CPR is an abbreviation for cardiopulmonary resuscitation. It is a life-saving procedure that temporarily circulates oxygenated blood to the brain of a person whose heartbeat has stopped. Immediate CPR can increase or triple a person's chances of survival following a heart arrest.

CPR is beneficial in situations of heart attack or near-drowning where patients' heartbeats have stopped and rapid treatment is required. When someone's life is in danger, expertise is not required; simple knowledge suffices. Knowing CPR may make you a life-saving hero in someone's life.

What are the most common Arrhythmias requiring Cardiopulmonary Resuscitation (CPR)?

Loss of effective cardiac activity is generally due to the spontaneous initiation of a nonperfusing arrhythmia, sometimes referred to as a malignant arrhythmia. Ventricular fibrillation is the leading cause of sudden cardiac arrest in adults.

Other common nonperfusing arrhythmias that causes cardiac arrest include the following:

• Pulseless ventricular tachycardia (VT)
• Pulseless electrical activity (PEA)
• Asystole
• Pulseless bradycardia

Even though advancements in emergency cardiac care are improving survival rates, sudden cardiac arrest is still a significant cause of mortality in many regions of the world.

Epidemiology

• Every year, almost 350,000 people in the United States die of heart disease.
• The sudden loss of spontaneous organized cardiac function will kill half of them outside of a hospital.
• Cardiovascular disease is still the top cause of mortality in the United States as of 2016.
• Seventy percent of cardiac arrests that occur outside of a hospital occur at home. Half of these cardiac arrests go unnoticed.

Adult victims of non-traumatic cardiac arrest who get resuscitation attempts by emergency medical personnel have a 10.8 percent chance of surviving until hospital release. Adult patients who have cardiac arrest in a hospital setting, on the other hand, have rates of survival of up to 25.5 percent.

Pathophysiology

Electrical defibrillation is the only proven therapy for ventricular fibrillation. Typically, an automated external defibrillator (AED) is used for this purpose. Brain death is likely to occur in less than 10 minutes if an AED is not quickly available for defibrillation. CPR is a technique for delivering artificial circulation and breathing until defibrillation is possible. When performed correctly, conventional manual CPR, which combines chest compressions with rescue breathing, can give up to 33% of normal cardiac output and oxygenation.

Why is CPR important?

When a person has a cardiac arrest as a result of conditions such as a heart attack, choking, or drowning, blood flow stops. The heart stops pumping oxygenated blood to the brain and other critical organs in such conditions. Keeping the blood flow active, even if just partially, increases the chances of successful resuscitation once skilled medical personnel arrive on the scene.

Nevertheless, such a person can still be resuscitated physiologically by rapidly restoring blood supply to the brain and other important organs. There are around ten minutes between clinical death and biological death, which allows us to keep the brain alive and preserve the individual's life. CPR can help keep the brain alive by pumping blood to it through external chest compressions and rescue breathing.

Who is the patient in need of CPR?

Patients who need CPR are unconscious, unresponsive, and have no pulses. Determining the last time the patient was seen normal, or better still, the moment when pulses were lost, has a predictive value. Bystanders, family members, friends, and the primary care physician can also contribute to the etiologic assessment.

Although no particular physical examination findings exist, indications of cyanosis and decreased peripheral perfusion may indicate a reason for the arrest.

Who can perform CPR?

CPR may be done by both qualified medical professionals and laypersons. While certain procedures for giving CPR must be followed, it is preferable to conduct CPR according to your expertise rather than being a bystander and witnessing someone lose their life.

Treatment / Management

• The American Heart Association is the source of the most generally acknowledged cardiopulmonary resuscitation recommendations (AHA).
• The approach described here is for conducting one-rescuer CPR on an adult victim in an out-of-hospital situation by a healthcare provider. These instructions are current as of the 2015 American Heart Association CPR and Emergency Cardiac Care Guidelines Update.
• It is critical to recognize cardiac arrest as soon as possible in order to activate emergency medical services (EMS) and begin CPR. Make sure the area is safe before calling for assistance.
• Remember the C-A-B acronym to ensure proper CPR performance . C-A-B stands for Compressions-Airflow-Breathing. Following these instructions will guarantee that CPR is performed appropriately.

Simultaneously:

• Begin CPR by first performing chest compressions (C),
• followed by opening the airway (A)
• and delivering rescue breaths (B)

Compressions

Compressions are performed to restore the blood circulation in a person. The steps to perform compressions are:

