e.g., paramedics, doctors, nurses) in:
    • Hospitals (e.g., during cardiac arrests in emergency or ICU settings).
    • Ambulances and pre-hospital settings.
    • Specialized clinics or cardiac units.

7. Required Training for Advanced CPR???

  • ACLS Certification:
    • Advanced Cardiovascular Life Support (ACLS) training covers advanced techniques like airway management, rhythm recognition, and medication administration.
  • Certification is required for healthcare professionals like paramedics, nurses, and physicians.

8. Key Goals of Advanced CPR

  • Improve survival rates by optimizing high-quality CPR and timely defibrillation.
  • Identify and treat the reversible causes of cardiac arrest.
  • Provide advanced post-resuscitation care to reduce long-term complications.
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