Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000500013
Brazilian Journal of Anesthesiology
Miscellaneous

Atualização das diretrizes de ressuscitação cardiopulmonar de interesse ao anestesiologista

Update on cardiopulmonary resuscitation guidelines of interest to anesthesiologists

Luiz Fernando dos Reis Falcão; David Ferez; José Luiz Gomes do Amaral

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Resumo

JUSTIFICATIVA E OBJETIVOS: As novas diretrizes de ressuscitação cardiopulmonar (RCP) enfatizam a importância das compressões torácicas de alta qualidade e modificam algumas rotinas. Este artigo tem por objetivo revisar as principais alterações na reanimação praticada pelo médico anestesiologista. CONTEÚDO: A ênfase para realização das compressões torácicas de alta qualidade, com frequência e profundidade adequadas, permitindo retorno total do tórax e com interrupção mínima nas compressões, assume posição de destaque nesta atualização. Não se deve levar mais de dez segundos verificando o pulso antes de iniciar a RCP. A relação universal de 30:2 é mantida, modificando-se sua ordem de realização, iniciando-se pelas compressões torácicas, para, em seguida, prosseguir para as vias aéreas e respiração (C-A-B, em vez de A-B-C). O procedimento "ver, ouvir e sentir se há respiração" foi removido do algoritmo e o uso de pressão cricoidea durante as ventilações, em geral, não é mais recomendado. A frequência das compressões foi modificada para um mínimo de cem por minuto, em vez de aproximadamente cem por minuto, sendo sua profundidade em adultos alterada para 5 cm, em lugar da faixa antes recomendada de 4 a 5 cm. Choque único é mantido, devendo ser de 120 a 200 J quando bifásico, ou 360 J quando monofásico. No suporte avançado de vida, o uso de capnografia e capnometria para confirmação da intubação e monitoração da qualidade da RCP é uma recomendação formal. A atropina não é mais recomendada para uso rotineiro no tratamento da atividade elétrica sem pulso ou assistolia. CONCLUSÕES: É importante a atualização quanto às novas diretrizes de RCP, sendo enfatizado o contínuo aprendizado. Isso irá melhorar a qualidade da reanimação e sobrevida de pacientes em parada cardíaca

Palavras-chave

COMPLICAÇÕES, Parada cardiorrespiratória, REANIMAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The new cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compressions and modify some routines. The objective of this report was to review the main changes in resuscitation practiced by anesthesiologists. CONTENTS: The emphasis on high-quality chest compressions with adequate rate and depth allowing full recoil of the chest and with minimal interruptions is highlighted in this update. One should not take more than ten seconds checking the pulse before starting CPR. The universal relationship of 30:2 is maintained, modifying its order, initiating with chest compressions, followed by airways and breathing (C-A-B instead of A-B-C). The procedure "look, listen, and feel whether the patient is breathing" was removed from the algorithm, and the use of cricoid pressure during ventilations is not recommended any more. The rate of chest compressions was changed for at least one hundred per minute instead of approximately one hundred per minute, and its depth in adults was changed to 5 cm instead of the prior recommendation of 4 to 5 cm. The single shock is maintained, and it should be of 120 to 200 J when it is biphasic; and 360 J when it is monophasic. In advanced cardiac life support, the use of capnography and capnometry to confirm intubation and monitoring the quality of CPR is a formal recommendation. Atropine is no longer recommended for routine use in the treatment of pulseless electrical activity or asystole. CONCLUSIONS: Updating the phases of the new CPR guidelines is important, and continuous learning is recommended. This will improve the quality of resuscitation and survival of patients in cardiac arrest

Keywords

Cardiopulmonary Resuscitation, Heart Arrest, Heart Massage

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