Cardiopulmonary resuscitation (CPR) is an
emergency procedure An emergency procedure is a plan of actions to be conducted in a certain order or manner, in response to a specific class of reasonably foreseeable emergency, a situation that poses an immediate risk to health, life, property, or the Natural enviro ...
consisting of chest compressions often combined with
artificial ventilation
Artificial ventilation (also called artificial respiration) is a means of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and interna ...
in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
. It is
recommended in those who are unresponsive with no breathing or abnormal breathing, for example,
agonal respiration
Agonal respiration, gasping respiration or agonal breathing is a distinct abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Possible causes include ...
s.
CPR involves chest compressions for adults between and deep and at a rate of at least 100 to 120 per minute.
The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose (
mouth-to-mouth resuscitation
Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses their mouth against that of the victim and blows air into the person's lungs. Artificial respiration ta ...
) or using a device that pushes air into the subject's lungs (
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air ...
). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving only chest compressions is recommended for untrained rescuers. With children, however, 2015
American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
guidelines indicate that doing only compressions may actually result in worse outcomes, because such problems in children normally arise from respiratory issues rather than from cardiac ones, given their young age.
[ Chest compression to breathing ratios is set at 30 to 2 in adults.
CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the ]brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
and heart
The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage
Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating t ...
. Administration of an electric shock to the subject's heart, termed defibrillation
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...
, is usually needed in order to restore a viable, or "perfusing", heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation
Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the ventricles of the heart quiver. It is due to disorganized electrical activity. Ventricular fibrillation results in cardiac arrest with loss of consciousness and no p ...
or pulseless ventricular tachycardia
Ventricular tachycardia (V-tach or VT) is a fast heart rate arising from the lower chambers of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period ...
, rather than asystole
Asystole (New Latin, from Greek privative a "not, without" + ''systolē'' "contraction") is the absence of ventricular contractions in the context of a lethal heart arrhythmia (in contrast to an induced asystole on a cooled patient on a heart-lun ...
or pulseless electrical activity
Pulseless electrical activity (PEA) refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 55% of people in cardiac arrest.
...
, which usually require the treatment of underlying conditions to restore cardiac function. Early shock, when appropriate, is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.
Medical uses
CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
.[ If a person still has a ]pulse
In medicine, a pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the nec ...
but is not breathing (respiratory arrest
Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long p ...
) artificial ventilation
Artificial ventilation (also called artificial respiration) is a means of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and interna ...
s may be more appropriate, but, due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse. In those with cardiac arrest due to trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
, CPR is considered futile but still recommended. Correcting the underlying cause such as a tension pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is ...
or pericardial tamponade
Cardiac tamponade, also known as pericardial tamponade (), is the buildup of fluid in the pericardium (the sac around the heart), resulting in compression of the heart. Onset may be rapid or gradual. Symptoms typically include those of obstruct ...
may help.[
]
Pathophysiology
CPR is used on people in cardiac arrest in order to oxygenate
Oxygenated chemical compounds contain oxygen as a part of their chemical structure. The term usually refers to oxygenated chemical compounds added to fuels. Oxygenates are usually employed as gasoline additives to reduce carbon monoxide and soot ...
the blood and maintain a cardiac output
In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...
to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen
Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
to the tissues. The physiology of CPR involves generating a pressure gradient between the arterial and venous vascular beds; CPR achieves this via multiple mechanisms The brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
may sustain damage
Damage is any change in a thing, often a physical object, that degrades it away from its initial state. It can broadly be defined as "changes introduced into a system that adversely affect its current or future performance".Farrar, C.R., Sohn, H., ...
after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. Typically if blood flow ceases for one to two hours, then body cells die
Die, as a verb, refers to death, the cessation of life.
Die may also refer to:
Games
* Die, singular of dice, small throwable objects used for producing random numbers
Manufacturing
* Die (integrated circuit), a rectangular piece of a semicondu ...
. Therefore, in general CPR is effective only if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings, prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain stem death
Brainstem death is a clinical syndrome defined by the absence of reflexes with pathways through the brainstem – the "stalk" of the brain, which connects the spinal cord to the mid-brain, cerebellum and cerebral hemispheres – in a de ...
, and allows the heart to remain responsive to defibrillation
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...
attempts.
Methods
In 2010, the American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
and International Liaison Committee on Resuscitation
The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide an opportunity for the major organizations in resuscitation to work together on CPR (Cardiopulmonary Resuscitation) and ECC (Emergency Cardiovascular Care) ...
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
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB). An exception to this recommendation is for those believed to be in a respiratory arrest
Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long p ...
(airway obstruction, drug overdose, etc.). The most important aspect of CPR are: few interruptions of chest compressions, a sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much. It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation.
