CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart. CPR is indicated for any person unresponsive with no breathing 2010 cpr guidelines pdf breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest. CPR serves as the foundation of successful cardiopulmonary resuscitation, preserving the body for defibrillation and advanced life support.
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 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. 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. This may be due to medical staff being ultimately unable to address the cause of the cardiac arrest, to other co-morbidities, or to the patient being gravely ill in more than one way.
While CPR is a last resort intervention, without which a person without a pulse will all but certainly die, the physical nature of how CPR is performed does lead to complications that may need to be rectified. The type and frequency of injury can be affected by factors such as gender and age. For instance, women have a higher risk of sternal fractures than men, and risk for rib fractures increases significantly with age. CPR training: CPR is being administered while a second rescuer prepares for defibrillation.
In 2010, the American Heart Association and International Liaison Committee on Resuscitation updated their CPR guidelines. 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. A universal compression to ventilation ratio of 30:2 is recommended for adults. With children, if at least 2 trained 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 a 15:2 ratio is reasonable. 100 per minute in all groups.
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 healthcare providers. CPR which involves chest compressions without artificial ventilation 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, compression-only CPR by the lay public has an equal or higher success rate than standard 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. As per the American Heart Association, the beat of the Bee Gees song “Stayin’ Alive” provides an ideal rhythm in terms of beats per minute to use for hands-only CPR. Standard CPR is performed with the person in supine position.
Prone CPR or reverse CPR is CPR performed on a person lying on their chest, by turning the head to the side and compressing the back. Due to the head’s being turned, the risk of vomiting and complications caused by aspiration pneumonia may be reduced. The American Heart Association’s current guideline recommends to perform CPR in the supine position, and limits prone CPR to situations where the patient cannot be turned. During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return.
Evidence generally supports family being present during CPR. This includes in CPR for children. 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 into the chest cavity, 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 is used on people in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. While several adjunctive devices are available, none other than defibrillation, as of 2010, have consistently been found to be better than standard CPR for out-of-hospital cardiac arrest. Some units can also give timing reminders for performing compressions, ventilating and changing operators. Mechanical chest compression devices are not currently recommended for widespread use.