Cardiopulmonary
Resuscitation (CPR)
What is CPR?
CPR stands for Cardiopulmonary Resuscitation. CPR is a life
saving rescue technique provided to someone whose heart suddenly stops beating
and not breathing (cardiopulmonary arrest).
CPR is a set of assessments and skills used in sequence to
provide rescue support and maintain oxygen and blood flow to the heart and
brain in the absence of spontaneous
breathing and circulation. CPR skills include a combination of Chest Compressions and Rescue Breathing.
Cardio means
heart.
Pulmonary means
lungs.
Resuscitation
means to revive.
Importance of CPR
Immediate CPR can make a significant difference in many
emergency life-threatening situations. Through CPR, “sudden cardiac arrest”
(the heart suddenly stops functioning as an effective pump) can be reversed.
Common causes of sudden cardiac arrest include heart attack (the most common
cause), stroke, airway obstruction, drug overdose, electric shock and severe
allergic reactions.
Time is Critical
The first few minutes are critical for someone whose
breathing and heartbeat that has stopped. After
4 – 6 minutes, the brain cells begin to die and by 10 minutes, all the brain
cells are dead. This condition is permanent
and irreversible because brain cells are dead. If you begin CPR within the
first four minutes, brain cells will be kept alive with continuous supply of
oxygen. Continue CPR until additional treatment (defibrillation) restores
normal heart action or until emergency medical personnel arrive.
Anatomy and Function
of The Normal Heart and Lungs
The heart is a hollow muscular organ that acts as a pump to
continually circulate blood through the lungs and the body. It is about the
size of a clenched fist, located in the centre of the chest behind the
breastbone (sternum) and in front the spine.
Location of the Heart
Coronary Arteries of
the Heart
All muscle, including the heart muscle, requires blood
supply with oxygen to perform their functions.
Arteries carry blood away from the heart; veins carry blood
towards the heart. The coronary arteries are special arteries that supply blood
to keep the heart muscle healthy in order to function effectively.
The heart works as a pump. It pumps blood that contains
oxygen from the lungs to the rest of our body. When the heart stops (cardiac
arrest), oxygen is not being circulated in the body, thus the oxygen that
stored in the brain and other vital organs is depleted very fast.
The Chain of Survival
The AHA Adult Chain of Survival symbol depicts the critical
actions required to treat life-threatening emergencies, including heart attack,
stroke, cardiac arrest and choking.
The 4 crucial links
or actions in the chain of survival are:
1. Early
Access
2. Early CPR
3. Early
Defibrillation
4. Early
Advanced Care
Early Early Early Early
Access CPR Defibrillation Advanced Care
Each set of actions or link in the Chain of Survival must be
performed as soon as possible. If any link in the chain is weak, delayed or
missing, the chance of survival is lessened. The 4 links in the Chain of
Survival are discussed below:
First Link: Early
Access to Help
You must know when to activate the Chain or Survival. You
must recognize when an emergency exists. Anyone who is unresponsive should
receive emergency care. Call for help early by paging for medical personnel;
bring medical equipment such as AED, Air-Viva and Oxygen Cylinder to the
victim. All victims who suddenly become unresponsive will benefit from
activation of the Chain of Survival. You perform the actions or links that
increase a victim’s chance of survival.
Second Link: Early
CPR
CPR is the critical link that buys time between the first
link (early access) and third link (early defibrillation). CPR alone is not
enough to save lives in most cardiac and respiratory emergencies. CPR allows
oxygen to flow to the brain and heart until defibrillation or other advanced
care can restore normal heart action. The earlier you give CPR to a person in
cardiac or respiratory arrest, the greater the victim’s chance of survival.
Third Link: Early
Defibrillation.
Many adult victims of sudden cardiac arrest have Ventricular Fibrillation (VF). VF is an
abnormal, chaotic heart rhythm that prevents the heart from pumping blood. The
only treatment for VF is defibrillation. Defibrillation
is delivery of an electrical shock that stops VF and allows a normal heart
rhythm to resume.