Compressions with rescue breaths
A normal CPR procedure uses chest compressions and ventilations. The compressions push on the bone that is in the middle of the chest (sternum
The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...
) and the ventilations are made pinching the victim's nose and blowing air mouth-to-mouth. If the victim is a baby, the rescuer would make the ventilations covering the baby's mouth and nose at the same time. It is recommended for all victims of any age a general compression-to-ventilation ratio of 30:2 (30 rhythmic compressions before each 2 ventilations).
As an exception for the normal compression-to-ventilation ratio of 30:2, if at least two trained rescuers are present, and the victim is a child, a ratio of 15:2 is preferred. And, according to the AHA 2015 Guidelines, the ratio in newborns is 30:2 if one rescuer is present and 15:2 if two rescuers are present. In an advanced airway treatment, such as an endotracheal tube
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide.
Many different types of tracheal tubes are a ...
or laryngeal mask airway
A laryngeal mask airway (LMA), also known as laryngeal mask, is a medical device that keeps a patient's airway open during anaesthesia or while they are unconscious. It is a type of supraglottic airway device. They are most commonly used by anae ...
, the artificial ventilation should occur without pauses in compressions, at a rate of 1 breath every 6 to 8 seconds (8–10 ventilations per minute).
In all the victims, the compression speed is of at least 100 compressions per minute. Recommended compression depth in adults and children is of 5 cm (2 inches), and in infants it is 4 cm (1.6 inches). In adults, rescuers should use two hands for the chest compressions (one on the top of the other), while in children one hand can be enough, and with babies the rescuer must use only two fingers.
There exist some plastic shields and respirators that can be used in the rescue breaths between the mouths of the rescuer and the victim, with the purposes of sealing a better vacuum and avoiding infections.
In some cases, the patient has experienced one of the failures in the rhythm of the heart (ventricular fibrillation and ventricular tachycardia) that can be corrected with the electric shock of a defibrillator
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''coun ...
. It is important then that someone asks for the defibrillator and to use it, which would be easy, because the common models of defibrillator (the AEDs) are automatic portable machines that guide to the user with recorded voice instructions along the process, and analyze the victim, and apply the correct shocks if they are needed. Besides, there exist written instructions of defibrillators that explain how to use them step-by-step.
The recommended order of normal cardiopulmonary resuscitation is the 'CAB': first 'Chest' (chest compressions), followed by 'Airway' (attempt to open the airway by performing a head tilt and a chin lift), and 'Breathing' (rescue breaths). Anyway, as of 2010, the Resuscitation Council (UK)
Resuscitation Council UK (RCUK) is a healthcare charity focused on resuscitation education and training for healthcare professionals and bystander CPR awareness for the public. It is the United Kingdom body responsible for setting central standards ...
was still recommending an 'ABC' order if the victim is a child. It can be difficult to determine the presence or absence of a pulse, so the pulse check has been removed for common providers and should not be performed for more than 10 seconds by healthcare providers.
Compression only
For adults with cardiac arrest, compression-only (hands-only or cardiocerebral resuscitation) CPR which involves chest compressions without artificial ventilation
Artificial ventilation (also called artificial respiration) is a means of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and interna ...
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 a phone. In adults with out-of-hospital cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
, compression-only CPR by the lay public has an equal or higher success rate than standard CPR.[ Acknowledgements include: Mary Fran Hazinski, RN, MSN; Michael Shuster, MD; Michael W. Donnino, MD; et al., 2015. "The ''2015 AHA Guidelines Update for CPR and ECC'' is based on an international evidence evaluation process that involved 250 evidence reviewers from 39 countries."] It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR.
Compression-only CPR is not as good for children who are more likely to have cardiac arrest from respiratory causes. Two reviews have found that compression-only CPR had no more success than no CPR whatsoever. Rescue breaths for children and especially for babies should be relatively gentle. Either a ratio of compressions to breaths of 30:2 or 15:2 was found to have better results for children. Both children and adults should receive a hundred chest compressions per minute. Other exceptions besides children include cases of drowning
Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer a ...
s and drug overdose
A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended. . In both these cases, compressions and rescue breaths are recommended if the bystander is trained and is willing to do so.
As per the American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
, the beat of the Bee Gees
The Bee Gees
were a musical group formed in 1958 by brothers Barry, Robin, and Maurice Gibb. The trio were especially successful in popular music in the late 1960s and early 1970s, and later as prominent performers in the disco music era in ...
song "Stayin' Alive
"Stayin' Alive" is a song written and performed by the Bee Gees from the ''Saturday Night Fever'' motion picture soundtrack. The song was released in 1977 as the second single from the ''Saturday Night Fever'' soundtrack. The band co-produced ...
