Cardio Pulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example agonal respirations. It may be performed both in and outside of a hospital.

CPR involves chest compressions at least 5 cm deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart. In addition, the rescuer may provide breaths by either exhaling into the subject's mouth or utilizing a device that pushes air into the subject's lungs. This process of externally providing ventilation is termed artificial respiration. Current recommendations place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.

CPR alone is unlikely to restart the heart; its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is only effective for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm which may be shockable. CPR is generally continued until the subject regains return of spontaneous circulation (ROSC) or is declared dead.

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In adults, major reasons that heartbeat and breathing stop include: Drug overdose. Excessive bleeding. Heart problem (heart attack or abnormal heart rhythm, fluid in the lungs or compressing the heart).

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. CPR can be performed by trained laypeople or healthcare professionals on infants, children, adolescents, and adults. CPR should be performed if an infant, child, or adolescent 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. In newborns, the most common cause of cardiopulmonary arrest is respiratory failure caused by sudden infant death syndrome (SIDS), airway obstruction (usually from inhalation of a foreign body), sepsis, neurologic disease, or drowning. Cardiac arrest in children over one year of age is most commonly caused by shock and/or respiratory failure resulting from an accident or injury.

CPR can cause injury to a person's ribs, liver, lungs, and heart. However, these risks must be accepted if CPR is necessary to save the person's life.

CPR should be done if a person has any of the following symptoms:

  • No breathing or difficulty breathing (gasping)
  • No pulse.
  • Unconsciousness.

For an unconscious, CPR is initiated as follows:

  • Give 30 chest compressions.
  • Perform the head-tilt chin-lift maneuver to open the airway and determine if the patient is breathing.
  • Before beginning ventilations, look in the patient's mouth for a foreign body blocking the airway.

CPR is a way to treat someone when they stop breathing or their heart stops beating.

If a person stops breathing, call your local emergency services or ask someone else to. Before beginning CPR, ask loudly, “Are you OK?” If the person doesn’t respond, begin CPR.

  1. Lay the person on their back on a firm surface.
  2. Kneel next to their neck and shoulders.
  3. Place the heel of your hand over the center of their chest. Put your other hand directly over the first one and interlace your fingers. Make sure that your elbows are straight and move your shoulders up above your hands.
  4. Using your upper body weight, push straight down on their chest at least 1.5 inches for children or 2 inches for adults. Then release the pressure.
  5. Repeat this procedure again up to 100 times per minute. These are called chest compressions.

To minimize potential injuries, only those trained in CPR should perform rescue breathing. If you haven’t been trained, perform chest compressions until medical help arrives.

If you’re trained in CPR, tilt the person’s head back and lift the chin to open up the airway.

  1. Pinch the person’s nose closed and cover their mouth with yours, creating an airtight seal.
  2. Give two one-second breaths and watch for their chest to rise.
  3. Continue alternating between compressions and breaths — 30 compressions and two breaths — until help arrives or there are signs of movement.

If unconsciousness is due to low blood pressure, a doctor will administer medication by injection to increase blood pressure. If low blood sugar level is the cause, the unconscious person may need something sweet to eat or a glucose injection.

Medical staff should treat any injuries that caused the person to become unconscious.

Prevention of cardiac arrest is the first link in the Chain of Survival. This section of the Resuscitation Council (UK) guidelines stresses the importance of preventing cardiac arrest in all age groups, and the decision-making process when cardiopulmonary resuscitation (CPR) is inappropriate.

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