Cardiopulmonary resuscitation

Cardiopulmonary Resuscitation (CPR) 

Definition

Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest).

Purpose

CPR is performed to restore and maintain breathing and circulation and to provide oxygen and blood flow to the heart, brain, and other vital organs. CPR should be performed if a person is unconscious and not breathing. Respiratory and cardiac arrest can be caused by allergic reactions, an ineffective heartbeat, asphyxiation, breathing passages that are blocked, choking, drowning, drug reactions or overdoses, electric shock, exposure to cold, severe shock, or trauma. CPR can be performed by trained bystanders or healthcare professionals on infants, children, and adults. It should always be performed by the person on the scene who is most experienced in CPR.

Precautions

CPR should never be performed on a healthy person because it can cause serious injury to a beating heart by interfering with normal heartbeats.

Description

CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of the problem and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advanced cardiac life support measures.

CPR must be performed within four to six minutes after cessation of breathing so as to prevent brain damage or death. It is a two-part procedure that involves rescue breathing and external chest compressions. To provide oxygen to a person's lungs, the rescuer administers mouth-to-mouth breaths, then helps circulate blood through the heart to vital organs by external chest compressions. Mouth-to-mouth breathing and external chest compression should be performed together, but if the rescuer is not strong enough to do both, the external chest compressions should be done. This is more effective than no resuscitation attempt, as is CPR that is performed "poorly."

When performed by a bystander, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.

According to the American Heart Association, early CPR and defibrillation combined with early advanced emergency care can increase survival rates for people with a type of abnormal heart beat called ventricular fibrillation by as much as 40%. CPR by bystanders may prolong life during deadly ventricular fibrillation, giving emergency medical service personnel time to arrive.

However, many CPR attempts are not ultimately successful in restoring a person to a good quality of life. Often, there is brain damage even if the heart starts beating again. CPR is therefore not generally recommended for the chronically or terminally ill or frail elderly. For these people, it represents a traumatic and not a peaceful end of life.

Each year, CPR helps save thousands of lives in the United States. More than five million Americans annually receive training in CPR through American Heart Association and American Red Cross courses. In addition to courses taught by instructors, the American Heart Association also has an interactive video called Learning System, which is available at more than 500 healthcare institutions. Both organizations teach CPR the same way, but use different terms. These organizations recommend that family members or other people who live with people who are at risk for respiratory or cardiac arrest be trained in CPR. A hand-held device called a CPR Prompt is available to walk people trained in CPR through the procedure, using American Heart Association guidelines. CPR has been practiced for more than 40 years.

Performing cpr

The basic procedure for CPR is the same for all people, with a few modifications for infants and children to account for their smaller size.

PERFORMING CPR ON AN ADULT. The first step is to call the emergency medical system for help by telephoning 911; then to begin CPR, following these steps:

PERFORMING CPR ON AN INFANT OR CHILD UNDER THE AGE OF EIGHT. The procedures outlined above are followed with these differences:

New developments in cpr

Some new ways of performing CPR have been tried. Active compression-decompression resuscitation, abdominal compression done in between chest compressions, and chest compression using a pneumatic vest have all been tested but none are currently recommended for routine use.

The active compression-decompression device was developed to improve blood flow from the heart, but clinical studies have found no significant difference in survival between standard and active compression-decompression CPR. Interposed abdominal counterpulsation, which requires two or more rescuers, one compressing the chest and the other compressing the abdomen, was developed to improve pressure and therefore blood flow. It has been shown in a small study to improve survival but more data is needed. A pneumatic vest, which circles the chest of an unconscious person and compresses it, increases pressure within the chest during external chest compression. The vest has been shown to improve survival in a preliminary study but more data is necessary for a full assessment.

Preparation

If a person suddenly becomes unconscious, a rescuer should call out for help from other bystanders, and then determine if the unconscious person is responsive by gently shaking the shoulder and shouting a question. Upon receiving no answer, the rescuer should call the emergency medical system. The rescuer should check to see whether the unconscious person is breathing by kneeling near the person's shoulders, looking at the person's chest, and placing a cheek next to the unconscious person's mouth. The rescuer should look for signs of breathing in the chest and abdomen, and listen and feel for signs of breathing through the person's lips. If no signs of breathing are present after three to five seconds, CPR should be started.