" provides an ideal rhythm in terms of beats per minute to use for hands-only CPR, which is 104 beats-per-minute. One can also hum Queen
Queen or QUEEN may refer to:
Monarchy
* Queen regnant, a female monarch of a Kingdom
** List of queens regnant
* Queen consort, the wife of a reigning king
* Queen dowager, the widow of a king
* Queen mother, a queen dowager who is the mother ...
's "Another One Bites The Dust
"Another One Bites the Dust" is a song by the British rock band Queen. Written by bassist John Deacon, the song was featured on the group's eighth studio album '' The Game'' (1980). It was a worldwide hit, charting number one on the US ''Billb ...
", which is 110 beats-per-minute and contains a memorable repeating drum pattern. For those in cardiac arrest due to non heart related causes and in people less than 20 years of age, standard CPR is superior to compression-only CPR.
Prone CPR
Standard CPR is performed with the victim in supine position
The supine position ( or ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; ...
. Prone CPR, or reverse CPR, is performed on a victim in prone position
Prone position () is a body position in which the person lies flat with the chest down and the back up. In anatomical terms of location, the dorsal side is up, and the ventral side is down. The supine position is the 180° contrast.
Etymolog ...
, lying on the chest. This is achieved by turning the head to the side and compressing the back. Due to the head being turned, the risk of vomiting and complications caused by aspiration pneumonia
Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may inclu ...
may be reduced.
The American Heart Association's current guideline recommends performing CPR in the supine position
The supine position ( or ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; ...
, and limits prone CPR to situations where the patient cannot be turned.
Pregnancy
During pregnancy
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
when a woman is lying on her back, the uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...
may compress the inferior vena cava
The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...
and thus decrease venous return.[ It is therefore recommended that the uterus be pushed to the woman's left. This can be done by placing a pillow or towel under her right hip so that she is on an angle of 15-30 degrees, and making sure their shoulders are flat to the ground. If this is not effective healthcare professionals should consider emergency ]resuscitative hysterotomy
A resuscitative hysterotomy, also referred to as a perimortem Caesarean section (PMCS) or perimortem Caesarean delivery (PMCD), is a hysterotomy performed to resuscitate a woman in middle to late pregnancy who has entered cardiac arrest. Combined ...
.[
]
Family presence
Evidence generally supports family being present during CPR. This includes in CPR for children.
Other
Interposed abdominal compressions may be beneficial in the hospital environment. There is no evidence of benefit pre-hospital or in children.[
Cooling during CPR is being studied as currently results are unclear whether or not it improves outcomes.
Internal cardiac massage is manual squeezing of the exposed heart itself carried out through a ]surgical incision
In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an Surgery, operation or medical procedure, procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as ...
into the chest cavity
The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment of the thoracic cavity is the mediastinum. There ...
, usually when the chest is already open for cardiac surgery.
Active compression-decompression methods using mechanical decompression of the chest have not been shown to improve outcome in cardiac arrest.
CPR for Heart Attack: Airway:
If you’ve been trained in CPR after you’ve done the 30 compressions to your chest, you can open the airway for your child by performing the head-tilted chin-lift technique.
* Place your fingers on the forehead of the child and gently tilt the child’s head to the side.
* On the other hand, use the other hand to gently lift the cheeks forward to open the airway
For more help.
Use of devices
Defibrillators
Defibrillators produce a defibrillation (electric shocks) that can restore the normal heart function of the victim.
Nevertheless, they are only indicated for some arrhythmia
Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
s (abnormal heart beatings), specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia
Ventricular tachycardia (V-tach or VT) is a fast heart rate arising from the lower chambers of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period ...
. Defibrillation is not indicated if the patient is conscious or has a normal pulse. Defibrillation is also not indicated if the heart has completely stopped, as in asystole
Asystole (New Latin, from Greek privative a "not, without" + ''systolē'' "contraction") is the absence of ventricular contractions in the context of a lethal heart arrhythmia (in contrast to an induced asystole on a cooled patient on a heart-lun ...
or pulseless electrical activity (PEA), in those cases a normal CPR would be used to oxygenate the brain until the heart function can be restored. Improperly given electrical shocks can cause dangerous arrhythmia
Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
s, such as the ventricular fibrillation (VF).
The standard defibrillation device, prepared for a fast use out of the medical centres, is the automated external defibrillator (AED), a portable machine of small size (similar to a briefcase) that can be used by any user with no previous training. That machine produces recorded voice instructions that guide to the user along the defibrillation process. It also checks the victim's condition to apply automatically electric shocks at a correct level, if they are needed. Other models are semi-automatic and need that the user push a button before producing an electric shock.
The defibrillation process is simple, but there exist writte
instructions of defibrillators
that explain it step-by-step.
There are several devices for improving CPR but, only defibrillators
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''coun ...