• Place the individual on their back.
• Get on your knees alongside the person’s neck.
• Place one hand on the lower part of the sternum and the other on top of the first. Make certain that your arms and shoulders are perfectly straight.
• Start with 100 to 120 compressions each minute. The aim is to compress the sternum to a depth of at least two inches without going too deep.
• Use your upper body strength and ensure that you do not compress more than 2.4 inches.
• To keep coronary artery perfusion pressure constant, allow the chest wall to fully recoil on the upstroke.
• Thirty compressions are performed, followed by a brief break for two rescue breaths. Because of the essential role of chest compressions to coronary artery perfusion, pauses in chest compressions should be avoided, and any breaks should be as minimal as possible when necessary.
• If you are not properly trained in doing CPR, continue compressions until you observe indications of activity in the victim or medical experts take over.
• The rescuer conducts a head tilt/chin lift technique to clear the airway after 30 chest compressions (assuming there is no suspicion of a cervical spinal injury). The jaw-thrust method is used to clear the airway without extending the head if a cervical spine injury is suspected.
• The rescuer takes a "normal" breath (not deep or excessive) and provides a rescue breath lasting about one second, which should be enough to enable the chest to raise. Before continuing chest compressions, the procedure is repeated for a second rescue breath.
• A healthcare practitioner who is willing to act as an out-of-hospital rescuer should ideally have quick access to a barrier device such as a rescue mask. This, however, is not always the case. The alternative has been mouth-to-mouth rescue breaths, which many inexperienced rescuers are unwilling to undertake, especially on an unknown victim.
• Healthcare providers must make this option on their own. For inexperienced lay rescuers, compression-only CPR has been regarded as acceptable. If a healthcare professional in the out-of-hospital situation is unable to administer rescue breathing without a barrier device due to extenuating circumstances, compression-only CPR should be given until EMS arrives.
• The sequence of 30 chest compressions followed by two rescue breaths is repeated until an AED or more assistance arrives. If an AED is available, the pads should be placed to the patient's front and back, with the goal of resuming chest compressions as soon as possible. The majority of contemporary technologies provide additional instructions in the form of spoken words.
• AEDs well detect the current cardiac rhythm and recommend defibrillation if necessary after being attached to the patient. If the AED recommends a shock, stop compressions and keep a safe distance from the patient until defibrillation is finished. Immediately resume cycles of chest compressions and rescue breaths following the CAB sequence when defibrillation is finished, or if no shock is indicated, until further aid arrives.

A strong Chain of Survival can improve chances of survival and recovery for victims of cardiac arrest.

Using an AED

Automated External Defibrillators (AED)

AEDs can significantly increase the chances of a cardiac arrest victim's survival. The American Heart Association has a guide on how to set up an AED program at a company or institution. AED deployment should not be confined to solely trained personnel to reduce the time to defibrillation for cardiac arrest sufferers (although training is still recommended). Give the first shock, then CPR for two minutes before administering the second. If an AED isn't accessible or you don't know how to use one, ask for help and keep performing CPR cycles until you see movement.

What are the things to do pre-CPR?

Before you start administering CPR, here are a few things you should check:

1. Assess the situation as well as the individual. Whether the scene appears to be safe, tap the victim on the shoulder and ask, "Are you OK?" to see if he or she need help.
2. If the person is awake, continue to converse with him to maintain him in that state. To encourage a response, keep asking questions.
3. Request help. If it's clear that the individual need assistance, phone (or ask a bystander to call), and then send someone to obtain an AED.
4. If an AED is not accessible or there is no bystander to assist, stay with the victim, call for assistance, and begin providing aid.
5. Open the airway. With the person lying on his or her back, tilt the head back slightly to lift the chin.
6. Check for breathing. Listen for breathing sounds for no more than 10 seconds. Gasping noises do not indicate breathing. Therefore, Begin CPR if there is no breathing.
   
   

Call emergency services ASAP

Check to see if there are any medical experts around. If they are, instruct them on how to carry out the process.

• Don’t panic. Panic can lead to you making a mistake.

Red Cross CPR Steps

• Push hard and fast. Place your hands in the centre of your chest, one on top of the other. Use your body weight to assist you in delivering compressions that are at least 2 inches deep and at a rate of at least 100 compressions per minute.
• Give rescue breaths. Pinch the nose tight and position your mouth over the person's mouth to form a full seal, with the person's head leaned back slightly and chin raised. Blow into the person's mouth to make their chest rise. After two rescue breaths, maintain compressions.

Note: If the chest does not rise with the first rescue breath, tilt the head again before taking the second. If the person's chest does not rise with the second breath, he or she is likely choking. Look for an item and, if found, remove it after each consecutive round of 30 chest compressions.

• Continue CPR procedures. Continue repeating chest compressions and breathing cycles until the individual shows signs of life, such as breathing, an AED becomes accessible, or EMS or a professional medical responder arrives on the scene.

About High-Quality CPR

High-quality CPR should be performed by anyone - including bystanders. There are five critical components:

• Minimize interruptions in chest compressions
• Provide compressions of adequate rate and depth
• Avoid leaning on the victim between compressions
• Ensure proper hand placement
• Avoid excessive ventilation

Men vs. Women

• According to a research published by the Resuscitation Science Symposium, males are more likely than women to get bystander CPR in public places.
• Within the house, both men and women got CPR help, but in public, 45 percent of males received aid compared to just 39 percent of women.
• Furthermore, males were 1.23 times more likely than women to get bystander CPR in public, with a 23 percent higher chance of survival.

The reason for this might be due to anatomy and the comfort level of a bystander performing CPR on a woman.

What if I don't know how to do CPR?

You can perform CPR even if you've never done it before or haven't been trained. All you have to do is push hard and fast on the victim's chest in the middle. It makes no difference if you have no idea what you're doing.

