CARDIOPULMONARY RESUSCITATION 

(CPR)

It is an emergency procedure which is performed in an effort to manually preserve intact

brain function until further measures are taken to restore spontaneous blood circulation and
breathing in a person in cardiac arrest. It is indicated in those who are unresponsive with no
breathing or abnormal breathing, for example agonal respirations. It may be performed both
in and outside of a hospital.

CPR involves chest compressions at least 5 cm deep and at a rate of at least 100 per minute in
an effort to create artificial circulation by manually pumping blood through the heart. In
addition, the rescuer may provide breaths by either exhaling into the subject's mouth or
utilizing a device that pushes air into the subject's lungs. This process of externally providing
ventilation is termed artificial respiration. Current recommendations place emphasis on high-
quality chest compressions over artificial respiration; a simplified CPR method involving
chest compressions only is recommended for untrained rescuers.

CPR alone is unlikely to restart the heart; its main purpose is to restore partial flow of
oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend
the brief window of opportunity for a successful resuscitation without permanent brain
damage. Administration of an electric shock to the subject's heart, termed defibrillation, is
usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is only
effective for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular
tachycardia, rather than asystole or pulseless electrical activity. CPR may succeed in inducing
a heart rhythm which may be shockable. CPR is generally continued until the subject
regains return of spontaneous circulation (ROSC) or is declared dead.

WHEN DO I PERFORM CPR?

CPR stands for Cardiopulmonary Resuscitation, which means Heart and Lung Resuscitation.
When an individual’s heart beat and breathing have stopped, it becomes your job to breathe
for them and to beat their heart in order to keep them alive. These are the two functions that
aren’t working, and these are the two functions you’re going to attempt to replace. Activate
911 first, but if you want to keep this person alive long enough for the fire department and
paramedics to arrive, CPR may be the key to their survival.

RISK FACTORS

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Cardiovascular diseases which include strokes and heart attacks kill more people than
anything else on the planet. Risk Factors are the things we do or don’t do that affect our
chances of having a heart attack or stroke (blockage of blood to the brain). There are
basically two types. These are: non-controllable and controllable risk factors.

Let’s start with controllable risk factors:

Smoking:

It’s no surprise to most people that smoking is bad for your health and for those around you
as well. Most people are aware of lung and respiratory diseases that are caused by smoking
but what many people aren’t aware of is that smoking is also a leading cause of heart attacks
as well! Nicotine is highly addictive stuff and is what keeps you coming back for more. It’s
also a vasodilator which means that it makes your blood vessels tighten up and get smaller
thereby decreasing the amount of blood flow to various parts of the body including the heart.
The heart needs oxygen to survive! Did you also know that the same stuff that comes out of
your cars tailpipe is also found in cigarettes? It’s called carbon monoxide. This chemical robs
oxygen from the red blood cells in your blood. The red blood cells are like a bus that delivers
oxygen. The problem is that the stuff that carries the oxygen is 250 times more attracted to
carbon monoxide (the bad stuff) than oxygen (life sustaining stuff). So now we’ve decreased
the amount oxygen within our blood! Smoking will also make the smoker more susceptible to
blood clots. If one of these blood clots gets lose and gets stuck in the brain causing a stroke or
block an artery in the heart causing a heart attack, it increases the chances of death. Think
twice before taking that next smoke break!! Especially think about the children that live
among us.

Diet:

We all know that a diet high in fat can cause a heart attack. Too much fat in the body will
simply move to the bloodstream making it a white milky substance that will tend to stick to
your arteries thicken the walls and diminish the free flow of blood. Control the amount of fat
you put into your body.

Exercise:

If any of the previous topics concern you, maybe you would benefit from a little exercise.
Exercising will help alleviate stress and will also increase the function of your heart. The best

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type of exercise for your heart is aerobic exercise. This type of exercise will increase your
heart beat and respirations for a prolonged period of time. It will also make your heart a more
efficient ‘pump’. A good aerobic program could help eliminate some if not all the dangers
associated with controllable risk factors. It can help improve circulation, lower blood pressure
and occasionally develop new blood vessels. Be sure to check with your physician before
starting a fitness program.

Let’s take a quick look at non-controllable risk factors. These include:

Heredity:

If your family is prone to having heart attacks, then you will be more susceptible to a heart
attack.

Gender:

Whether you’re male or female also plays a part in your chances of having a heart attack.
Women are at lower risk of having a heart attack because of the estrogen in their bodies.

Age:

We cannot control how old we get. But we can control how healthy we are when we get
there. By assuring a healthy life style now we can avoid problems in the future. Our advice is
to reduce the controllable risk factors every day. By stopping or slowing your smoking, by
increasing your activity level and reducing the amount of fat and cholesterol in your diet, you
may reduce the chances of having a heart attack.

RECOGNIZING A HEART ATTACK

Recognizing the signs and symptoms of a heart attack and knowing what to do can be the
most critical step in saving your life or the life of a loved one. If an artery leading to the heart
becomes blocked it will prevent blood from getting to certain parts of the heart. The tissue of
the heart will almost instantly start to die. This is called a heart attack. A heart attack does not
mean that the heart has stopped. Rather it’s a warning; indicating that the heart may stop at
any moment. DO NOT perform CPR on a person that is still breathing or has an obvious
pulse. Call 911 immediately!

Signs and symptoms of a heart attack

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1) Pain in the chest. This is the most common sign. The pain may move around to other parts
of the body. You may begin feeling pain in the jaw or arms. Women especially may feel pain
in other parts of the body such as in the belly or back.