(as of 2010) have been found better than standard CPR for an out-of-hospital cardiac arrest.
Devices for timing CPR
Timing devices can feature a metronome
A metronome, from ancient Greek μέτρον (''métron'', "measure") and νομός (nomós, "custom", "melody") is a device that produces an audible click or other sound at a regular interval that can be set by the user, typically in beats pe ...
(an item carried by many ambulance crews) in order to assist the rescuer in achieving the correct rate. Some units can also give timing reminders for performing compressions, ventilating and changing operators.
Devices for assisting in manual CPR
Mechanical chest compression devices have not been found to be better than standard manual compressions. Their use is reasonable in situations where manual compressions are not safe to perform such as a moving vehicle.[
Audible and visual prompting may improve the quality of CPR and prevent the decrease of compression rate and depth that naturally occurs with fatigue, and to address this potential improvement, a number of devices have been developed to help improve CPR technique.
These items can be devices to be placed on top of the chest, with the rescuer's hands going over the device, and a display or audio feedback giving information on depth, force or rate, or in a wearable format such as a glove. Several published evaluations show that these devices can improve the performance of chest compressions.
As well as its use during actual CPR on a cardiac arrest victim, which relies on the rescuer carrying the device with them, these devices can also be used as part of training programs to improve basic skills in performing correct chest compressions.
]
Devices for providing automatic CPR
Mechanical CPR has not seen as much use as mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air ...
; however, use in the prehospital setting is increasing. Devices on the market include the LUCAS device
The Lund University Cardiopulmonary Assist System (LUCAS) device provides mechanical chest compressions to patients in cardiac arrest. It is mostly used in emergency medicine as an alternative to manual CPR because it provides consistent compressi ...
, developed at the University Hospital of Lund, and AutoPulse. Both use straps around the chest to secure the patient. The first generation of the LUCAS uses a gas-driven piston and motor-driven constricting band, while later version are battery operated.
There are several advantages to automated devices: they allow rescuers to focus on performing other interventions; they do not fatigue and begin to perform less effective compressions, as humans do; they are able to perform effective compressions in limited-space environments such as air ambulance
Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
s, where manual compressions are difficult, and they allow ambulance workers to be strapped in safely rather than standing over a patient in a speeding vehicle. However the disadvantages are cost to purchase, time to train emergency personnel to use them, interruption to CPR to implement, potential for incorrect application and the need for multiple device sizes.
Several studies have shown little or no improvement in survival rates but acknowledge the need for more study.
Mobile apps for providing CPR instructions
To support training and incident management, mobile apps have been published on the largest app markets. An evaluation of 61 available apps has revealed that a large number do not follow international guidelines for basic life support and many apps are not designed in a user-friendly way. As a result, the Red Cross updated and endorsed its emergency preparedness application, which uses pictures, text and videos to assist the user.
The UK Resuscitation Council, has an app, called Lifesaver, which shows how to perform CPR.
Effectivity rate
CPR oxygenates the body and brain, which favours making a later defibrillation
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...
and the advanced life support
Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing).
Components
These include:
* Tracheal in ...
. Even in the case of a "non-shockable" rhythm, such as pulseless electrical activity
Pulseless electrical activity (PEA) refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 55% of people in cardiac arrest.
...
(PEA) where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.
Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed "shockable" arrest. In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest. Similarly in-hospital CPR is more successful when arrests are witnessed or are in the ICU or in patients wearing heart monitors, where the arrests are noticed immediately, as shown in the table and graph later in this article.
\* AED data here exclude health facilities and nursing homes, where patients are sicker than average.
In adults compression-only CPR by bystanders appears to be better than chest compressions with rescue breathing. Compression-only CPR may be less effective in children than in adults, as cardiac arrest in children is more likely to have a non-cardiac cause. In a 2010 prospective study of cardiac arrest in children (age 1–17) for arrests with a non-cardiac cause, provision by bystanders of conventional CPR with rescue breathing yielded a favorable neurological outcome at one month more often than did compression-only CPR ( OR 5.54). For arrests with a cardiac cause in this cohort, there was no difference between the two techniques (OR 1.20). This is consistent with American Heart Association guidelines for parents.
When done by trained responders, 30 compressions interrupted by two breaths appears to have a slightly better result than continuous chest compressions with breaths being delivered while compressions are ongoing.
Measurement of end-tidal carbon dioxide during CPR reflects cardiac output and can predict chances of ROSC.
In a study of in-hospital CPR from 2000 to 2008, 59% of CPR survivors lived over a year after hospital discharge and 44% lived over 3 years.
Consequences
Performing CPR is advised as an urgent intervention, for when a person is not breathing and therefore would certainly die without it.
Survival rates: In US hospitals in 2017, 26% of patients who received CPR survived to hospital discharge.
