What is Cardiopulmonary Resuscitation (CPR)?
Cardiopulmonary resuscitation, or CPR, is a set of procedures performed to maintain blood flow and oxygen supply to the body during a cardiac arrest when the heart stops beating. The way we do CPR today grew from the work of a few doctors in the 1950s and has since turned into the process we’ll be talking about in this piece. The American Heart Association (AHA) guidelines are the most commonly followed in North America for this purpose. These guidelines are updated every 5 years after a meeting conducted by the International Liaison Committee on Resuscitation (ILCOR).
What Causes Cardiopulmonary Resuscitation (CPR)?
Each year, around 350,000 Americans lose their lives to heart disease. Half of them unfortunately pass away suddenly, outside of hospitals, due to the abrupt stopping of organized heart function. The most common cause of this sudden heart failure in adults is something called ventricular fibrillation.
Despite advancements in emergency heart care that continue to increase survival rates, sudden cardiac arrest is still a major cause of death globally. As of 2016, heart disease remains the number one cause of death in the United States.
Risk Factors and Frequency for Cardiopulmonary Resuscitation (CPR)
Most cardiac arrests happening outside a hospital, about 70%, occur at home and half of these are not witnessed by anyone. Despite improvements in emergency medical services, the survival rate is still quite low. In fact, only 10.8% of adult victims of non-traumatic cardiac arrest who get emergency medical help survive until they are discharged from the hospital. On the other hand, in a hospital setting, the survival rate for adult patients who experience cardiac arrest can be as high as 25.5%.
Signs and Symptoms of Cardiopulmonary Resuscitation (CPR)
When someone needs CPR, they are passed out and don’t respond, and do not have any noticeable pulse. Finding out the last time the person seemed healthy or when the pulse was last noticeable can assist with their care. More insights can be gathered from talking to individuals who were present, such as loved ones, friends, or the patient’s doctor, to help establish the reason for the incident.
While there are no particular physical signs to look for, appearance of a bluish discoloration of the skin or lips, along with poor blood flow to body parts like the hands and feet, may help point to why the patient’s heart stopped beating.
Testing for Cardiopulmonary Resuscitation (CPR)
If a patient is unresponsive and you can’t feel their pulse, it means that they might need CPR (cardiopulmonary resuscitation).
Treatment Options for Cardiopulmonary Resuscitation (CPR)
Here’s a guide for any caregiver performing first-aid CPR on an adult. It follows the 2015 American Heart Association’s Guidelines for CPR and Emergency Cardiac Care. They’re slightly different for children, babies, and those being attended to in the hospital.
Sensing a possible heart attack right away is crucial. It allows you to call emergency medical services (EMS) and start CPR quickly. Nowadays, mobile phones are so widespread that you could reach out to EMS while staying by the side of the person having a heart attack. Make sure you’re in a safe environment, and call for help while beginning CPR. The steps are in the order of Chest compressions (C), Airway (A), and Breathing (B). This is a change from the previous order of ABC.
The CPR consists of placing your hands on the person’s lower chest bone or sternum and pushing down at a pace of 100 to 120 times per minute. Make sure to apply enough pressure to push the sternum inward at least two inches, but not too much. Also, let the chest return to its normal position after each compression to allow the heart to refill with blood. Do 30 compressions and then stop to give two rescue breaths. In order to keep blood flowing to the heart, try to minimize the breaks between compressions and make unavoidable pauses as brief as possible.
After 30 compressions, you should open up the person’s airway. This is done through a head tilt/chin lift maneuver, unless the person might have a neck injury. If there’s a risk of a neck injury, use the jaw-thrust technique without lifting the head. Then administer two rescue breaths: breathe in normally (not a deep breath) and breathe out into the person’s mouth for about a second, just enough to see the chest rise. Repeat this process before going back to chest compressions.
Healthcare providers likely have access to a facemask or mouth barrier, but this may not always be true. If this is not available, performing mouth-to-mouth resuscitation is the alternative. However, many people are uncomfortable doing this, particularly with an unknown person. In these cases, doing chest compressions only is an accepted practice until EMS arrives.
Continue the cycle of 30 chest compressions followed by two rescue breaths until help arrives or you have access to an Automated External Defibrillator (AED). When available, attach the AED pads to the patient and follow the device’s voice instructions to analyze the patient’s heart rhythm and decide whether a shock is required. If a shock is recommended, stop chest compressions and stand back while the defibrillation occurs. If a shock is not required or after the shock, resume the chest compressions and breaths using the CAB sequence until help arrives.
What else can Cardiopulmonary Resuscitation (CPR) be?
A simple physical check-up that includes checking the patient’s pulse and mental alertness is crucial as sometimes signs of excessive drug or alcohol use can resemble symptoms of a heart attack.
What to expect with Cardiopulmonary Resuscitation (CPR)
Based on 2015 data from the American Heart Association, the survival rate for patients who have a cardiac arrest outside of a hospital is quite low, with only 10.6% making it to their hospital discharge. Alongside, only 8.3% of these patients are able to leave the hospital with their neurological functions intact.
However, patients with cardiac arrest who are promptly given high-quality CPR by a bystander have better outcomes. In fact, 25.5% of these patients survive until they are discharged from the hospital.
Possible Complications When Diagnosed with Cardiopulmonary Resuscitation (CPR)
Cardiac arrest has a very serious outlook–most patients do not survive. For the few who do, they may face a range of neurological injuries because their brain did not get enough oxygen. Each organ in the body is also at risk of damage due to reduced blood flow. Additionally, if someone is performing chest compressions correctly, it can result in broken ribs. This can lead to a complication where air escapes into the area between the lungs and chest wall (pneumothorax).
Preventing Cardiopulmonary Resuscitation (CPR)
If a person has a heart attack, it’s important to alert their family or the person they’ve designated to make decisions on their behalf. Important details to note include the patient’s wishes related to their treatment, as stated in their medical records. If there are prior instructions and they comply with local legal regulations, these should always be followed.
