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CPR in
basic life support. Figure A: The victim should be flat
on his back and his mouth should be checked for debris.
Figure B: If the victim is unconscious,
open
airway, lift neck, and tilt head back. Figure C: If
victim is not breathing, begin artificial breathing with
4 quick full breaths. Figure D: Check for carotid pulse.
Figure E: If pulse is absent, begin artificial
circulation by depressing sternum. Figure F:
Mouth-to-mouth resuscitation of an infant.
Cardiopulmonary
resuscitation (CPR) is a procedure to support and
maintain breathing and circulation on a person who has
stopped breathing (respiratory arrest) and/or whose
heart has stopped (cardiac arrest).
CPR is performed to
restore and maintain breathing and circulation and to
provide oxygen and blood flow to the heart, brain, and
other vital organs. It should be performed if a person
is unconscious and not breathing. Respiratory and
cardiac arrest can be caused by allergic reactions, an
ineffective heartbeat, asphyxiation, breathing passages
that are blocked, choking, drowning, drug reactions or
overdoses, electric shock, exposure to cold, severe
shock, or trauma. CPR can be performed by trained
bystanders or healthcare professionals on infants,
children, and adults. It should always be performed by
the person on the scene who is most experienced in CPR.
CPR is part of the
emergency cardiac care system designed to save lives.
Many deaths can be prevented by prompt recognition of
the problem and notification of the emergency medical
system (EMS), followed by early CPR, defibrillation
(which delivers a brief electric shock to the heart in
attempt to get the heart to beat normally), and advanced
cardiac life support measures.
CPR must be performed
within 4-6 minutes of when breathing stopped to prevent
brain damage or death. It is a two-part procedure that
involves rescue breathing and external chest
compressions. To provide oxygen to the person's lungs,
the rescuer administers mouth-to-mouth breaths, then
helps circulate the blood through the heart to vital
organs by external chest compressions. Mouth-to-mouth
breathing and external chest compression should be
performed together, but if the rescuer isn't strong
enough to do both, the external chest compressions
should be done. This is more effective than no
resuscitation attempt, as is CPR that is performed
"poorly."
When performed by a
bystander, CPR is designed to support and maintain
breathing and circulation until emergency medical
personnel arrive and take over. When performed by
healthcare personnel, it is used in conjunction with
other basic and advanced life support measures.
According to the
American Heart Association, early CPR and defibrillation
combined with early advanced emergency care can increase
survival rates for people with a type of abnormal heart
beat called ventricular fibrillation by as much as 40%.
CPR by bystanders may prolong life during deadly
ventricular fibrillation, giving emergency medical
service personnel time to arrive.
It must be appreciated,
however, that most CPR attempts are not ultimately
successful in restoring the victim to a good quality of
life. Often, there is brain damage even if the heart
starts beating again. CPR is therefore not generally
recommended for the chronically or terminally ill or
frail elderly. For these people, it is traumatic and not
a peaceful end of life.
Each year, CPR helps
save thousands of lives in the United States. More than
five million Americans receive training in CPR through
American Heart Association and American Red Cross
courses annually. In addition to courses taught by
instructors, the American Heart Association also has an
interactive video called Learning System, which is
available at more than 500 healthcare institutions. Both
organizations teach CPR the same way, but use different
terms. They recommend that family members or other
people who live with patients who are at risk for
respiratory or cardiac arrest be trained in CPR. A
hand-held device called CPR Prompt is available to walk
people trained in CPR through the procedure, using
American Heart Association guidelines. CPR has been
practiced for more than 40 years.
The basic procedure for
CPR is the same for adults, infants, and children, with
a few modifications for infants and children to account
for their smaller size.
The first
step is to call the emergency medical system for help by
telephoning 911; then CPR can begin, following these
steps:
The rescuer opens the
person's airway by placing the head face up, with the
forehead tilted back and the chin lifted. The rescuer
checks again for breathing (three to five seconds), then
begins rescue breathing (mouth-to-mouth artificial
respiration). He pinches the person's nostrils shut
while holding the chin in the other hand. The rescuer
places his mouth against the person's mouth with the
lips making a tight seal, then gently exhales for about
one to one and a half seconds. The rescuer breaks away
for an instant and then repeats. The preson's head is
repositioned after each mouth-to-mouth breath.
After two breaths, the
rescuer checks the person's pulse by moving the hand
that was under the person's chin to the artery in the
neck (carotid artery). If the person has a heartbeat,
the rescuer continues rescue breathing until the help
arrives or the person begins breathing on his or her
own. If the person is breathing, the rescuer turns the
person onto his or her side.
If there is no
heartbeat, the rescuer performs chest compressions. The
rescuer kneels next to the person, placing the heel of
one hand in the spot on the lower chest where the two
halves of the rib cage come together. The rescuer puts
his other hand on top of the one on the chest and
interlocks the fingers. He straightens his arms, leans
forward to position the shoulders directly above the
hands on the person's chest, and presses down, using
only the palms, so that the person's breastbone sinks in
about 1½-2 in. The rescuer releases without removing the
hands, then repeats about 15 times in 10-15 seconds.
The rescuer tilts the
person's head and returns to rescue breathing for one or
two quick breaths. Then he alternates breathing and
heart presses for one minute, and checks for a pulse. If
the rescuer finds signs of a heartbeat and breathing,
CPR is stopped. If the person is breathing but has no
pulse the heart press is continued; if the person has a
pulse but is not breathing, rescue breathing is
continued.
For children over the
age of eight, the rescuer performs CPR the same as on an
adult.
The procedures outlined
above are followed with these differences:
The rescuer
administers CPR for one minute, then calls for help.
The rescuer makes a
seal around the infant/child's mouth (and nose with
infants) to give gentle breaths. The rescuer delivers
20 rescue breaths per minute, taking 1½-2 seconds for
each breath.
Chest compressions
are given with only one hand for a child and with two
or three fingers for an infant. The breastbone is
depressed only 1-1½ in for a child and ½-1 in for an
infant, the rescuer gives at least 100 chest
compressions per minute.
Some new ways of
performing CPR have been tried. Active
compression-decompression resuscitation, abdominal
compression done in between chest compressions, and
chest compression using a pneumatic vest have all been
tested but none are currently recommended for routine
use.
The active compression-decompression device was
developed to improve blood flow from the heart, but
clinical studies have found no significant difference in
survival between standard and active
compression-decompression CPR.
Interposed abdominal counterpulsation, which requires
two or more rescuers, one compressing the chest and the
other compressing the abdomen, was developed to improve
pressure and therefore blood flow. It has been shown in
a small study to improve survival but more data is
needed. Using a pneumatic vest, which circles the chest
of the patient and compresses it, increases pressure
within the chest during external chest compression. It
has been shown to improve survival in a preliminary
study. More data is necessary.
If
a person suddenly becomes unconscious, the rescuer
should call out for help from other bystanders, and then
determine if the person is responsive by shaking him or
her gently on the shoulder and asking, loudly, if they
are okay. Upon receiving no answer, the rescuer should
call the emergency medical system.
The rescuer should check to see whether the person is
breathing by kneeling near the person's shoulders,
looking at the person's chest, and placing his cheek
next to the person's mouth. The rescuer should look for
signs of breathing in the chest and abdomen, and listen
and feel for signs of breathing through the person's
lips. If no signs of breathing are present after three
to five seconds, CPR should be started.
Emergency medical care
is always necessary after successful CPR. Once the
person's breathing and heartbeat have been restored, the
rescuer should make him or her comfortable and stay
there until emergency medical personnel arrive. The
resucer can continue to reassure the person that help is
coming and talk positively until the professionals
arrive and take over.