2) Tightness of the chest. The person may describe a sensation as if someone were sitting on
their chest, causing difficulty breathing. Any chest pain or breathing difficulty should be
reported to 911.

3) Sweating along with cool, pale skin is another sign.

4) Nausea or vomiting.

5) Denial. Who wants to admit that they’re having a heart problem? Usually no one. Denial is
another sign usually accompanied by anyone of the signs listed above. Heart attack victims
often say that they’re having pains due to indigestion, heartburn, asthma, or illness. The
longer you argue with the person about the validity of their symptoms the less time they may
have to live. Go to the other room if necessary and call 911 from there. Don’t wait until the
heart stops. As the heart tissue continues to die, the heart may actually stop beating. This is
called Cardiac Arrest. If the person in cardiac arrest doesn’t get help immediately they will
likely die. Do not hesitate to call 911.

PERFORMING CPR

The first step in determining if there is a true emergency is to find out if the person really
requires help. Approach the victim cautiously and tap them as you ask, “Are you O.K.?”. If
the person does not respond, Activate 911 immediately. Call 911 or have a bystander call for
you. Make eye contact and shout’ “Call 911 and come back”. It may take several minutes for
help to arrive, so you should begin the ABC’s of CPR. Before we go into details with
numbers, the ABC’s apply to everyone, whether they’re an adult, child or an infant. Lets’ go
over them first.

Airway

Open the airway. Place on hand over the victim’s forehead, and two fingers under the bony
part of the chin. Gently tilt the head backward. This will open the airway and lift the tongue
off the back of the throat.

Breathing

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Lean over the victim’s face and look, listen and feel. Look for the chest to rise. Listen for air
movement and feel for air movement. If the victim is not breathing, continue tilting the head
back, pinch the nostrils and administer 2 effective rescue breaths. You should blow until the
victims chest slowly stops rising.

Circulation

Look, listen and feel for signs of circulation. While attempting to find the victims pulse, look
to see if there’s movement, listen for sounds of movements or moaning, and feel for
movement and pulse. If the victim has a pulse but is not breathing begin Rescue Breathing for
the victim by giving them one breath every 5 seconds. If there’s no pulse present begin CPR.
You should wait no more than 10 seconds to find a pulse. If you don’t know or are just
unsure begin CPR.

Let’s now look at the details of administering CPR. We’ve divided the lesson into three
separate tables. Each table will give details about administering CPR to an adult, child and to
an infant. All of them will begin the same. Remember, the initial ABC’s check will be the
same for all victims regardless of age.

ADULT CPR

In 2010, the American Heart Association and International Liaison Committee on

Resuscitation updated their CPR guidelines. The importance of high quality CPR (sufficient
rate and depth without excessively ventilating) was emphasized. The order of interventions
was changed for all age groups except newborns from airway, breathing, chest compressions
(ABC) to chest compressions, airway, breathing (CAB). An exception to this
recommendation is for those who are believed to be in a respiratory arrest (drowning, etc.).

Standard

A universal compression to ventilation ratio of 30:2 is recommended. With children, if at

least 2 rescuers are present a ratio of 15:2 is preferred. In newborns a rate of 3:1 is
recommended unless a cardiac cause is known in which case 15:2 ratio is reasonable. If an
advanced airway such as an endo-tracheal tube or laryngeal mask airway is in place delivery
of respirations should occur without pauses in compressions at a rate of 8–10 per minute. The
recommended order of interventions is chest compressions, airway, breathing or CAB in most
situations, with a compression rate of at least 100 per minute in all groups. Recommended

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compression depth in adults and children is about 5 cm (2 inches) and in infants it is 4 cm
(1.5 inches. As of 2010 the Resuscitation Council (UK) still recommends ABC for
children. As it can be difficult to determine the presence or absence of a pulse the pulse check
has been removed for lay providers and should not be performed for more than 10 seconds by
health care providers. In adults rescuers should use two hands for the chest compressions,
while in children they should use one, and with infant’s two fingers (index and middle
fingers).

Compression only

Compression-only (hands-only or cardio-cerebral resuscitation) CPR is a technique that

involves chest compressions without artificial respiration. It is recommended as the method
of choice for the untrained rescuer or those who are not proficient as it is easier to perform
and instructions are easier to give over the phone. In adults with out-of-hospital cardiac
arrest, compression-only CPR by the lay public has a higher success rate than standard
CPR. The exceptions are cases of drowning, drug overdose, and arrest in children. Children
who receive compression-only CPR have the same outcomes as those who received no
CPR. The method of delivering chest compressions remains the same, as does the rate (at
least 100 per minute). It is hoped that the use of compression-only delivery will increase the
chances of the lay public delivering CPR. As per the American Heart Association, the beat of
the Bee Gees song "Staying Alive" provides an ideal rhythm in terms of beats per minute to
use for hands-only CPR. One can also hum "Another One Bites The Dust" performed
by Queen, which is exactly 100 beats-per-minute and its repeating drum pattern is easier to
remember. For those with non cardiac arrest and people less than 20 years of age, standard
CPR is superior to compression-only CPR.

In pregnancy

During pregnancy when a woman is lying on her back the uterus may compress the inferior

vena cava and thus decrease venous return. It is recommended for this reason that the uterus
be pushed to the woman's left and if this is not effective either roll the person 30° or consider
emergency cesarean section.