In 2017 in the US, outside hospitals, 16% of people whose cardiac arrest was witnessed survived to hospital discharge.
Since 2003, widespread cooling of patients after CPR
and other improvements have raised survival and reduced mental disabilities.
Organ donation
Organ donation is usually made possible by CPR, even if CPR does not save the patient. If there is a return of spontaneous circulation Return of spontaneous circulation (ROSC) is the resumption of a sustained heart rhythm that perfuses the body after cardiac arrest. It is commonly associated with significant respiratory effort. Signs of return of spontaneous circulation include bre ...
(ROSC), all organs can be considered for donation. If the patient does not achieve ROSC, and CPR continues until an operating room is available, the kidneys and liver can still be considered for donation.
1,000 organs per year in the US are transplanted from patients who had CPR.
Donations can be taken from 40% of patients who have ROSC and later become brain dead.
Up to 8 organs can be taken from each donor,
and an average of 3 organs are taken from each patient who donates organs.
Mental abilities
Mental abilities are about the same for survivors before and after CPR for 89% of patients, based on before and after counts of 12,500 US patients' Cerebral-Performance Category (CPC) codes in a 2000-2009 study of CPR in hospitals. 1% more survivors were in comas than before CPR. 5% more needed help with daily activities. 5% more had moderate mental problems and could still be independent.
For CPR outside hospitals, a Copenhagen study of 2,504 patients in 2007-2011 found 21% of survivors developed moderate mental problems but could still be independent, and 11% of survivors developed severe mental problems, so they needed daily help. Two patients out of 2,504 went into comas (0.1% of patients, or 2 out of 419 survivors, 0.5%), and the study did not track how long the comas lasted.
Most people in comas start to recover in 2–3 weeks. 2018 guidelines on disorders of consciousness say it is no longer appropriate to use the term "permanent vegetative state." Mental abilities can continue to improve in the six months after discharge, and in subsequent years. For long-term problems, brains form new paths to replace damaged areas.
[
*]
Injuries
Injuries from CPR vary. 87% of patients are not injured by CPR. Overall, injuries are caused in 13% (2009-12 data) of patients, including broken sternum or ribs (9%), lung injuries (3%), and internal bleeding (3%).
The internal injuries counted here can include heart contusion, hemopericardium
Hemopericardium refers to blood in the pericardial sac of the heart. It is clinically similar to a pericardial effusion, and, depending on the volume and rapidity with which it develops, may cause cardiac tamponade.
The condition can be caused by ...
, upper airway complications, damage to the abdominal viscera − lacerations of the liver and spleen, fat emboli, pulmonary
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...
complications − pneumothorax, hemothorax, lung contusions. Most injuries did not affect care; only 1% of those given CPR received life-threatening injuries from it.[
Broken ribs are present in 3%]
of those who survive to hospital discharge, and 15% of those who die in the hospital, for an average rate of 9% (2009-12 data)
to 8% (1997–99).
In the 2009-12 study, 20% of survivors were older than 75. A study in the 1990s found 55% of CPR patients who died before discharge had broken ribs, and a study in the 1960s found 97% did; training and experience levels have improved. Lung injuries were caused in 3% of patients and other internal bleeding in 3% (2009–12).
Bones heal in 1–2 months.
Training and experience levels have improved since the study in the 1990s which found 55% broken ribs among CPR patients who died before discharge, and the study in the 1960s which found 97%.
The costal cartilage also breaks in an unknown number of additional cases, which can sound like breaking bones.
The type and frequency of injury can be affected by factors such as sex and age. A 1999 Austrian study of CPR on cadavers, using a machine which alternately compressed the chest then pulled it outward, found a higher rate of sternal fractures in female cadavers (9 of 17) than male (2 of 20), and found the risk of rib fractures rose with age, though they did not say how much.
Children and infants have a low risk of rib fractures during CPR, with an incidence less than 2%, although, when they do occur, they are usually anterior
Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
and multiple.
Where CPR is performed in error by a bystander, on a person not in cardiac arrest, around 2% have injury as a result (although 12% experienced discomfort).
A 2004 overview said, "Chest injury is a price worth paying to achieve optimal efficacy of chest compressions. Cautious or faint-hearted chest compression may save bones in the individual case but not the patient's life."
Other side effects
The most common side effect is vomiting, which necessitates clearing the mouth so patients do not breathe it in.
It happened in 16 of 35 CPR efforts in a 1989 study in King County, WA, USA.
Survival differences, based on prior illness, age or location
The American Heart Association guidelines say that survival rates below 1% are "futility," but all groups have better survival than that. Even among very sick patients at least 10% survive: A study of CPR in a sample of US hospitals from 2001 to 2010, where overall survival was 19%, found 10% survival among cancer patients, 12% among dialysis patients, 14% over age 80, 15% among blacks, 17% for patients who lived in nursing homes, 19% for patients with heart failure, and 25% for patients with heart monitoring outside the ICU.
