Cardiopulmonary resuscitation (CPR)

Overview

Cardiopulmonary resuscitation (CPR) is a lifesaving technique used when someone’s heart stops pumping blood or they cease breathing, as in cases of cardiac arrest, heart attacks, or near-drowning incidents. The primary component of CPR is chest compressions, designed to maintain blood flow to vital organs until the heart can be restarted. While it’s a straightforward method that anyone can learn, the American Heart Association emphasizes the importance of beginning CPR with hard and fast chest compressions, a recommendation applicable to both untrained individuals and first responders.

Reason for undergoing the procedure

CPR is necessary for individuals of all ages in the following situations:

• Sudden collapse.
• Unresponsiveness.
• Absence of breathing.
• Lack of a detectable pulse.

It’s crucial to note that in over 50% of cases where cardiac arrest occurs outside of a medical facility, immediate assistance is not provided. If CPR is administered promptly following the onset of cardiac arrest, the likelihood of survival can increase two- to threefold.

Risk

CPR carries risks due to the necessary force required for effective chest compressions, which can potentially result in rib fractures and damage to chest organs.

Procedure

The American Heart Association utilizes the letters C-A-B to make it easier for people to recall the proper sequence for performing CPR.

• C: Compressions refer to applying pressure to the person’s chest in a particular way using the hands. The most crucial CPR procedure is compressions.
• A: Airway, after 30 chest compressions have been given by a CPR-trained individual, they should use the head-tilt, chin-lift maneuver to open the patient’s airway. Gently tilt the person’s head back, place the palm on their forehead. To open the airway, gently raise the chin forward with the other hand.
• B: Breathing, if the mouth is significantly wounded or unable to be opened, rescue breathing may be performed mouth-to-mouth or mouth-to-nose. According to current standards, rescue breathing should be performed while wearing a bag-mask with a high-efficiency particulate air (HEPA) filter.

Before the procedure

Before initiating CPR, follow these steps:

• Ensure the safety of the surrounding area.
• Gently tap or shake the person’s shoulder and loudly ask, “Are you okay?”
• If there is no response and you have assistance available, instruct one person to call the local emergency number and retrieve the Automated External Defibrillator (AED), if available. Have the other person begin CPR.
• While the person is lying on their back, tilt their head back gently.
• Listen for 10 seconds to check if the person is breathing.
• Observe for signs of breathing or movement in their chest.
• Assess for a pulse by placing your fingers on the side of their neck.
• If no pulse is detected, proceed with CPR.
• If an AED becomes available, administer one shock if directed by the device, and then resume CPR.

During the procedure

In the event that someone is not breathing, follow these steps to perform CPR:

• Position your hands one on top of the other in the center of the person’s chest, just below their nipples.
• Apply downward pressure with your body weight, keeping your arms straight. Use the heel of your hand or the area just before your wrist to exert pressure.
  Administer chest compressions at a rate of 100 to 120 compressions per minute, ensuring that each compression pushes the chest down by approximately 2 inches. Allow the chest to fully recoil between compressions.
• If you have CPR training, pause after every 30 compressions to provide two mouth-to-mouth rescue breaths, taking about 20 seconds to do so.
• Continue the cycle of chest compressions and rescue breaths until the person regains consciousness or until additional help arrives.

To provide rescue breaths, follow these steps:

• Pinch the person’s nose closed
• Slightly tilt their head back and lift their chin to open the airway.
• Form a seal by placing your mouth over theirs and gently blow to inflate their chest. Ensure that the person’s chest rises with each breath. Check for any obstructions in their mouth if the chest does not rise.
• Administer a total of two rescue breaths, then return to performing chest compressions.

During CPR, if available, have someone retrieve an Automated External Defibrillator (AED) to assist in the resuscitation process.

It’s important to note that even without formal CPR training, you can perform “hands-only CPR” on a teenager or adult in cardiac arrest. Call your local emergency number and perform chest compressions until professional help arrives. Hands-only CPR helps distribute the oxygen already present in the person’s body and can be a life-saving measure.

If you need to perform CPR on an infant as a single rescuer, use one hand to gently tilt their head back for proper rescue breaths and use two fingers from your other hand to perform chest compressions, pressing to approximately a third or half the depth of their chest. The number of compressions and breaths is the same as for adults.

For a two-person rescue team, one person provides rescue breaths while the other uses a two-thumb method for chest compressions, placing both thumbs in the center of the infant’s chest (below the nipple) with the remaining fingers wrapped around the sides of the infant. Use the same compression and breath ratios as for adults.

After the procedure

Once first responders assume responsibility for the individual receiving CPR, they will swiftly transport them to a hospital. In the event of survival, healthcare professionals will assess for potential organ damage resulting from oxygen deprivation. Furthermore, they will work to identify the underlying cause of the cardiac arrest and administer appropriate treatments. Following successful resuscitation, it’s important to note that a significant number of individuals may enter a coma, with roughly half eventually regaining consciousness.

Outcome

Recovery from mild memory, learning, and concentration issues in individuals who survive cardiac arrest and emerge from a coma can often span several months. Following a cardiac arrest incident, regular follow-up appointments with your healthcare provider are essential, and the timing of these appointments will be tailored to your specific condition. It’s crucial to reach out to your healthcare provider promptly if your recovery progress is not as expected or if you develop new symptoms during your rehabilitation journey.