アメリカ心臓協会 心肺蘇生と救急心血管治療のためのガイドライン 2010 2010 American Heart Association Guidelines for CPR and ECC の ハイライト 目次 全救助者に共通の主要な問題 1 市民救助者による成人への CPR 3 ヘルスケアプロバイダーによる BLS 5 電気的治療 9 心肺蘇生手技と器具 12 二次救命処置 13 急性冠症候群 17 脳卒中 18 小児の一次救命処置 18 小児の二次救命処置 20 新生児の蘇生 22 倫理問題 24 教育 実施 チーム 25 応急処置 26 まとめ 28
Editor Mary Fran Hazinski, RN, MSN Associate Editors Leon Chameides, MD Robin Hemphill, MD, MPH Ricardo A. Samson, MD Stephen M. Schexnayder, MD Elizabeth Sinz, MD Contributor Brenda Schoolfield Guidelines Writing Group Chairs and Cochairs Michael R. Sayre, MD Marc D. Berg, MD Robert A. Berg, MD Farhan Bhanji, MD John E. Billi, MD Clifton W. Callaway, MD, PhD Diana M. Cave, RN, MSN, CEN Brett Cucchiara, MD Jeffrey D. Ferguson, MD, NREMT-P Robert W. Hickey, MD Edward C. Jauch, MD, MS John Kattwinkel, MD Monica E. Kleinman, MD Peter J. Kudenchuk, MD Mark S. Link, MD Laurie J. Morrison, MD, MSc Robert W. Neumar, MD, PhD Robert E. O Connor, MD, MPH Mary Ann Peberdy, MD Jeffrey M. Perlman, MB, ChB Thomas D. Rea, MD, MPH Michael Shuster, MD Andrew H. Travers, MD, MSc Terry L. Vanden Hoek, MD 2010 American Heart Association
AHA 2010 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) AHA Circulation October 20102010 AHA Guidelines for CPR and ECC CPR ECC 2010 1 Circulation 2 Resuscitation 3 2010 International Consensus on CPR and ECC Science With Treatment Recommendations CPR ECC 2010 4 50 CPR 1 ALS AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 2010 1 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC basic life support, BLS AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 2005 2005 1 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR 2 emergency medical services EMS 3 CPR AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR 2005 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR 100 100 2 5 cm 1/3 1.5 4 cm 2 5 cm 1.5 2 AHA CPR ECC AHA Guidelines for CPR and ECC 1 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AHA ECC Circulation 2 Resuscitation 3 ILCOR 2010 International Consensus on CPR and ECC Science With Treatment Recommendations ILCOR 2010 CPR ECC 2010 29 356 2010 2010 CPR ECC 36 ECC 277 411 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 1 CPR ECC AHA 2010 2010 AHA Guidelines for CPR and ECC 41
L AY R E S C U E R A D U LT C P R 1 newly born infants 30 2 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 1 100 6 8 1 1 8 10 A-B-C C-A-B AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC newly born BLS A-B-C C-A-B CPR CPR AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC ventricular fibrillation VF ventricular tachycardia VT BLS A-B-C C-A-B 30 18 2 CPR A-B-C 1 CPR 1 BLS automated external defibrillator AED 3 1 AED CPR AED 5 2 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 2 AHA ECC 1 5 1 AHA ECC AHA ECC 1. 2. CPR 3. 4. 5. 32
H E A LT H C A R E P R O V I D E R B L S CPR CPR 2 BLS AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR BLS 2 CPR CPR CPR 1 A-B-C C-A-B 1 CPR 2 30 2 2010 American Heart Association 100 100 1.5 2 2 5 cm * * 2010 CPR Hands-Only CPR EMS AED EMS CPR 30 2 AED EMS CPR 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR CPR CPR AHA 2010 2010 AHA Guidelines for CPR and ECC 43