Aftercare

Emergency medical care is always necessary after successful CPR. Once a person's breathing and heartbeat have been restored, the rescuer should

CPR in basic life support. Figure A: The victim should be flat on his back and his mouth should be checked for debris. Figure B: If the victim is unconscious, open airway, lift neck, and tilt head back. Figure C: If victim is not breathing, begin artificial breathing with four quick full breaths. Figure D: Check for carotid pulse. Figure E: If pulse is absent, begin artificial circulation by depressing sternum. Figure F: Mouth-to-mouth resuscitation of an infant.

(Illustration by Electronic Illustrators Group.)

make the person comfortable and stay there until emergency medical personnel arrive. The rescuer can continue to reassure the person that help is coming and talk positively until professionals arrive and take over.

Risks

CPR can cause injury to a person's ribs, liver, lungs, and heart. However, these risks must be accepted if CPR is necessary to save the person's life.

Normal results

In many cases, successful CPR results in restoration of consciousness and life. Barring other injuries, a revived person usually returns to normal functions within a few hours of being revived.

Abnormal results

These include injuries incurred during CPR and lack of success with CPR. Possible sites for injuries include a person's ribs, liver, lungs, and heart. Partially successful CPR may result in brain damage. Unsuccessful CPR results in death.

Key terms

Cardiac arrest — Temporary or permanent cessation of the heartbeat.

Cardiopulmonary — Relating to the heart and the lungs.

Defibrillation — A procedure to stop the type of irregular heart beat called ventricular fibrillation, usually by using electric shock.

Resuscitation — Bringing a person back to life after an apparent death or in cases of impending death.

Ventricular fibrillation — An irregular heartbeat where the heart beats very fast but ineffectively. Ventricular fibrillation is fatal if not quickly corrected.

Resources

Books

Alton, Thygerson. First Aid and CPR. 4th ed. Sudbury, Massachusetts: Jones & Bartlett Pub, 2001.

Knoop, Kevin J., and Lawrence B. Stack. Atlas of Emergency Medicine. 2nd ed. New York: McGraw Hill, 2001.

National Safety Council. First Aid and CPR for Infants and Children. 4th ed. Sudbury, Massachusetts: Jones & Bartlett Pub, 2001.

Periodicals

Davies, N., and D. Gould. "Updating cardiopulmonary resuscitation skills: a study to examine the efficacy of self-instruction on nurses' competence." Journal of Clinical Nursing 9 (2000): 400-410.

Eftestol T., K. Sunde, S. O. Aase, J. H. Husoy, and P. A. Steen. "'Probability of successful defibrillation' as a monitor during CPR in out-of-hospital cardiac arrested patients." Resuscitation 48 (2001): 245-254.

Kern, K. B., H. R. Halperin, and J. Field. "New guidelines for cardiopulmonary resuscitation and emergency cardiac care: changes in the management of cardiac arrest." Journal of the American Medical Association 285 (2001): 1267-1269.

Meyer W., and F. Balck. "Resuscitation decision index: a new approach to decision-making in prehospital CPR." Resuscitation 48 (2001): 255-263.

Organizations

American College of Emergency Physicians. P.O. Box 619911, Dallas, TX 75261-9911. (800) 798-1822 or (972) 550-0911. Fax: (972) 580-2816. http://www.acep.org/. info@acep.org.

American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago, IL 60611. (312) 587-3709 or (800) 521-3709. Fax: (312) 587-9951. http://www.acoep.org.

American Heart Association, National Center. 7272 Greenville Avenue, Dallas, TX 75231. (877) 242-4277. 〈http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/heim.html〉.

Heimlich Institute. PO Box 8858, Cincinnati, OH 45208. 〈http://www.heimlichinstitute.org/index.htm〉. heimlich@iglou.com.

National Safe Kids Campaign. 1301 Pennsylvania Avenue, Suite 1000, Washington, DC 20004-1707. http://pedsccm.wustl.edu/All-Net/english/neurpage/protect/drown.htm.

Other

American Heart Association. http://www.cpr-ecc.org/ and http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cprs.html.

Columbia Presbyterian Medical Center. http://cpmcnet.columbia.edu/texts/guide/hmg13_0001.html.

Learn CPR. http://www.learn-cpr.com.

National Registry of Cardiopulmonary Resuscitation. http://www.nrcpr.org/.

University of Washington School of Medicine. http://depts.washington.edu/learncpr/.

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cardiopulmonary resuscitation

n.

Abbr. CPR Restoration of cardiac output and pulmonary ventilation by artificial respiration and closed-chest massage after cardiac arrest and apnea.

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cardiopulmonary resuscitation,

n life-saving technique for restarting cardiac function and respira-tion. Includes manual pumping with a rhythmic pressure on the chest and breathing mouth to mouth.