Another study, of advanced cancer patients, found the same 10% survival mentioned above.
A study of Swedish patients in 2007–2015 with ECG monitors found 40% survived at least 30 days after CPR at ages 70–79, 29% at ages 80–89, and 27% above age 90.
An earlier study of Medicare patients in hospitals 1992–2005, where overall survival was 18%, found 13% survival in the poorest neighborhoods, 12% survival over age 90, 15% survival among ages 85–89, and 17% survival among ages 80–84.
Swedish patients 90 years or older had 15% survival to hospital discharge, 80-89 had 20%, and 70-79 had 28%.
A study of King County WA patients who had CPR outside hospitals in 1999–2003, where 34% survived to hospital discharge overall, found that among patients with 4 or more major medical conditions, 18% survived; with 3 major conditions 24% survived, and 33% of those with 2 major medical conditions survived.
Nursing home residents' survival has been studied by several authors,
and is measured annually by the Cardiac Arrest Registry to Enhance Survival The Cardiac Arrest Registry to Enhance Survival or CARES was initiated in 2004 as an agreement between the Centers for Disease Control and Prevention and the Department of Emergency Medicine at Emory University. It is a simple but powerful database ...
(CARES). CARES reports CPR results from a catchment area of 115 million people, including 23 state-wide registries, and individual communities in 18 other states as of 2019. CARES data show that in health care facilities and nursing homes where AEDs are available and used, survival rates are double the average survival found in nursing homes overall.
Geographically, there is wide variation state-to-state in survival after CPR ''in US hospitals,'' from 40% in Wyoming to 20% in New York, so there is room for good practices to spread, raising the averages.
For CPR ''outside hospitals'', survival varies even more across the US, from 3% in Omaha to 45% in Seattle in 2001. This study only counted heart rhythms which can respond to defibrillator shocks (tachycardia).
A major reason for the variation has been delay in some areas between the call to emergency services and the departure of medics, and then arrival and treatment. Delays were caused by lack of monitoring, and the mismatch between recruiting people as firefighters, though most emergency calls they are assigned to are medical, so staff resisted and delayed on the medical calls. Building codes have cut the number of fires, but staff still think of themselves as firefighters.
Dysthanasia
In some instances CPR can be considered a form of dysthanasia.
Prevalence
Chance of receiving CPR
Various studies show that in out-of-home cardiac arrest, bystanders in the US attempt CPR in between 14% and 45% of the time, with a median of 32%. Globally, rates of bystander CPR reported to be as low as 1% and as high as 44%. However, the effectiveness of this CPR is variable, and the studies suggest only around half of bystander CPR is performed correctly. One study found that members of the public having received CPR training in the past lack the skills and confidence needed to save lives. The report's authors suggested that better training is needed to improve the willingness to respond to cardiac arrest. Factors that influence bystander CPR in out-of-hospital cardiac arrest include:
* Affordable training.
* Target CPR training to family members of potential cardiac arrest
* CPR classes should be simplified and shortened.
* Offer reassurance and education about CPR.
* Provide clearer information about legal implications for specific regions.
* Focus on reducing the stigma and fears around providing bystander CPR.
There is a relation between age and the chance of CPR being commenced. Younger people are far more likely to have CPR attempted on them before the arrival of emergency medical services.[ Bystanders more commonly administer CPR when in public than when at the person's home, although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts.][ People with no connection to the person are more likely to perform CPR than are a member of their family.]
There is also a clear relation between the cause of arrest and the likelihood of a bystander initiating CPR. Laypersons are most likely to give CPR to younger people in cardiac arrest in a public place when it has a medical cause; those in arrest from trauma, exsanguination
Exsanguination is death caused by loss of blood. Depending upon the health of the individual, people usually die from losing half to two-thirds of their blood; a loss of roughly one-third of the blood volume is considered very serious. Even a sing ...
or intoxication are less likely to receive CPR.[
It is believed that there is a higher chance that CPR will be performed if the bystander is told to perform only the chest compression element of the resuscitation.][
The first formal study into gender bias in receiving CPR from the public versus professionals was conducted by the ]American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
and the National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
(NIH), and examined nearly 20,000 cases across the U.S. The study found that women are six percent less likely than men to receive bystander CPR when in cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
in a public place, citing the disparity as "likely due to the fear of being falsely accused of sexual assault
Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which ...
."
