Bringing The Dying Back To Life by Cardiopulmonary Resuscitation

CARDIOPULMONARY RESUSCITATION
                          (CPR)

Cardiopulmonary resuscitation, commonly known as CPR,is an emergency procedure 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 who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

Cardiopulmonary resuscitation (CPR) is a combination of techniques, including chest compressions, designed to pump the heart to get blood circulating and deliver oxygen to the brain until definitive treatment can stimulate the heart to start working again.

INDICATIONS
● Any person who has become unconscious and is found to be pulseless
● Cardiac arrest
● Ventricular fibrillation (VF)
● Pulseless ventricular tachycardia (VT)
● Pulseless electrical activity (PEA)
● Asystole
● Pulseless bradycardia

EQUIPMENTS/REQUIREMENTS

CPR, in its most basic form, can be performed anywhere without the need for specialized equipment. Universal precautions (ie, gloves, mask, gown) should be taken. However, CPR is delivered without such protections in the vast majority of patients who are resuscitated in the out-of-hospital setting, and no cases of disease transmission via CPR delivery have been reported.

PROCEDURE
CPR comprises the following 3 steps, performed in order:

● Chest compressions
● Airway
● Breathing

Positioning for CPR is as follows:
● CPR is most easily and effectively performed by laying the patient supine on a relatively hard surface, which allows effective compression of the sternum
● The person giving compressions should be positioned high enough above the patient to achieve sufficient leverage, so that he or she can use body weight to adequately compress the chest

For an unconscious adult, CPR is initiated as follows:
● Give 30 chest compressions
● Place the heel of one hand on the patient’s sternum and the other hand on top of the first, fingers interlaced
● Extend the elbows and the provider leans directly over the patient
● Press down, compressing the chest at least 2 in
● Release the chest and allow it to recoil completely
● The compression depth for adults should be at least 2 inches (instead of up to 2 inches, as in the past)
● The compression rate should be at least 100/min
● After 30 compressions, 2 breaths are given; however, an intubated patient should receive continuous compressions while ventilations are given 8-10 times per minute
● This entire process is repeated until a pulse returns or the patient is transferred to definitive care
● To prevent provider fatigue or injury, new providers should intervene every 2-3 minutes (ie, providers should swap out, giving the chest compressor a rest while another rescuer continues CPR

Ventilation
● If the patient is not breathing, 2 ventilations are given via the provider’s mouth or a bag-valve-mask (BVM). If available, a barrier device (pocket mask or face shield) should be used.
● To perform the BVM or invasive airway technique, the provider does the following:
● Ensure a tight seal between the mask and the patient’s face
● Squeeze the bag with one hand for approximately 1 second, forcing at least 500 mL of air into the patient’s lungs

To perform the mouth-to-mouth technique, the provider does the following:
● Pinch the patient’s nostrils closed to assist with an airtight seal
● Put the mouth completely over the patient’s mouth
● After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
● Give each breath for approximately 1 second with enough force to make the patient’s chest rise
● Failure to observe chest rise indicates an inadequate mouth seal or airway occlusion
● After giving the 2 breaths, resume the CPR cycle.

COMPLICATIONS
● Fractures of ribs or the sternum from chest compression
● Gastric insufflation from artificial respiration using noninvasive ventilation methods (eg, mouth-to-mouth, BVM); this can lead to vomiting, with further airway compromise or aspiration; insertion of an invasive airway prevents this problem.