CARDIOPULMONARY RESUSCITATION (CPR)

Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest. CPR traditionally has integrated chest compressions and rescue breathing with the goal of optimizing circulation and oxygenation.

Building blocks of CPR

Multi-rescuer coordinated CPR
Team work Rescue breaths 30:2 CPR

Chest compressions

Hands-only CPR

The Change From A-B-C to C-A-B

The newest development in the 2010 AHA Guidelines for CPR and ECC is a change in the basic life support (BLS) sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing) for adults and pediatric patients (children and infants, excluding newly borns).

Reasons:

The vast majority of cardiac arrests occur in adults, and the highest survival rates from cardiac arrest are reported among patients of all ages with witnessed arrest and a rhythm of VF or pulseless ventricular tachycardia (VT) In the A-B-C sequence chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths or retrieves a barrier device or other ventilation equipment.

Fewer than 50% of persons in cardiac arrest receive bystander CPR. It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest

BLS- basic life support

is the foundation for saving lives following cardiac arrest. Fundamental aspects of adult BLS include immediate recognition of sudden cardiac arrest andactivation of the emergency response system, early performance of high-quality CPR, and rapid defibrillation when appropriate.

changes in AHA guidelines 2010 for CPR and ECC

The BLS algorithm has been simplified, and Look, Listen and Feel has been removed from the algorithm. Encourage Hands-Only (compression only) CPR for the untrained lay rescuer. There is an increased focus on methods to ensure that high-quality CPR is performed.

Many tasks performed by healthcare providers during resuscitation attempts, such as chest compressions, airway management, rescue breathing, rhythm detection, shock delivery, and drug administration (if appropriate), can be performed concurrently by an integrated team of highly trained rescuers in appropriate settings.

CPR techniques
High-Frequency Chest Compressions Open-Chest CPR Interposed Abdominal Compression-CPR Cough CPR Prone CPR Precordial Thump Percussion Pacing

Chain of Survival

Chain of Survival. The links in this Chain are: Immediate recognition and activation, early CPR, rapid defibrillation, effective advanced life support and integrated post-cardiac arrest care. The links include the following: Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated postcardiac arrest care

When encountering a victim of sudden adult cardiac arrest, the lone rescuer must first recognize that the victim has experienced a cardiac arrest, based on unresponsiveness and lack of normal breathing. After recognition, the rescuer should immediately activate the emergency response system, get an AED/defibrillator, if available, and start CPR with chest compressions. If an AED is not close by, the rescuer should proceed directly to CPR. If other rescuers are present, the first rescuer should direct them to activate the emergency response system and get the AED/defibrillator; the first rescuer should start CPR immediately. When the AED/defibrillator arrives, apply the pads, if possible, without interrupting chest compressions and turn the AED on. The AED will analyze the rhythm and direct the rescuer either to provide a shock (ie, attempt defibrillation) or to continue CPR.

Rescuers should focus on delivering high-quality CPR: providing chest compressions of adequate rate (at least 100/minute) providing chest compressions of adequate depth
adults: a compression depth of at least 2 inches (5 cm) infants and children: a depth of least one third the anterior-posterior (AP) diameter of the chest or about 1 inches (4 cm) in infants and about 2 inches (5 cm) in children

allowing complete chest recoil after each compression minimizing interruptions in compressions avoiding excessive ventilation If multiple rescuers are available, they should rotate the task of compressions every 2 minutes.

Airway and Ventilations

Opening the airway (with a head tiltchin lift or jaw thrust) followed by rescue breaths can improve oxygenation and ventilation. Ventilations should be provided if the victim has a high likelihood of an asphyxial cause of the arrest (eg, infant, child, or drowning victim). Once an advanced airway is in place, healthcare providers will deliver ventilations at a regular rate 1 breath every 6 to 8 seconds (8 to 10 breaths/minute) and chest compressions can be delivered without interruption.

ratio
30 chest compressions is to 2 breaths /30:2 how ever if you have 2 rescuers then the ratio is 15 compressions the two breaths for infant and children.

A variety of CPR techniques and devices may improve hemodynamics or short-term survival when used by well-trained providers in selected patients. All of these techniques and devices have the potential to delay chest compressions and defibrillation. In order to prevent delays and maximize efficiency, initial training, ongoing monitoring, and retraining programs should be offered to providers on a frequent and ongoing basis.

To date, no adjunct has consistently been shown to be superior to standard conventional (manual) CPR for out-ofhospital basic life support, and no device other than a defibrillator has consistently improved long-term survival from out-ofhospital cardiac arrest.

Special Resuscitation considerations

Acute Coronary Syndromes Stroke Drowning Hypothermia Foreign-Body Airway Obstruction (Choking)