Chance of receiving CPR in time
CPR is likely to be effective only if commenced within 6 minutes after the blood flow stops because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4–6 minutes in an oxygen deprived environment and, therefore, cannot survive the reintroduction of oxygen in a traditional resuscitation. Research using cardioplegic blood infusion resulted in a 79.4% survival rate with cardiac arrest intervals of 72±43 minutes, traditional methods achieve a 15% survival rate in this scenario, by comparison. New research is currently needed to determine what role CPR, defibrillation, and new advanced gradual resuscitation techniques will have with this new knowledge.
A notable exception is cardiac arrest that occurs in conjunction with exposure to very cold temperatures. Hypothermia
Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe h ...
seems to protect by slowing down metabolic
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
and physiologic
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
processes, greatly decreasing the tissues' need for oxygen. There are cases where CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia.
Society and culture
Portrayed effectiveness
CPR is often severely misrepresented in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation.
A 1996 study published in the New England Journal of Medicine showed that CPR success rates in television shows was 75% for immediate circulation, and 67% survival to discharge. This gives the general public an unrealistic expectation of a successful outcome. When educated on the actual survival rates, the proportion of patients over 60 years of age desiring CPR should they have a cardiac arrest drops from 41% to 22%.
Training and stage CPR
It is dangerous to perform CPR on a person who is breathing normally. These chest compressions create significant local blunt trauma
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical traumas, and particularly in the elderly who fall. It is contrasted with penetrating trauma which occurs when an object pierces the skin and enters a tissue ...
, risking bruising
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...
or fracture
Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
of the sternum
The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...
or ribs
The rib cage, as an enclosure that comprises the ribs, vertebral column and sternum in the thorax of most vertebrates, protects vital organs such as the heart, lungs and great vessels.
The sternum, together known as the thoracic cage, is a semi- ...
. If a patient is not breathing, these risks still exist but are dwarfed by the immediate threat to life. For this reason, training is always done with a mannequin
A mannequin (also called a dummy, lay figure, or dress form) is a doll, often articulated, used by artists, tailors, dressmakers, window dressers and others, especially to display or fit clothing and show off different fabrics and textiles. Pr ...
, such as the well-known Resusci Anne
Resusci Anne, also known as Rescue Anne, Resusci Annie, CPR Annie, Resuscitation Annie, Little Annie, or CPR Doll is a model of medical simulator used for teaching both emergency workers and members of the general public. Resusci Anne was deve ...
model.
The portrayal of CPR technique on television and film often is purposely incorrect. Actors simulating the performance of CPR may bend their elbows while appearing to compress, to prevent force from reaching the chest of the actor portraying the patient.
Self-CPR hoax
A form of "self-CPR" termed " cough CPR" was the subject of a hoax
A hoax is a widely publicized falsehood so fashioned as to invite reflexive, unthinking acceptance by the greatest number of people of the most varied social identities and of the highest possible social pretensions to gull its victims into pu ...
chain e-mail
A chain letter is a message that attempts to convince the recipient to make a number of copies and pass them on to a certain number of recipients. The "chain" is an exponentially growing pyramid (a tree graph) that cannot be sustained indefinite ...
entitled "How to Survive a Heart Attack
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...
When Alone," which wrongly cited "ViaHealth Rochester General Hospital" as the source of the technique. Rochester General Hospital has denied any connection with the technique.
"Cough CPR" in the sense of ''resuscitating'' oneself is impossible because a prominent symptom of cardiac arrest is unconsciousness, which makes coughing impossible.
The American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
(AHA) and other resuscitation bodies do not endorse "cough CPR", which it terms a misnomer as it is not a form of ''resuscitation''. The AHA does recognize a limited legitimate use of the coughing technique: "This coughing technique to maintain blood flow during brief arrhythmias
Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
has been useful in the hospital, particularly during cardiac catheterization
Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.
A common example of cardiac catheterization is coronary catheterization that ...
. In such cases the patient's ECG
Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...
is monitored continuously, and a physician is present." When coughing is used on trained and monitored patients in hospitals, it has been shown to be effective only for 90 seconds.
Learning from film
In at least one case, it has been alleged that CPR learned from a film was used to save a person's life. In April 2011, it was claimed that nine-year-old Tristin Saghin saved his sister's life by administering CPR on her after she fell into a swimming pool, using only the knowledge of CPR that he had gleaned from a motion picture, '' Black Hawk Down.''
Hands-only CPR portrayal
Less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location have CPR performed on them. Most bystanders are worried that they might do something wrong. On October 28, 2009, the American Heart Association and the Ad Council
The Advertising Council, commonly known as the Ad Council, is an American nonprofit organization that produces, distributes, and promotes public service announcements on behalf of various sponsors, including nonprofit organizations, non-governme ...
launched a hands-only CPR public service announcement
A public service announcement (PSA) is a message in the public interest disseminated by the media without charge to raise public awareness and change behavior. In the UK, they are generally called a public information film (PIF); in Hong Kong, ...
and website as a means to address this issue. In July 2011, new content was added to the website including a digital app that helps a user learn how to perform hands-only CPR.