When VF is present, prompt defibrillation will increase the
victim’s chance of survival. With each minute that defibrillation is delayed
during cardiac arrest caused by VF, the victim’s chance of survival is reduced
by 7% to 10%. After 10-20 minutes of cardiac arrest, there is very little
chance of a successful rescue unless CPR has been provided. CPR prolongs the
time that defibrillation can be effective and you must provide CPR until
defibrillator arrives.
Fourth Link: Early
Advanced Care
The fourth link in the Chain of Survival is advanced care.
Highly trained EMS personnel or paramedics also provide CPR and defibrillation
a well as more advanced care, such as use of cardiac drugs, airway control and
breathing tubes. These advanced actions help the heart in VF to respond to
defibrillation or maintain a normal rhythm after successful defibrillation.
When to Start CPR?
CPR should be started immediately on victim who has a sudden
cardiac arrest or cardiopulmonary arrest with these signs present:
Unresponsiveness
No Breathing
No Circulation
Performing CPR – The
Assessment and Skills Steps of CPR
The skills could be acquired easily with proper training and
practice. In all emergencies, a first aider should observe the following
principles to ensure a systematic approach. To help us remember the steps, use
this simple mnemonic: DRABC.
Adult CPR (Age 8
years and above)
Danger – Scene
Safety and Personal protection)
Ensure no danger at the scene to yourself and the victim.
Observe universal precautions by using protective equipment
e.g.: wear gloves and use Air-Viva Resuscitator.
Response –
Check for Responsiveness
Shake victim’s shoulders and call out “Are You OK? Are You
Alright?”
If victim is
unresponsive: Call for help immediately!
Airway –
Open the airway
In an unresponsive victim, the tongue is relaxed and often
falls back to the throat and closes the airway. Therefore in an unresponsive or
unconscious victim, the closed airway must be opened.
If you find the victim lying face down, turn him over.
Support victim’s head and neck, rolling him towards you. For CPR to be
effective, the victim must be flat on his back on a firm surface.
Open the airway with the head tilt-chin lift or Jaw-thrust
technique (if suspected of having neck or spinal injury).
Breathing (10
seconds)
To check for breathing, maintain head tilt chin lift, look,
listen and feel for no more than 10
seconds to determine if the victim is breathing normally.
If victim is not
breathing normally, give 2 slow rescue breaths.
Give 2 slow rescue breaths (take 1 second for each breath).
Be sure the victim’s chest rises each time you give a rescue breath and allow
the lungs to deflate between breaths. Use CPR barrier device to provide rescue
breathing when it is available.
If the chest does not rise when you give the first rescue
breath, reopen the airway or reposition the victim’s head and try to give the 2
rescue breaths again.
After you deliver the 2 slow rescue breaths, look for signs
of circulation such as: normal
breathing, coughing or movement in response to the 2 slow rescue breaths.
Do not take more than
10 seconds to check for signs of circulation.
Look, listen and feel for breathing while scanning the
victim for signs of movement. The victim may start breathing normally, coughing
or moving.
If the victim has all the signs of circulation, CPR is not
required.
If the victim is not breathing normally but has other signs
of circulation,, continue to give rescue breaths (1 breath every 5 seconds).
If no signs of
circulation are present, begin CPR starting with chest compressions followed by
rescue breathing.
Child CPR (1 to 8
years)
CPR performed for children is similar to CPR for adults
except for some differences:
Do the DRABC of CPR
for Child
- Open airway gently suing head tilt-chin lift or jaw thrust technique. Do not tilt the head too for back.
- Check for signs of circulation (10 seconds).
- After giving the 2 slow rescue breaths, check for signs of
circulation such as normal breathing,
coughing or movement.
- If there are no signs of circulation, begin chest compressions.
Place the heel of
one hand in the center of the chest (right between the nipples), on the
lower sternum. Maintain head tilt with your other hand on the child’s forehead
to keep the airway open.
- Give 30 chest compressions followed by 2 slow rescue breaths (1 second for each breath).
- Depress the lower sternum: 1 -1½ inches.
- Provide chest compression at a rate of 100 compressions per minute.
- Repeat cycles of 30 chest compression and 2 rescue breaths (30:2) for 2 minutes or 5 cycles.
If no signs of circulation,
continue CPR cycles, beginning with chest compressions.