CPR CPR A-B-C C-A-B* * 2010 2005 CPR 2 30 2 2 30 CPR CPR 2 1 2 1 30 1 CPR 2 CPR 1 CPR 100 CPR 2010 CPR 1 30 2 2005 CPR CPR CPR C-A-B 1 2 1 100 * 2010 100 2005 100 CPR 1 return of spontaneous circulation ROSC 1 AED CPR 1 2 * 2010 2 5 cm 2005 1.5 2 4 5 cm 1 4
BLS 2 1.5 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 1.5 2 4 5 cm 2 5 cm CPR BLS AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR CPR AED 10 10 CPR AED CPR A-B-C C-A-B CPR 2 30 100 100 CPR * CPR 2010 CPR CPR CPR CPR AED CPR AED 2005 CPR CPR AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 2005 CPR AHA 2010 2010 AHA Guidelines for CPR and ECC 5
BLS CPR CPR CPR 2010 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR CPR 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 2005 3 7 * 2010 CPR CPR AED EMS CPR BLS EMS CPR CPR CPR CPR CPR CPR CPR CPR 2010 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR AHA 2008 CPR 6
BLS * 2010 2010 1 30 2 2005 2 AED 10 CPR AED CPR A-B-C C-A-B* 2010 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC 2005 CPR 2 30 2 2 30 CPR 2 1 2 1 30 1 CPR 2005 CPR C-A-B 1 2 1 100 * 2010 100 2005 100 CPR 1 ROSC 1 AED CPR 1 4 2 * 2010 2 5 cm 2005 1.5 2 4 5 cm 1 2 1.5 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AHA 2010 2010 AHA Guidelines for CPR and ECC 7
BLS 1 * BLS 10 HCP CPR C-A-B 100 2 5 cm ¹ ³ 2 5 cm ¹ ³ 1.5 4 cm HCP 2 10 HCP 30 2 1 2 30 2 1 15 2 HCP 2 HCP 6 8 1 8 10 1 1 AED CPR AED automated external defibrillator CPR cardiopulmonary resuscitation HCP healthcare provider * 2010 BLS 1 1 CPR EMS 1 2 3 4 1 BLS BLS 2005 BLS BLS AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECCAHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC BLS newly born infants CPR 1 8
AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR AED AED AED CPR VF 1 3 2 AED 2010 1 AED AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AED AHA EMS 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC AED 4 CPR AED EMS AED AED 2010 2005 3 AED AED 20101 8 AED CPR AED AED 1 AED AED 20051 8 CPR AED AED 1 AED 4 J/kg 9 J/kg CPR 2010 2005 AED CPR AED AED CPR AED AED CPR EMS AHA 2010 2010 AHA Guidelines for CPR and ECC 9
EMS AED electrocardiogram ECG CPR 1.5 3 CPR 2 CPR CPR VF VF 3 CPR VF 2 3 VF ROSC AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR 2 1.5 3 CPR VF EMS 4 5 CPR VF 2 EMS CPR VF CPR 30 1 2010 2005 200 J VF ROSC 120 200J 2010 2 4 J/kg 2 J/kg 4 J/kg 10 J/kg 1 3 2010 2005 International Liaison Committee on Resuscitation ILCOR 2010 International Consensus Conference on CPR and ECC Science with Treatment Recommendations CPR ECC 2001 VF 1 3 2 2 1 3 1 VF 1 CPR 1 3 CPR 1 CPR 2005 2 J/kg 2 4 J/kg 2 J/kg 18 50 VF 9 J/kg 2010 2005 2 2 VT 2 10
2010-3 - - - 4 AED 2005 AED - 1 4 - - - - AHA 2005 ROSC 2010 - - 2010 120 200 J 200 J 50 100 J 2005 100 200 J 100 120 J 80 85 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 120 200 J 2005 1 2.5 cm 2005 8 cm AED VF 2010 VT 100 J QRS VF VT VT VT AHA 2010 2010 AHA Guidelines for CPR and ECC 11
2005 VT AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC VT VT AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC VT 2010 2005 VF 2010 2005 BLS CPR CPR AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR CPR 2010 VT VT CPR 2005 VF ROSC 2 CPR CPR CPR CPR ROSC CPR AutoPulse CPR 4 CPR CPR CPR CPR 12