History
In the 19th century, Doctor H. R. Silvester described a method (the Silvester method) of artificial ventilation in which the patient is laid on their back, and their arms are raised above their head to aid inhalation and then pressed against their chest to aid exhalation. Another technique, called the Holger Nielsen technique, described in the first edition of the '' Boy Scout Handbook'' in the United States in 1911, was a form of artificial ventilation where the person was laid face down, with their head to the side, resting on the palms of both hands.
It was not until the middle of the 20th century that the wider medical community started to recognize and promote artificial ventilation in the form of mouth-to-mouth resuscitation
Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses their mouth against that of the victim and blows air into the person's lungs. Artificial respiration ta ...
combined with chest compressions as a key part of resuscitation following cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
. The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude
James R. Jude (June 7, 1928 – July 28, 2015) was an American thoracic surgeon who was one of the developers of cardiopulmonary resuscitation (CPR). He was the brother of Victor N. Jude, a businessman and politician from Minnesota, and the uncl ...
, Guy Knickerbocker, and Peter Safar
Peter Safar (12 April 19242 August 2003) was an Austrian anesthesiology, anesthesiologist of Czechs, Czech descent. He is credited with pioneering cardiopulmonary resuscitation (CPR).
Early life
Safar was born in Vienna, Austria, in 1924 into a m ...
. Jude and Knickerbocker, along with William Kouwenhoven and Joseph S. Redding had recently discovered the method of external chest compressions, whereas Safar had worked with Redding and James Elam to prove the effectiveness of mouth-to-mouth resuscitation. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Pearson. Soon afterward, the technique was used to save the life of a child. Their combined findings were presented at the annual Maryland Medical Society meeting on September 16, 1960, in Ocean City, and gained widespread acceptance over the following decade, helped by the video and speaking tour they undertook. Peter Safar
Peter Safar (12 April 19242 August 2003) was an Austrian anesthesiology, anesthesiologist of Czechs, Czech descent. He is credited with pioneering cardiopulmonary resuscitation (CPR).
Early life
Safar was born in Vienna, Austria, in 1924 into a m ...
wrote the book ''ABC of Resuscitation'' in 1957. In the U.S., it was first promoted as a technique for the public to learn in the 1970s.
Mouth-to-mouth resuscitation was combined with chest compressions based on the assumption that active ventilation is necessary to keep circulating blood oxygenated, and the combination was accepted without comparing its effectiveness with chest compressions alone. However, research over the past decade has shown that assumption to be in error, resulting in the American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
's acknowledgment of the effectiveness of chest compressions alone (see '' Compression only'' in this article).
CPR has continued to advance, with recent developments including an emphasis on constant, rapid heart stimulation, and a de-emphasis on the respiration aspect. Studies have shown that people who had rapid, constant heart-only chest compression are 22% more likely to survive than those receiving conventional CPR that included breathing. Because people tend to be reluctant to do mouth-to-mouth resuscitation, chest-only CPR nearly doubles the chances of survival overall, by increasing the odds of receiving CPR in the first place.
On animals
It is feasible to perform CPR on animals, including cats and dogs. The principles and practices are similar to CPR for humans, except that resuscitation is usually done through the animal's nose, not the mouth. CPR should only be performed on unconscious animals to avoid the risk of being bitten; a conscious animal would not require chest compressions. Animals, depending on species, may have a lower bone density than humans and so CPR can cause bones to become weakened after it is performed.
Research
Cerebral performance category (CPC scores) are used as a research tool to describe "good" and "poor" outcomes. Level 1 is conscious and alert with normal function. Level 2 is only slight disability. Level 3 is moderate disability. Level 4 is severe disability. Level 5 is comatose or persistent vegetative state. Level 6 is brain dead or death from other causes.
See also
* Advance healthcare directive
An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no ...
* Automated external defibrillator
An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them thro ...
(AED)
* Impedance threshold device
* Lazarus syndrome
Lazarus syndrome (the Lazarus heart), also known as autoresuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of a normal cardiac rhythm after failed attempts at resuscitation. It is also the spontaneous return ...
, spontaneous autoresuscitation where attempts at artificial resuscitation have failed
* Slow code
Slow code refers to the practice in a hospital or other medical centre to purposely respond slowly or incompletely to a patient in cardiac arrest, particularly in situations for which cardiopulmonary resuscitation (CPR) is thought to be of no medi ...
References
Further reading
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External links
CPR
NHS Choices
How to resuscitate a child
NHS Choices
{{DEFAULTSORT:Cardiopulmonary Resuscitation
Articles containing video clips