If the child is not breathing
normally but has other signs of circulation present such as coughing or
movement, you must continue to gibe rescue breathing (1 breath every 3 seconds or 20 breaths per minute). Monitor for
signs of circulation every minute.
- If the child begins breathing normally, administer oxygen and place in the recovery position. Monitor and record the vital signs closely.
CPR in infants must be performed
with special consideration for size and vulnerabilities. For this reason,
infants require several differences in techniques when performing CPR.
- Do the DRABC of CPR for infant. Open airway using head tilt-chin lift. Take care not to tilt the head too far back.
Look, listen and feel for breathing
(10 seconds)
If infant is not breathing normally,
give 2 slow rescue breaths (1 second
for each breath). Make a tight seal around the infant’s mouth and nose; deliver
breaths slowly and gently through puff of air from your cheeks.
Check for signs of circulation (10 seconds)
After giving the 2 slow rescue breaths, check for signs of
circulation such as normal breathing, coughing or movement.
If no signs of circulation, begin chest compressions.
Imagine a line drawn between the infant’s nipples. Place 3
fingers of one hand (index, middle and ring fingers) on the infant’s sternum or
center of the chest. The index finger is next to the imaginary nipple line;
lift up the index finger off the chest. Use 2 fingers (middle and ring fingers) to apply the chest compressions
at about 1 finger’s width below the
nipples line. Do not press over the very bottom of the sternum (the
xiphoid). Maintain head tilt with your other hand.
- Give 30 chest compressions followed by 2 slow breaths (1 second for each breath).
- Depth of compressions: ½ - 1 inch.
- Provide compression at a rate of at least 100 compressions per minute.
- Repeat cycles of 30 chest compression and 2 rescue breaths (30:2) for 2 minutes or 5 cycles.
Recheck for signs of circulation after about 1 minute of
CPR.
If the child is not breathing normally but has other signs
of circulation present such as coughing or movement, you must continue to give
rescue breathing (1 breath every 3
seconds or 20 breaths per minute). Monitor for signs of circulation every
minute.
If the infant begins breathing normally, give oxygen and
place in recovery position. Monitor and record the vital signs closely.
Summary Table for CPR
Adult
|
Child
(1 – 8 years)
|
Infant
(0 – 12 months)
|
|||
Ratio of Chest
Compressions to
Rescue Breathing
|
30:2
|
30:2
|
30:2
|
||
No. Of CPR
Cycles
over 2 Minutes
|
5
|
5
|
5
|
||
Depth of
Compressions
|
1½” – 2”
|
1” - 1½”
|
½” – 1”
|
||
Compression rate
(refer to speed of
Compressions)
|
100 compression per minute
|
||||
Location of Chest Compression
|
Lower Sternum
|
1 finger’s width below
nipples line
|
|||
Compression to be performed with
|
Two Heels of
hand
|
Heel of one
Hand
|
2 fingers
|
||
Rescue Breathing
Only
|
Once every 5 seconds or 12 breaths per minute
|
Once every 3 seconds
or 20 breaths per minute
|
|||
Note: The above ratio applies to one and two rescuers
for all victims.
When to Stop CPR
- The general guidelines for stopping CPR are when:
- Effective spontaneous breathing and circulation is restored.
- The victim is transferred to property trained EMS personnel.
- A physician or doctor assumes responsibility for the victim.
- You are too exhausted to continue resuscitation; environmental hazards endanger your safety.
Apparent Death
Only a qualified Medical Doctor (M.D); can pronounce a
person “dead”. Should you suspect a person has died during, you shall treat
this as a medical emergency. You are to commence CPR until medical assistance
is obtained.
Some Possible Hazards or Common Errors of CPR
Incorrect performance of CPR can bring about injuries to
victims or decrease the effectiveness of CPR. These are as follow:-
- Incorrect hand position for chest compression may lead to rib fractures, xiphoid fractures, and bruising or bleeding of the liver, lungs or spleen.
- Compressing the chest too deeply may cause internal organ injury.
- Provide rescue breathing too rapidly or too forcefully can cause gastric distention (air in the stomach) and lead to vomiting and decrease the effectiveness of CPR.
- Failing to compress the sternum deeply enough which results in inadequate blood flow to the brain and other vital organs.