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Cardiopulmonary resuscitation
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Cardiopulmonary resuscitation

For other meanings of CPR, see CPR (disambiguation).

CPR, or cardiopulmonary resuscitation, is emergency first aid for an unconscious person whose breathing and pulse have stopped.

The medical term for this condition is cardiac arrest or, if the patient still has a pulse, respiratory arrest. The most common cause of treatable cardiac arrest outside of a hospital is a heart attack leading to a heart rhythm disturbance. CPR is also effective for cardiac or respiratory arrest due to drowning, electrocution, drug overdoses and other poisonings.

Without oxygen, the human brain begins to suffer irreversible brain damage after about five minutes. The heart also rapidly loses the ability to maintain a normal rhythm. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation.

For cardiac arrest following a heart attack defibrillation is the most effective treatment. CPR is not usually effective on its own, although as defibrillation is rarely available within four to five minutes of cardiac arrest bystander CPR remains essential. Even if a defibrillator arrives, two to three minutes of CPR before attempting defibrillation improves the victimís outcome [1].

CPR is commonly taught to ordinary people who may be the only ones present in the crucial few minutes before emergency personnel are available.

Table of contents
1 Effectiveness
2 History
3 CPR for an adult patient
4 CPR for children age twelve months to eight years
5 CPR for infants
6 CPR Training
7 Note
8 External links
9 See also

Effectiveness

If you have been trained in CPR, do not assume that it will not be effective. When a victim receives effective CPR within minutes of the collapse, and a defibrillator is used within ten minutes, the survival rate is about a third. You should perform CPR to the best of your ability until a trained medical professional (for example, a paramedic) is available to assess the casualty's condition.

In respiratory arrest, when the victim still has a heartbeat such as in drowning, choking, or drug overdose with opioids or sedatives, the "a"irway and "b"reathing part of CPR is very effective.

CPR is almost never effective if started more than about 15 minutes after collapse because of the permanent brain damage. A notable exception is cardiac arrest occurring with exposure to very cold temperatures. Hypothermia seems to exert a protective effect on the victim. There are cases where CPR, defibrillation and advanced, hospital-based warming techniques have revived hypothermia victims after over 30 minutes.

History

CPR was created by Peter Safar in the 1950s and he wrote the book ABC of resuscitation in 1957. It was first promoted as a technique for the public to learn in the 1970s. Early marketing efforts oversold the effectiveness of CPR in rescuing heart attack and other victims. The standards for CPR, in the United States, are established by the American Heart Association. Rewritten every several years, most recently in 2000, these standards now have a more conservative view of the potential of bystander CPR and stress the importance of rapid defibrillation.

In the United Kingdom, the guidelines for CPR are written by the Resuscitation Council (UK). They are detailed in the current First aid manual (8th ed., Dorling Kindersley, ISBN 0751337048).

CPR for an adult patient

Adult CPR is generally appropriate children over 8 years old. Use child CPR (below) for children smaller than an average 8-year-old.

Although this page describes CPR, it is not possible to truly learn the correct technique from a written description. Experts recommend you get CPR Training from a qualified trainer. You are much more likely to learn and remember the correct technique with practice on a dummy, and assistance from an instructor.

DANGER

Always check that there is no ongoing danger to yourself or the casualty as you approach. Make sure the area is safe before continuing. Poisonous gas or live electric wires could make you the second victim.

RESPONSE

Try to get a response by asking the casualty a question like "can you hear me?" or "what happened?" or issuing a command like "open your eyes!". Tap or firmly squeeze the casualty's shoulders as you speak. If the victim may have injured their neck do not use much force.

If the casualty responds, and the area is safe, leave them in their current position, and summon help if needed.

Shout for help

If there is no response, call for help. Yell "HELP!" to attract the attention of someone who may be nearby.

AIRWAY

If possible, place the victim on their back on a firm surface.

Open the victims' airway by gently tilting their head back with one hand while lifting up their chin with the other hand. In order to get the jaw to move forward, you may need to open their mouth a little to 'unlock' their teeth.

If there is a chance of neck injury, try just lifting up the chin. Tilting the head in the presence of a neck injury has a small risk of damaging the spinal cord. If chin lift alone does not clear the airway, then gently tilt the head back anyway.

