SEKELUMIT: BANTUAN HIDUP

DASAR

Dr. Vera Irawany, SpAn

HENTI JANTUNG MENDADAK(SUDDEN CARDIAC ARREST)

Amerika (CDC)kematian CAD/thn• 330.000 di luar RS / UGD• 250.000 di luar RSInsidens 0,55 kematian/1000 pop/thn

Eropa (ESC)700.000 kematian/tahun40% Fibrilasi ventrikel

Indonesia (Depkes)Penyebab kematian utama sistem sirkulasi (26,4%)

Courtesy dr George, 2010

Profil Kesehatan Indonesia 2001 Depkes RI 2002

PENYAKIT PENYEBAB KEMATIAN UMUM DI

INDONESIA

16%

18,9%

26,4%

Sistim sirkulasi = henti jantung

Courtesy of Arif Mansjoer

SEJARAH

resusitasi = "resuscitare" = membangunkan lagi

1950-an : resusitasi nafas buatan (Safar & Elam)

1960-an : resusitasi KJL (Kouwenhoven)

1961 : nafas buatan + KJL (Safar)

RJP RJPO

1950

-1960

SAFAR Pengendalian jalan napas

& Pernapasan buatan

KOUWENHOVENKompresi jantung tertutup

1974

American Heart Association Cardiopulmonary Resuscitation (CPR)

1993

International Liaison Committee on Resuscitation

(ILCOR)

History of Modern CPR

6

RESUSITASI MODERN

guidelines

research

research

ANGKA KESELAMATAN ?

10

Tanpa BHD (RJP) kemungkinan korban utk “survive”

berkurang antara 7%-10% /menit

Dengan BHD (RJP) kemungkinan korban utk “survive” berkurang antara 3%-4% /menit sampai

dilakukan defibrilasi

ILCOR = International Liaison Comittee on Resuscitation

1. American Heart Association AHA

2. European Resuscitation Council ERC

3. Heart and Stroke Foundation of Canada HSFC

4. Resuscitation Councils of Southern Africa RCSA

5. Australian Resuscitation Council ARC

6. Resuscitation Councils of Latin America CLAR

7. New Zealand Resuscitation Council NZRC

Circulation 102, 2000 Resuscitation 46, 2000

International Guidelines 2000 Conference on Cardio-pulmonary

Resuscitation and Emergency Cardiovascular Care

BACKGROUNDData2 tentang angka survival

sewaktu keluar RS terhadap korban2 henti jantung karena VF di luar RS yg disaksikan sangat rendah yaitu hanya 6% seluruh dunia. Dengan catatan hanya sedikit perbaikan setelah guideline thn 2000 di keluarkan. Data2 ini dibuat hanya bberapa waktu sebelum dimulainya konferensi CPR ILCOR2005.

Ada 2 penelitian yg dipublukasi sebelum konferensi 2005 menunjukkan buruknya kualitas CPR yg dilakukan baik itu di luar RS atau di dalam RS.

PERUBAHAN UTAMA PADA CPR 2005

✖

✖

Check and assess - “hands-off time” = time without chest

compression reduce survival

100 per menit

Ratio 15:2

“HANDS-OFF” TIME = TIME WITHOUT CHEST COMPRESSION

Repeatedly assessing the patient

Interruption for ventilation

Operator delay for CVP, intubation, changing rescuer

Time taker by AED for analysis• A fall in coronary perfusion pressure• A deterioration in waveform of VF• A decrease of successful outcome after DC shock

Remove check breath and

assess circulationRATIO 30:2

(less ventilation)

AED

In VF SCA, ventilation NOT AS important as compressionsVQ mismatch (need less Vt)Increases intrathoracic pressure

• Decreases venous return• Prevents adequate filling

• DECREASES CARDIAC OUTPUTGastric insufflation

Why 30:2 or less ventilation?

Hyperventilation is bad….

Percobaan 3 kelompok hewan hiperventilasi

Tekanan intra toraks rata-rata

Tekanan perfusi koroner

Aufderheide TP, Sigurdsson G, Pirrallo R, Yannopoulos D, McKnite S, von-Briesen C, et al Hyperventilation-induced hypotension during CPRCirculation. 2004;109:1960-5

Observasi pada penolong terlatih dalam memberikan pernapasan buatan

30 + 3.2Kelompok 3 (n=13)

22 + 3*Kelompok 2 (n=6)

37 + 4*Kelompok 1 (n=7)

Kecepatan ventilasi (napas/menit)

Kelompok pasien yang ditolong

Tidak ada korban yang selamat

Penolong profesional pemberian ventilasi berlebih pada tindakan RJP. Hiperventilasi (pada hewan) tekanan intratorakal meningkat, tekanan perfusi koroner menurun, dan angka ketahanan hidup menurun

22

Early recognition & EMS activation Early CPR

Early defibrilationEarly ALS & post resuscitation

care

RANTAI KESELAMATAN (CHAIN OF SURVIVAL)

WHY AED?WITNESSED VS UNWITNESSED

Witnessed Collapse//Cardiac Arrest • AED first

Unwitnessed arrest• CPR first (2 minutes or 5 cycles), then AED

ETIOLOGY OF SUDDEN CARDIAC ARREST

Nolan J. ERC Guidelines for Resuscitation 2005-introduction. Resuscitation. 2005; 67 (suppl 1):S3-S6

Etiologi• Cardiac (primary)

• Heart attack (MCI)• Kelaianan jantung lain

• Non-Cardiac (secondary)• Internal

• Pneumonia berat, syok, dll• Eksternal

• Trauma, keracunana dll

ETIOLOGY OF SUDDEN CARDIAC ARREST

Nolan J. ERC Guidelines for Resuscitation 2005-introduction. Resuscitation. 2005; 67 (suppl 1):S3-S6

Etiologi

HENTI JANTUNG

100%

Henti jantung/par

u

80%

Penyakit jantung

? %

Henti jantungVT/VF

40%

Saat di EKG:VT/VF

Saat di EKG: asistol

Potensial untuk defibrilasi (AED)

0-4 menit

• Electrical phase

• Th/ Defib

4-10 menit

• Circulatory phase

• Th/ kompresi-ventilasi

• Tujuan: memberi perfusi pada otak dan jantung

> 10 menit

• Th/ hipotermia (32-340C)

• Menurunkan kebutuhan oksigen otak

Fase Henti Jantung(Weisfeldt & Becker)

ELECTRICAL PHASEA E D F I RS T

VF early defibrillation (class I)

Each passing minute decreased survival by 8-10%

Survival rate approaching 50%

Chicago airport study• AED 10/18 VF case survival

Circulation 1997

NEJM 2002

CHICAGO AIRPORTAED within 1 minute anywhere in the airport

Survival approaching 50% (10/18) for VF

AUTOMATED EXTERNAL DEFIBRILLATOR

BANTUAN HIDUP DASAR

1. AKSES DINI (EARLY ACCESS)

2. RJP DINI (EARLY CPR)

3. DEFIBRILASI DINI (EARLY

DEFIBRILLATION)

SAAT INI YANG DIPAKAI..

Guidelines AHA 2010