A C L S 2010 advanced cardiovascular life support ACLS CPR CPR CPR ROSC pulseless electrical activity PEA QRS ROSC 2010 CPR Petco2 ROSC 3A 3B 3 1 mm Hg 50 37.5 25 12.5 0 A. Petco 2 mm Hg Petco 2 1 mm Hg 50 37.5 25 12.5 0 CPR ROSC B. 2 Petco 2 mm Hg CPR 1 8 10 100 1 Petco 2 12.5 mm Hg 2 3 Petco 2 12.5 25 mm Hg return of spontaneous circulation ROSC 4 ROSC Petco 2 4 40 mm Hg AHA 2010 2010 AHA Guidelines for CPR and ECC 13
A C L S 4 ACLS CPR 2 3 5 VF VT ROSC CPR CPR CPR 2 5 cm 100 2 30 2 PETCO 2 10 mm HgCPR 20 mm HgCPR ROSC PETCO 2 40 mm Hg 120 200 J 2 360 J 3 51 mg 2 40 300 mg 2 150 mg ET 18 10 Hypovolemia Hypoxia Hydrogen ion Hypo-/hyperkalemia Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary 2005 CO2 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC Petco2 CPR CO2 ROSC Petco2 ROSC Petco2 ROSC Petco2 ACLS 2010 ACLS CPR CPR ACLS 4 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 14
ROSC BLS CPR ACLS 2005 ACLS CPR ACLS 2005 advanced life support ALS CPR AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR ACLS ACLS VF VT CPR 2010PEA ACLS PEA ACLS pediatric advanced life support PALS QRS ACLS PALS VF QRS 2005 ACLS PEA QRS PEA QRS IV 2010 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC ROSC 3 percutaneous coronary interventions PCIs ACS ROSC 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC ACLS VF 2005 2 PEA/ ROSC A C L S AHA 2010 2010 AHA Guidelines for CPR and ECC 15
A C L S 3 ROSC ROSC 2010 94 ROSC 94 fraction of inspired oxygen Fao2 100 80 mm Hg 500 mm Hg Pao2 94 100 FIO2 2005 94 99 2010 International Consensus on CPR and ECC Science With Treatment Recommendations 2,3 CPR ECC 2010 ACLS 5 ROSC 100 80 mm Hg 500 mm Hg PaO2 ACLS PALS 94 100 3 1. ROSC 2. 3. ACS 4. 5. ACS PCI 16
ACS ST 2010 15 PCI 2005 10 ST ST-segment elevation myocardial infarction STEMI EMS STEMI ACS EMS ACS emergency department ED BLS ACLS AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 15 BLS ACLS 12 ECG STEMI 12 ECG EMS 12 ECG AHA CPR ECC AHA Guidelines for CPR and ECC 2000 12 ECG PCI PCI EMS ED ACS PCI PCI AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC acute coronary syndromes ACS ACS ACS ACS AHA CPR ECC AHA Guidelines for CPR and ECCAHA/ AHA/American College of Cardiology Guidelines VF VT STEMI ACS PCI VF ECG STEMI ROSC PCI PCI AHA 2010 2010 AHA Guidelines for CPR and ECC 17
BLS 2010 94 2005 90 ACS 6 ACS ACS 94 STEMI NSTEMI ED 90 mm Hg 1 QOL quality of life recombinant tissue plasminogen activator rtpa AHA 3 rtpa 3 4.5 rtpa 3 3 4.5 rtpa Food and Drug Administration FDA rtpa D 119 EMS BLS BLS CPR A-B-C C-A-B CPR 2 CPR 1/3 1.5 4 cm 2 5 cm 18
BLS 10 CPR 1/2 1.5 4 cm 2 5 cm AED AED AED AED CPR A-B-C C-A-B 2010 CPR A-B-C C-A-B CPR 2 30 1 15 2 2005 2 CPR C-A-B CPR CPR CPR C-A-B 18 30 2 2010 1/3 1.5 4 cm 2 5 cm 2010 2005 CPR C-A-B 2010 10 10 2005 10 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AED 2010 AED AED AED 2005 1/3 1/2 2005 1 8 AED 1 AED AHA 2010 2010 AHA Guidelines for CPR and ECC 19