Chin lift and head tilt may sometimes be enough to allow the victim to breathe.

It is possible, and sometime necessary, to effectively chin lift and head tilt while the victim is still sitting upright or floating in water.

BREATHING

(also known as "rescue breathing")

Having opened the victim's airway, you need to find out if they are breathing for themselves. Put your cheek close to the victim's nose and mouth while looking at the victim's chest, to look, listen, and feel for breathing. Do this for 10 seconds. Is the victim's chest rising and falling normally*? Listen for normal breathing sounds and feel the air escaping from the victim's nose and mouth against your cheek. Other noises may indicate a possible complication.

If the casualty is breathing, place them on their side (the 
recovery position) and go to get help.

If you cannot see, feel and hear breathing then you need to summon emergency medical help and start mouth to mouth breathing:

Send a bystander to call for help using the emergency telephone number. Tell the bystander something like:

Call for an ambulance. Tell them we're in [your current location] and there is one casualty about [casualty's approximate age] who is not breathing. Come back as soon as you have done that. Is that clear?

If you are in a public place, like a shopping centre or mall, the bystander should alert the security service to bring a public access defibrillator if one is available.

If you are on your own, and the casualty's condition is obviously as a result of injury, drowning, or choking, perform CPR for a minute, then go and get help. For any other adult casualty, go and get help yourself immediately if you find that breathing is absent. When you return to the patient begin this procedure again from opening the airway.

Pinch the casualty's nose closed and breath two full breaths into their mouth. Watch to see if the chest rises as you do this.

(* Normally both the abdomen and the chest rise an fall together. If the abdomen rises while the chest falls and visa versa, this suggests the airway is still obstructed)

Chest not rising?

If breath does not reach the lungs (victims' chest does not rise), probable causes are: If you did not tilt the head tilt because of possible neck injury but the breaths are now not entering the lungs, tilt the head anyway. The victim will certainly die without air in their lungs.

CIRCULATION

Check for signs of circulation such as colour in the skin or movement like coughing or twitching, for no more than 10 seconds.

Return to the victim's chest and put your hands in the correct position again.
Do 15 more compressions, followed by 2 more breaths.
Repeat this cycle of 15 and 2 for a total of 4 times every minute.

Continue until there is: Only stop to recheck for signs of a circulation if the victim moves or breaths.

Common mistakes in performing chest compressions include rocking back and forth and bending the elbows. It is also important to note that, particularly in elderly patients, crepitations will often occur. Crepitations are the shattering of bones in the rib cage and sternum. They can be both heard and felt. Do not discontinue CPR due to crepitations, although check you hand position if bone breakage appears to be excessive.

Experts no longer advise laypersons to assess the carotid pulse because it wastes time and studies have shown it leads to an incorrect conclusion in up to 50% of cases. Health professionals are still advised to perform a carotid pulse check, taking no more than 10 seconds, whilst also checking the other signs of a circulation.

CPR for children age twelve months to eight years

The method of CPR for children is similar to that used for adults, however there are some differences as children have less lung capacity and a somewhat faster respiration rate. Also, compressions should be considerably less forceful than those used on adults.

The sequence of CPR for children is as follows:

DANGER

Firstly, quickly check that there is no danger to yourself or the casualty. Make sure the area is safe before continuing.

RESPONSE

The response is checked in the same way as for an adult patient, as described above.

You must quickly determine if injury is present and determine consciousness. If head, neck, or spinal injury is suspected, great care must be exercised in positioning the child on her back on a firm flat surface. Turn and position the child, supporting the head and neck to avoid spinal cord injury caused by rolling, twisting, or tilting the head and neck.

A conscious child struggling to breathe will often find the best position to keep a partially obstructed airway open and should be allowed to maintain that position until medical help is available. If the young victim is unresponsive, position the child or infant on the back on a firm, flat surface and begin CPR.

Shout for help

If the child is unresponsive, shout for help, as described above for adult CPR.

AIRWAY

If you are certain the child has not suffered a spinal injury, place your hand on the child's forehead and gently tilt the head slightly backward to open the airway.