Have the guidelines for doing CPR changed?

Yes. All rescuers used to be obligated to check a victim's airway and provide rescue breaths if the person wasn't breathing. Since 2010, persons who do not know CPR have been urged to do "hands-only" CPR, which involves simply chest compressions and no concern for the airway or rescue breathing.

Differential Diagnosis

A rapid physical assessment focusing on palpable pulses and mental condition is essential since drug overdose, especially excessive alcohol use, can resemble cardiac death.

Prognosis

• Survival rates and neurologic outcomes for patients with cardiac arrest are low, but early adequate resuscitation, which includes cardiopulmonary resuscitation (CPR), early defibrillation, and proper implementation of post–cardiac arrest treatment, improves survival and neurologic outcomes. However, cardiac arrest survival rates have risen considerably as a result of targeted education and training addressed at emergency medical services (EMS) personnel as well as the general public.
• According to 2015 AHA data, individuals who have out-of-hospital cardiac arrest have a 10.6 percent chance of surviving until hospital discharge. 8.3% of individuals who have a cardiac arrest outside of the hospital will be released with normal neurologic function. Patients who have seen cardiac arrest and are given high-quality CPR had a better prognosis, with 25.5 percent surviving to hospital discharge.

Complications

Cardiac arrest has a poor prognosis; the majority of victims do not survive. Those who survive may have various degrees of brain damage as a result of hypoxia encephalopathy, complicating their hospital stay. Ischemic damage can affect every organ system. In addition, when performed appropriately, chest compressions can result in rib fractures, which can be exacerbated by pneumothorax.

Pediatric CPR

The instructions for doing CPR on adults are different from the instructions for doing CPR on children.

Infant CPR, by definition, refers to patients under the age of one year. Child CPR is used on patients aged one year and up until adolescence. Adult CPR standards apply after puberty. The modifications for infant and child CPR are listed below. All other parts of CPR follow adult standards, such as beginning the procedure with the Compression first (CAB) sequence and compressing at a rate of 100 to 120 compressions per minute. The sternum should be depressed to one-third of the anteroposterior diameter of the chest, which is about two inches in a child and 1.5 inches in an infant.

Child CPR Modifications

When doing chest compressions on a kid, place the heel of one or both hands (depending on the child's size) on the bottom part of the sternum. The chest is compressed to a depth of about two inches at a rate of 100 to 120 compressions per minute. After 30 compressions, take two consecutive breaths before returning to chest compressions. Continue the cycle of 30 compressions to two breaths until help arrives.

Infant CPR Modifications

On a newborn, conduct chest compressions by putting two fingers on the sternum right below the nipple line. At a rate of 100 to 120 per minute, the infant's chest is compressed to a depth of around 1.5 inches. After 30 compressions, take two consecutive breaths before returning to chest compressions. Continue the 30 compressions to two breaths cycle until help comes.

In-hospital CPR

In a hospital context, many rescuers are frequently available, and breathing is typically administered with a bag-valve-mask (BVM) system. BVM ventilation must be conducted by a trained professional. If the patient is not intubated, CPR is performed by one physician who performs chest compressions while the second provider breathes with BVM breathing. In this case, the compression-to-breath ratio shifts to 15 compressions to two breaths. Once a patient is intubated, it is unnecessary to do compression and ventilation cycles; chest compressions are administered constantly, and rescue breaths are delivered independently via the BVM at a rate of 10 per minute (one breath every six seconds). Novice operators typically give BVM ventilations at a rate higher than this.

The following are the six links in the adult out-of-hospital Chain of Survival:

1. Recognizing cardiac arrest and activating the emergency response system
2. Early CPR with a focus on chest compressions
3. Rapid defibrillation
4. Advanced resuscitation provided by EMTs and other healthcare professionals
5. Post-cardiac arrest care
6. Recovery including additional treatment, observation, rehabilitation, and psychological support.

Post Cardiac Arrest Care Guidelines

According to the AHA guidelines, a comprehensive, structured, multidisciplinary system of care should be implemented in a consistent manner for the treatment of post-cardiac arrest patients. Components of structured interventions include the following:

• Therapeutic hypothermia
• Optimization of hemodynamics and gas exchange
• Immediate coronary reperfusion using percutaneous coronary intervention (PCI) when warranted for restoration of coronary blood flow
• Glycemic control
• Neurological diagnosis, treatment, and prognosis

What are the contraindications to cardiopulmonary resuscitation (CPR)?

A do-not-resuscitate (DNR) order or other advanced directive stating a person's intention not to be resuscitated in the case of cardiac arrest is the sole absolute contraindication to CPR. If a practitioner reasonably believes that doing CPR would be medically useless, this is a relative contraindication.

Summing it up

Correct CPR administration can be the difference between life and death. To be able to do CPR in an emergency, it is important to be knowledgeable on the procedure.

You may learn and master the CPR method by enrolling in a CPR training course. Conversely, if you do not want to take a professional training, you may practice the fundamental procedures with a dummy or a known individual. In any event, learning about this life-saving talent is critical since it may help you become a rescuer for someone, particularly your loved ones.