Resuscitation and CPR:

Description:

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with mouth-to-mouth ventilation or chest compression only. It is an effort to manually preserve intact heart and brain function in a person who is in cardiac arrest until further measures are taken to restore spontaneous blood circulation and breathing.

 

Sign & Symptoms:

It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations. Treatment: In accordance with International Liaison Committee on Resuscitation guidelines (ILCOR) CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. The rescuer may also provide ventilation by either mouth-to-mouth resuscitation or using a face mask that, if used correctly, pushes air into the patient’s lungs.

 

Current recommendations place emphasis on high-quality chest compressions over ventilation; a simplified CPR method involving chest compressions only is recommended for untrained rescuers or anyone unwilling to perform mouth-to-mouth ventilation. Mouth-to-mouth and chest compressions is the ‘gold standard’ treatment.

 

In children only doing compressions may result in worse outcomes.

 

More information on defibrillation

CPR’s main purpose is to restore partial flow of oxygenated blood to the heart and brain. 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 beating heart rhythm.

 

Defibrillation is effective only 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 that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.

 

Simple overview of CPR

CPR is indicated for any person unresponsive, not breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest. Resuscitation Council (UK) 2015 guidelines recommend that laypersons should not check for a pulse.

 

Effectiveness

CPR serves as the foundation of resuscitation, preserving the body for defibrillation and advanced life support. CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.

 

Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden (VF) cardiac arrest dramatically improves survival.

 

Compression Ratio

Compression to ventilation ratio of 30:2 is recommended. With children if untrained 30:2. Recommended minimum compression depth in adults (5-6cm), and children is at least 5 cm (2 inches) and in infants it is 4 centimetres (1.6 in). In adults, rescuers should use two hands for the chest compressions, while in children they should use one, and with infants two fingers (index and middle fingers). (The depth is extremely important).

 

Compression only

Compression-only (hands-only resuscitation) CPR is a technique that involves chest compressions without mouth-to-mouth ventilation. It is recommended as the method of choice for the untrained rescuer or those who are not proficient because it is easier to perform and instructions are easier to give over a phone by the ambulance service dispatcher.

 

It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR.

 

Pregnancy

During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left.

 

Chance of receiving CPR

Effectiveness of CPR is variable, and the studies suggest only around half of bystander CPR is performed correctly. A recent study has shown that members of the public having received CPR training in the past lack the skills and confidence needed to save lives. Experts believe annual training is needed to improve the willingness to respond to cardiac arrest.

 

Type of Arrest Chance / Survival:

  • Out-of-Hospital Cardiac Arrest Overall / 10%
  • Unwitnessed Out-of-Hospital Cardiac Arrest / 4%
  • Witnessed Out-of-Hospital Cardiac Arrest / 15%
  • Witnessed and "Shockable" with Bystander CPR / 37%
  • Bystander Compression-only Resuscitation / 13%

 

Resuscitation Council (UK) 2015

Recommends the following:

  • All school children should be taught CPR and how to use a defibrillator.
  • All Adults who are able should be taught CPR.

 

There is a clear correlation between age and the chance of CPR being commenced. Younger people are far more likely to have CPR attempted on them before the arrival of emergency medical services. It was also found that bystanders more commonly administer CPR when in public than when at the patient's home, although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts.

 

There is also a clear correlation between cause of arrest and the likelihood of a bystander initiating CPR. Laypersons are most likely to give CPR to younger cardiac arrest victims in a public place.

 

Chance of receiving CPR in time

CPR is likely to be effective only if commenced within 6 minutes after the blood flow stops because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4–6 minutes in an oxygen deprived environment.

 

 

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