L AY ALS R E S C U E R A D U LT C P R AED AED QRS 0.08 0.09 CO2 PALS 2010 CO2 ED 13 3ACPR 13 3B CPR 2005 CO2 PALS 2 CPR 2 J/kg 4 J/kg 2 J/kg 2005 2 4 J/kg 4 J/kg 10 J/kg 94 100 CO2 / CO2 Petco2 CPR Petco2 10 15 mm Hg Petco2 ROSC Petco2 2010 2 J/kg 4 J/kg 2 J/kg VF 4 J/kg 10 J/kg 2005 2 J/kg 4 J/kg 20
ALS 2010 94 ROSC 94 Fio2 100 80 mm Hg 500 mm Hg Pao2 94 100 Fio2 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 2010 QRS QRS 0.09 2005 QRS QRS 0.08 6 4 QRS 0.09 4 16 QRS 0.1 QRS PALS 0.09 QRS 0.01 ECG QRS 2010 AHA 94 99 Pao2 Fio2 Pao2 5 2005 AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC 2010 Fontan hemi-fontan bidirectional Glenn 2005AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC ECMO AHA 2010 2010 AHA Guidelines for CPR and ECC 21
L AY R E S C U E R A D U LT C P R 2010 32 C 34 C VF 32 C 34 C 2005 32 C 34 C 12 24 VF 2010 / 50 ECG 3 1 A-B-C 2010 3 2005 CO2 2005 2010 2005 2010 37 39 2010 3 2005 2005 22
CO2 2010 100 2005 100 2010 CO2 2005 CO2 60 90 10 2010 3 1 15 2 2005 3 1 1 90 30 1 120 2010 2005 100 2010 2005 1 3 1 15 2 2 2010 36 2005 36 33.5 34.5 18 AHA 2010 2010 AHA Guidelines for CPR and ECC 23
2010 1 ALS EMS ALS CPR 2010 2005 10 10 ROSC 2005 2010 BLS BLS BLS EMS 1 CPR AED 3 ROSC AED BLS ALS EMS 40 60 EMS 2010 3 72 2005 33 3 3 3 24
72 24 N20 3 ROSC 3 2 N20 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC BLS ACLS 2 CPR CPR CPR CPR CPR CPR CPR BLS practice while watching AED AED ACLS PALS ACLS PALS ACLS PALS CPR ALS AHA 2010 2010 AHA Guidelines for CPR and ECC 25
2 2010 2 2 AHA ECC ECC 2010 CPR CPR ACLS PALS 2010 ACLS PALS AED AED 2010AED AED AED CPR 3 AHA CPR ECC 2010 2010 AHA Guidelines for CPR and ECC CPR CPR 2010 CPR 2010 BLS 2010 AHA American Red Cross ARC 2010 AHA/ARC 30 International First Aid Science Advisory Board ILCOR Consensus on CPR and ECC Science with Treatment Recommendations CPR ECC ILCOR 26
2010 AHA/ARC International First Aid Science Advisory Board 2010 AHA/ARC H E A LT H C A R E P R O V I D E R B L S 2005 2005 2010 AHA/ARC 18 35 2 ACS 2 EMS 2010 EMS EMS 1 2 2010 2005 2010 2005 ACS EMS 2010 2005 2010 2005 2010 2010 2010 2010 AHA 2010 2010 AHA Guidelines for CPR and ECC 27
2010 40 70 mm Hg 55 70 mm Hg 2005 2005 2010 4 6 30 2 20 2010 2005 EMS EMS 2010 AHA/ARC 3 IV AHA CPR ECC 2005 2005 AHA Guidelines for CPR and ECC CPR CPR Kouwenhoven Jude Knickerbocker 4 50 CPR CPR REFERENCES 1. Field JM, Hazinski MF, Sayre M, et al. Part 1 Executive Summary of 2010 AHA Guidelines for CPR and ECC. Circulation. In press. 2. Hazinski MF, Nolan JP, Billi JE, et al. Part 1 Executive Summary 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. In press. 3. Nolan JP, Hazinski MF, Billi JE, et al. Part 1 Executive Summary 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. In press. 4. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960;173 1064-1067. 5. Kilgannon JH, Jones AE, Shapiro NI, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010;303 2165-2171. 6. Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram, Part III Intraventricular Conduction Disturbances. Circulation. 2009;119 e235-e240. 28
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その他の American Heart Association プログラムについてのお問い合わせ先は 下記のとおりです www.heart.org/cpr 7272 Greenville Avenue Dallas, Texas 75231-4596 U.S.A www.heart.org 90-2100JP JA-JA 10/10