Français
English 
Urgences feuille de transfert
Premiers secours, en pratique (Samaritains de Genève)
Adult Basic Life Support (BLS)
American Heart Association Guidelines for CPR and ECC
Epilepsie
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Extract
Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada.Although estimates of the annual number of deaths due to out-of-hospital SCA vary widely,data from the Centers for Disease Control and Prevention estimates that in the United States approximately 330 000 people die annually in the out-of-hospital and emergency department settings from coronary heart disease. About 250 000 of these deaths occur in the out-of-hospital setting.The annual incidence of SCA in North America is &0.55 per 1000 population.
Cardiac Arrest and the Chain of Survival
Most victims of SCA demonstrate ventricular fibrillation (VF) at some point in their arrest. Resuscitation is most successful if defibrillation is performed in about the first 5 minutes after collapse. The interval between call to the emergency medical services (EMS) system and arrival of EMS personnel at the victim’s side is typically longer than 5 minutes. The best results of lay rescuer CPR and automated external defibrillation programs have occurred in controlled environments, with trained, motivated personnel, a planned and practiced response, and short response times.
CPR is important both before and after shock delivery. When performed immediately after collapse from VF SCA, CPR can double or triple the victim’s chance of survival. CPR should be provided until an automated external defibrillator (AED) or manual defibrillator is available. After about 5 minutes of VF with no treatment, outcome may be better if shock delivery (attempted defibrillation) is preceded by a period of CPR with effective chest compressions that deliver some blood to the coronary arteries and brain. CPR is also important immediately after shock delivery; most victims demonstrate asystole or pulseless electrical activity (PEA) for several minutes after defibrillation. CPR can convert these rhythms to a perfusing rhythm.
For the first time, a universal compression-ventilation ratio (30:2) is recommended for all single rescuers of infant, child, and adult victims (excluding newborns).
Differences in CPR for Lay Rescuers and Healthcare Providers
- Lay rescuers should immediately begin cycles of chest compressions and ventilations after delivering 2 rescue breaths for an unresponsive victim. Lay rescuers are not taught to assess for pulse or signs of circulation for an unresponsive victim.
- Lay rescuers will not be taught to provide rescue breathing without chest compressions.
- The lone healthcare provider should alter the sequence of rescue response based on the most likely etiology of the victim’s problem.
— For sudden, collapse in victims of all ages, the lone healthcare provider should telephone the emergency response number and get an AED (when readily available) and then return to the victim to begin CPR and use the AED.
— For unresponsive victims of all ages with likely asphyxial arrest (eg, drowning) the lone healthcare provider should deliver about 5 cycles (about 2 minutes) of CPR before leaving the victim to telephone the emergency response number and get the AED. The rescuer should then return to the victim, begin the steps of CPR, and use the AED.
- After delivery of 2 rescue breaths, healthcare providers should attempt to feel a pulse in the unresponsive, nonbreathing victim for no more than 10 seconds. If the provider does not definitely feel a pulse within 10 seconds, the provider should begin cycles of chest compressions and ventilations.
- Healthcare providers will be taught to deliver rescue breaths without chest compressions for the victim with respiratory arrest and a perfusing rhythm (ie, pulses). Rescue breaths without chest compressions should be delivered at a rate of about 10 to 12 breaths per minute for the adult and a rate of about 12 to 20 breaths per minute for the infant and child.
- Healthcare providers should deliver cycles of compressions and ventilations during CPR when there is no advanced airway (eg, endotracheal tube, laryngeal mask airway [LMA], or esophageal-tracheal combitube [Combitube]) in place. Once an advanced airway is in place, 2 rescuers no longer deliver "cycles" of compressions interrupted with pauses for ventilation. Instead, the compressing rescuer should deliver 100 compressions per minute continuously, without pauses for ventilation. The rescuer delivering the ventilations should give 8 to 10 breaths per minute and should be careful to avoid delivering an excessive number of ventilations. The 2 rescuers should change compressor and ventilator roles approximately every 2 minutes to prevent compressor fatigue and deterioration in quality and rate of chest compressions. When multiple rescuers are present, they should rotate the compressor role about every 2 minutes. The switch should be accomplished as quickly as possible (ideally in less than 5 seconds) to minimize interruptions in chest compressions.
The rescue sequence performed by the healthcare provider is similar to that recommended for the lay rescuer, with the following differences:
- If the lone healthcare provider witnesses the sudden collapse of a victim of any age, after verifying that the victim is unresponsive the provider should first phone 911 and get an AED if available, then begin CPR and use the AED as appropriate. Sudden collapse is more likely to be caused by an arrhythmia that may require shock delivery.
- If the lone healthcare provider is rescuing an unresponsive victim with a likely asphyxial cause of arrest (eg, drowning), the rescuer should provide 5 cycles (about 2 minutes) of CPR (30 compressions and 2 ventilations) before leaving the victim to phone the emergency response number.
Rescue Breaths
Each rescue breath should be delivered in 1 second and should produce visible chest rise.
- When rescue breaths are provided without chest compressions to the victim with a pulse, the healthcare provider should deliver 10 to 12 breaths per minute for an adult.
- Once an advanced airway is in place (eg, endotracheal tube, Combitube, LMA) during 2-rescuer CPR, the compressor should provide 100 compressions per minute without pausing for ventilation, and the rescuer delivering breaths should deliver 8 to 10 breaths per minute.
Chest Compressions
Chest compressions should depress the chest by one third to one half the depth of the chest. Rescuers should push hard, push fast (rate of 100 compressions per minute), allow complete chest recoil between compressions, and minimize interruptions in compressions for all victims.
For adult victims (about 8 years of age and older):
- The rescuer should compress in the center of the chest at the nipple line.
- The rescuer should compress the chest approximately 1
to 2 inches, using the heel of both hands.
Lay rescuers should use a 30:2 compression-ventilation ratio for all (infant, child, and adult) victims. Healthcare providers should use a 30:2 compression-ventilation ratio for all 1-rescuer and all adult CPR and should use a 15:2 compression-ventilation ratio for infant and child 2-rescuer CPR.