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resuscitationCritical care The restoration of consciousness to a person who appears dead. See Active compression-decompression-cardiopulmonary resuscitation, Cardiopulmonary resuscitation, Fluid resuscitation, Mouth-to-snout resuscitation.
resuscitation(re-sus?i-ta'shon) [L. resuscitare, to raise up again, rebuild]
active compression decompression cardiopulmonary resuscitationSee: active compression decompression cardiopulmonary resuscitation.
cardiopulmonary resuscitationAbbreviation: CPR
In emergency cardiac care, CPR involves either opening the airway, providing artificial breathing, and assisting circulation with chest compressions (until definitive treatments can restore spontaneous cardiac, pulmonary, and cerebral function) or providing chest compressions alone, without rescue breathing. When trained providers are available, CPR includes defibrillation with automated external defibrillators. In the U.S., the American Heart Association (AHA) develops and disseminates standard techniques for emergency cardiac care.
The first step in CPR is to ensure that an unarousable patient needs cardiopulmonary support and is not merely asleep or unconscious. If the patient does not respond to a loud voice or gentle shaking, the best thing a rescuer can do is to call for skilled assistance because successful resuscitation usually depends on the speed with which the patient can be defibrillated.
Before the defibrillator arrives, the rescuer can either position the patient for chest compressions only or begin rescue breathing. The patient should be placed supine on a firm, flat surface, with care taken to protect his cervical spine if traumatic injury is suspected. Kneeling at the level of the patient's shoulder, the rescuer performing rescue breathing may open the patient's airway, either with the jaw-thrust or the head-tilt chin-lift technique. If foreign bodies are present in the airway, they must be removed; dentures must also be removed if they interfere with resuscitation. Next, breathing is assessed by listening for breath sounds at the nose and lips and watching for the rise and fall of the chest. If these signs are not present, the patient is apneic, and rescue breathing can be performed. Survival rates of patients undergoing CPR are roughly equivalent with or without rescue breathing.
Rescue breathing can be performed with mouth-to-mouth technique or through a mask with a one-way valve if one is available. The rescuer gives two deep, slow positive-pressure breaths to the patient, the duration of each breath depending on the patient's age. If the supplied breaths meet obvious resistance, the rescuer should make another attempt to reopen the airway, and, if this is ineffective, to clear the airway with the Heimlich maneuver in children and adults. Infants should receive chest thrusts and blows to the back instead of the Heimlich maneuver.
The AHA formerly suggested checking the victim for a pulse after the first two breaths but eliminated the pulse check in its revised guidelines of 2000. If the patient is not breathing on his own, rescue breathing continues. If there is no pulse, external chest compression is begun and continued, with periodically interposed ventilations, until a defibrillator arrives or the patient revives. The precise number of ventilations and chest compressions per minute depends on the patient's age and the number of rescuers. For a single rescuer caring for an adult patient, two breaths are given for every 15 chest compressions. According to the AHA, for resuscitation purposes, infants are those who are up to a year old, children are from 1 to 8 years old, and adults are over the age of 8.
Compressions are given to adults (the usual victims of cardiac arrest) at the center of the sternum between the nipples, with the heel of one hand below the other hand; the fingers of the two hands are interlaced for support and to minimize the possibility of fracturing the ribs. The rescuer's elbows should be locked and straight, and the direction of compression should be exactly perpendicular to the patient's chest.
The chest is depressed 1.5 to 2.0 in for a normal-sized adult. For a child, the chest is depressed 1.0 to 1.5 in; for an infant, 0.5 to 1.0 in. The chest should return to its normally inflated position after each compression.
When professional rescuers arrive, the patient should be defibrillated immediately. If a defibrillator is not available, two-person CPR continues; the two rescuers alternate in giving rescue breaths and chest compressions to minimize fatigue. Ventilation and chest compressions are held for 5 sec at the end of the first minute and every few minutes after to determine whether the patient has responded. illustration; advanced cardiac life support; defibrillation; emergency cardiac care;
hypotensive resuscitationLow-volume resuscitation.
load-distributing band cardiopulmonary resuscitationAbbreviation: LDB-CPR
mechanical piston cardiopulmonary resuscitation
The cornerstone of neonatal resuscitation is the prompt recognition of the newborn who is failing to breathe and perfuse organs effectively. Immediately after birth, the newborn should be dried, gently suctioned, and assessed for: adequate respiratory effort (versus apnea); a heart rate above 100 beats/min; good muscle tone (as opposed to flaccidity); skin color that indicates effective cardiac output (rather than cyanosis); and evidence of full-term versus pre-term birth.
The neonate who lacks some of these findings should be professionally managed, with warming, gentle stimulation (e.g., rubbing its back gently with a towel to stimulate effective breathing) and airway suctioning. When apnea, hypothermia, respiratory distress, bradycardia, or poor skin perfusion is evident, evidenced-based interventions (e.g., those recommended by the Neonatal Resuscitation Program of the American Academy of Pediatrics and the AHA) should be begun immediately.
Positive-pressure ventilation (PPV), with breaths supplied via a bag mask device, effectively resuscitates most infants at risk for neonatal asphyxia. Those who have meconium in the upper airways (evidenced by meconium staining of the amniotic fluid), as well as inadequate breathing, slow heart rate, and poor muscle tone, require endotracheal intubation and suctioning, preferably by an experienced practitioner.
Most neonates respond favorably to airway and ventilatory management, breathe spontaneously, and maintain a heart rate above 100 beats/min. Chest compressions should be begun only if the heart rate remains below 60 beats/min despite 30 sec of PPV with 100% oxygen. Chest compressions should cease when the heart rate is above 60 beats/min, but PPV should be continued until the heart rate is above 100 beats/min and the newborn has begun to breathe on his own. PPV should always accompany chest compressions and be coordinated so that a breath is provided after every third compression. After 30 sec of PPV and chest compressions, the compressions should be stopped and the heart rate evaluated while PPV is continued. If there is no palpable pulse at the base of the umbilical cord, PPV should be stopped and the chest auscultated to determine the heart rate.
Chest compressions are most effective when the sternum is depressed to a depth equal to one third of the anteroposterior chest diameter of the newborn. The preferred technique is to use the thumbs to depress the sternum, with the hands encircling the newborn’s thorax. An alternative is to perform compressions with two fingers on the same hand, so that the umbilical vein can be cannulated by another resuscitator. Ninety compressions a minute should be coordinated with 30 positive-pressure breaths, with care taken to avoid simultaneous compressions and ventilations.
Access to the circulation can be gained through the umbilical vein or intraosseously into the tibia. Normal saline or lactated Ringer’s solution is the preferred fluid. Narcotic antidotes should be given to reverse any depression in respiratory or neurological status from maternal narcotic overdose. Inotropes such as epinephrine should be used when ventilation and chest compressions do not revive the dying infant.
In prolonged resuscitations, blood gases should be drawn to help guide additional therapies.
Resuscitative interventions that have not proved to be helpful include the use of high-dose epinephrine, the induction of cerebral hypothermia, and the use of carbon dioxide detectors on the endotracheal tube.
Resuscitation should not be initiated for children born with severe anomalies incompatible with life, e.g., anencephaly or birth weights of less than 400 g. Resuscitative efforts that do not resolve apnea and pulselessness after more than 10 min are rarely successful in newborns. In these circumstances, efforts may be discontinued.