HIGH QUALITY

CARDIOPULMONARY
RESUSCITATION
Sourabh Ved
15087
INDEX
● Introduction.
● Importance of high quality cpr.
● Components.
● Sequence of CPR.
● Summary.
INTRODUCTION
● CPR is a life saving intervention and
cornerstone of resuscitation from cardiac
arrest.
● Goal of CPR- to deliver oxygen and
substrate to vital tissues by generating
adequate blood flow by effective chest
compression during a majority of total
cardiac arrest time.
IMPORTANCE OF HIGH QUALITY
CPR
● CPR is inherently inefficient as it provides only

10-30 % of normal blood flow to the heart.

30-40% of normal blood flow to the brain.

When delivered according to guidelines.

● So given cpr should be of highest quality possible in

order to achieve optimum results.
● Poor quality CPR should be considered a preventable
harm.
COMPONENTS OF HIGH QUALITY
CPR
● CPP( coronary perfusion pressure)is the primary determinant of
myocardial blood flow during CPR.
● So maximizing CPP during CPR is the primary physiological goal.
● CPP can not be measured easily in most patient hence rescuers should
focus on specific components of cpr that have evidence to support
either better hemodynamics or human survival.
1. Chest compression fraction.
2. Chest compression rate.
3. Chest compression depth.
4. Chest recoil.
5. Ventilation.
CHEST COMPRESSION
FRACTION(CCF)
● CCF is the proportion of time that chest compression
are performed during a cardiac arrest.
CCF>80%
● Minimal interruptions in chest compressions results
in maximum amount of time chest compressions
generate blood flow hence maximum perfusion.
CHEST COMPRESSION RATE
● It should be 100 to 120 / min.
● If rate is less significant drop in RETURN OF
SPONTANEOUS CIRCULATION occurs.
● If rate is more it may reduce coronary blood
flow and decrease percentage of compression
that achieve target depth.
CHEST COMPRESSION DEPTH
● In infants- at least one-third of anterior-
posterior dimension or 1.5 inch or 4 cm.
● In children- at least one third of anterior-
posterior dimension or 2 inch or 5 cm.
● In adults- greater than or equal to 2 inch.
CHEST RECOIL
● Full chest recoil on completion of compression.
● No residual leaning.
● Leaning can result into
Decrease blood flow throughout the heart
Decrease venous return and cardiac output
VENTILATION
● Goal of assisted ventilation- Providing sufficient oxygen
without impeding the perfusion.
● So Avoid excessive ventilation: Rate< 12 breaths per minute.
● Because it Increases intrathoracic pressure and impedes
venous return and therefore decreases cardiac output, cerebral
blood flow, and coronary perfusion.
● Causes air trapping and barotrauma in patients with small-
airway obstruction.
● Increases the risk of regurgitation and aspiration in patients
without an advanced airway.
● Decreases CCF(chest compression fraction).
● Chest rise produced by ventilation volume should be
minimal(no more than visible chest rise).
● Compression ventilation ratio without advance airway- in
adults 30:2 and in children and infants if one rescuer 30:2 if
2 or more rescuers than 15:2.
● Compression ventilation ratio with advance airway-
continuous compressions at the rate of 100-120/min And
give one breath every 6 seconds( 10 breaths / min).
CHAIN OF SURVIVAL - ADULT
CHAIN OF SURVIVAL- PEDIATRIC
SEQUENCE OF CPR
COMPRESSIONS
POSITION OF VICTIM

● Supine on firm flat surface.

● If victim facing down - logroll the victim.
● Supine cpr - recommended.
● Prone cpr-in conditions where patient cant be turned. It is performed on a person
lying on chest by turning head to the side and compressing the back.
● During pregnancy when a woman is lying on her back the uterus may compress
the inferior Vena Cava and there is decrease the venous return, it is therefore
recommended that the uterus be pushed to the woman’s left if this is not effective
either roll the woman 30° or healthcare professionals should consider emergency
resuscitated hysterectomy.
● Stabilize the cervical spine by either cervical collar if available or any hard object
that restricts neck movement
POSITION OF RESCUER
● All regardless of training should provide chest compressions
● Untrained loan rescuer -chest compressions only
● Trained loan rescuer -chest compression +rescue breathing
● Healthcare provider- chest compression + Rescue breathing ,cordinate
teamwork
● Firm surface (blackboard or floor).
● Kneel beside victim’s chest or stand beside bed.
● Heel of one hand on Inter mammary line (which is the lower half of the
sternum).
● heel of the other hand on the top of first so that the hands are overlapped and
parallel.
● Lock elbows.
● Never use palm of your hand use heel of the hand.
TECHNIQUES OF CHEST COMPRESSIONS
IN INFANT(<1 YEAR)

TWO THUMB TECHNIQUE

● The infant's chest is encircled with both hands; fingers are

spread around the thorax and the thumbs brought together
over the lower half of the sternum avoiding the
xiphisternum. The sternum is compressed with the thumbs
and the thorax with the fingers for counter pressure.
● It is preferred technique.
● Done when there are two or more providers.
TWO FINGER TECHNIQUE

● Two fingers of one hand are placed vertically over the sternum just
below the intermammary line (between the two nipples) ensuring that
the fingers are not over xiphoid process.
● Rescuer is alone or unable to physically encircle the victim's chest
IN CHILDREN (1-8 YEARS)

The heel of one hand should be placed over lower half of sternum avoiding
pressure over xiphoid with fingers lifted above the chest wall to prevent
compression of rib cage. Rescuer should position himself vertically above the
victim's chest.
 IN LARGE CHILDREN AND THOSE ABOVE 8 YEAR OLD

The two-hand method

placing heel of one hand over the lower half of sternum and heel of the other hand
over the first hand, interlocking the fingers of both hands with fingers lifted
above the chest wall.
AIRWAY

● POSITIONING-If the child is unresponsive but breathing or signs of

life present, the child should be placed on a hard surface with face up or in
supine position. If head or neck trauma is suspected, head and torso should
be moved as a unit and the neck immobilized.

● OPENING THE AIRWAY

● HEAD TILT CHIN LIFT MANEUVER
● JAW THRUST
In case of suspected foreign body obstruction

● one should open the mouth and look for the

foreign body. If seen, it should be carefully
removed under vision.
● If the victim is an infant who is responsive and
has had features of airway obstruction, back
slaps and chest thrusts should be performed till
the foreign body comes out or till the infant
becomes unresponsive.
● if the victim is an older child or adolescent, abdominal
thrusts can be given by standing behind the victim till the
foreign body is expelled out or till the patient becomes
unresponsive. If such a victim becomes unresponsive,
CPR should be initiated with an additional maneuver of
checking the airway for the foreign body after giving the
chest compressions and before breaths are given.
BREATHING

● RESCUE BREATHING
BAG AND MASK VENTILATION
THANK YOU !