Augment the head tilt by placing 1 or 2 fingers from the other hand under the chin and gently lifting upward. Note that when opening the airway, a child's head should not be tilted as far back as you would an adult's.

BREATHING

While maintaining an open airway place your ear near the child's mouth and listen for breathing, look at the chest and abdomen for movement, and feel for air flow from the mouth. If the victim is breathing, maintain the airway by placing the child in the recovery position.

If no breathing is detected, and you have a bystander, send them for help (as described for an adult patient, above). If breathing is absent and you are on your own, conduct one minute of CPR as described below, then go and call for an ambulance. When you return begin CPR again, starting by opening the child's airway.

Give two effective resuce breaths, in the same manner as you would for an adult. However, remember that an infant will need much less air than a larger child or an adult would. A proper amount of air will move the chest up and down between breaths. A slow, deliberate delivery will reduce the likelihood of forcing air into the stomach, causing distention.

Rescue breathing is the single most important maneuver in rescuing a nonbreathing child or infant. If repeated rescue breathing attempts do not result in airflow into the lungs, evidenced by chest movement, a foreign body obstruction should be suspected.

CIRCULATION

As discussed in the section on adult CPR, either check for circulation by checking a pulse or alternatively by checking for obvious signs of life, according to your training. In children over 1 year the pulse can be felt at the side of the neck. To check the pulse: while maintaining the head tilt with one hand, find the windpipe at the level of the Adam's apple with two fingers of the other hand. Slide the fingers into the groove between the windpipe and neck muscles, as for adults.

If circulation is present but there is no breathing, initiate and continue rescue breathing about 20 times a minute (1 breath every 3 seconds) for a child.

If circulation is absent, proceed with chest compression and rescue breathing as follows.

The child must be on her back on a firm surface such as the floor.

If the child is over 1 year of age, compression is applied to the breastbone by the heel of one hand, located in the midline, 2 fingers'-breadth above the tip of the breastbone (just below the imaginary line between the two nipples). With one hand, the chest is compressed to about one third of the depth of the chest (the exact distance depends on the size of the child) at a rate at about 100 compressions per minute, as for an adult. Compression and relaxation time should be equal and the rhythm smooth and even. The fingers must be kept off the chest.

External compression should be accompanied by rescue breathing in a 5:1 ratio of compressions to ventilation breaths for an infant or child. (Note that this is different to the procedure for adults). Continue compression and rescue breathing until the child's condition changes, help arrives, or you become too exhausted to continue.

While the 5:1 ratio has been used in the U.S. for decades "because oxygen is more important for children," a March 2002 study by Norwegian Air Ambulance recommends that children and infants receive the same 15:2 ratio as adults, because the 5:1 approach provides exactly the same number of breaths per minute in actual practice, but fewer chest compressions, as a substantial amount of time is lost due to switching positions.

CPR for infants

Infants under twelve months of age have significantly higher pulse and respiration rates than adults. CPR must be modified significantly to account for the differences.

Tilting the head and lifting the chin will not work in infants, as they have little or no neck. The infant should be cradled in the dominant arm, with the head resting in the rescuer's palm. As in children, the compression/respiration ratio should be 5:1, not 15:2 as in adults.

Respirations are easiest if performed with the mouth covering the entire nose and mouth, given in short puffs of air and not full exhalations. Chest compressions should be delivered at a rate of at least one hundred per minute using two fingers on the sternum at the nipple line, with a compression depth of half an inch to an inch depending on the size of the child.

CPR Training

CPR training is available through the American Red Cross as well as many other volunteer and governmental organizations worldwide.

CPR is a practical skill and needs to be regularly practiced on a resuscitation manikin to ensure full competency. Where knowledge of CPR is a job requirement, six monthly refresher courses are recommended.

CPR training should not be confined to just the medical professionals. Almost anyone is able to perform CPR and there are numerous reports of where CPR used by people first on the scene has saves a life.

Note

Continue CPR until help arrives or your life is placed in danger by continuing to perform CPR.

See also wilderness first aid for situations where it may be impossible to continue CPR and guidelines for how to proceed in such a situation.

Also note that it may be inappropriate to perform CPR in a disaster or triage situation with mass casualties.

External links

See also