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Cardiopulmonary resuscitation (CPR)
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10.21.06 (1 year ago)
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Cardiopulmonary resuscitation (CPR) is an emergency first aid protocol for an unconscious person on whom neither breathing nor pulse can be detected.
The medical term for a patient whose heart has stopped is cardiac arrest (also referred to as cardiorespiratory arrest), in which case CPR is used. If the patient still has a pulse, but is not breathing, this is called respiratory arrest and Rescue breathing is used.
The most common treatable cause of cardiac arrest outside of a hospital is a heart attack leading to a heart rhythm disturbance. Cardiac arrest may be caused by a number of events, including drowning, drug overdoses, poisoning, electrocution and many other conditions.
Many countries have official guidelines on how CPR should be provided, and these naturally override the general description of CPR in this article.
Beginning in 2004, some jurisdictions began receiving automated CPR machines such as the AutoPulse, which will do the necessary chest compressions automatically and allow the first responders to attend to other needs for the affected patient.
In 2005, new CPR guidelines were published with input from the American Heart Association, the Canadian Heart and Stroke Foundation and European Resuscitation Council, with the primary goal of simplifying CPR for laypersons and healthcare providers alike.
Contents
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1 Importance
2 Effectiveness
3 CPR training
4 History
5 Myths and popular culture
6 External links
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Importance
Heart action and respiratory effort are absolute requirements in transporting oxygen to the tissues. One of the main organs to suffer from oxygen starvation is the brain, which may sustain damage after four minutes and irreversible damage after about seven minutes. The heart also rapidly loses the ability to maintain a normal rhythm. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts. We talk about first aid ABC.
CPR is commonly taught to the general public as these may be the only ones present in the crucial few minutes before emergency personnel are available. If administered properly it can save lives but when done badly or inappropriately it can interfere with life saving operations later. Sometimes CPR should not be attempted, particularly if other persons are injured and need immediate help. CPR takes a lot of effort and may keep care providers from helping others. See triage.
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Effectiveness
CPR is almost never effective if started more than 15 minutes after collapse because permanent brain damage has probably already occurred. Especially if the person has stopped breathing, since the brain can only survive for 3 minutes without oxygen. A notable exception is cardiac arrest occurring in conjunction with exposure to very cold temperatures. Hypothermia seems to protect the victim by slowing down metabolic and physiologic processes, greatly decreasing the oxygen needed by tissues. There are cases where CPR, defibrillation, and advanced warming techniques have revived hypothermia victims after over 30 minutes or longer. A patient cannot be pronounced dead before he has been brought back to a normal temperature by appropriate means.
Used alone, few patients will make a complete recovery, and those that do survive often develop serious complications. Estimates vary, but many organizations stress that CPR does not "bring anyone back", it simply preserves the body for defibrillation and advanced life support. As a general rule, CPR has a success rate of only 5 to 10 percent.[1]
In 2005, new resuscitation guidelines were published jointly by the International Liaison Committee on Resuscitation (ILCOR) and several regional bodies (Such as the American Heart Association, the European Resuscitation Council, & the Resuscitation Council (UK)), designed to increase the effectiveness of CPR. They found that in order for CPR to be most effective:
There should be minimal interruptions to chest compressions: no more than 5 seconds.
Compressions should be of adequate depth: 1 1/2 to 2 inches of the depth of the chest for an adult victim, 1/3 to 1/2 the depth of the chest for children and infants.
Compressions should be given at a fast rate: 100 per minute, or approximately 30 compressions in 15 to no more than 23 seconds for one rescuer.
It is also considered by ILCOR and a number of national and international bodies that in order for CPR to be effective, the guidelines must be simple and easy to remember, as the biggest barrier to providing CPR is thought to be the confidence of the rescuer.[2]
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CPR training
CPR is a practical skill and needs professional instruction followed up by regular practice on a resuscitation mannequin to gain and maintain full competency. Training is available through many commercial, volunteer and government organizations worldwide.
CPR training is not confined to the medical professionals. To be effective, CPR must be applied almost immediately after a patient's heart has stopped. Early CPR on the scene of an incident is essential to the prevention of brain damage during a cardiac arrest. Blood flow and air supply to the brain and other major organs is maintained until a defibrillator and professional medical help arrives. Almost anyone is able to perform CPR with training, and health organizations advocate the development of CPR skills throughout the general public.
It is best to obtain training in CPR before a medical emergency occurs. One needs hands-on training by experts to perform CPR safely, and guidelines change, so that training should be repeated every one or two years. Training in first aid is often available through community organizations such as the Red Cross and St. John Ambulance. In many countries in the Commonwealth of Nations, St. John Ambulance provides CPR training. In Scotland, St. Andrew's Ambulance Association provides first aid training. In the United States, the American Heart Association and American CPR Training also offer CPR training.
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History
CPR has been known in theory, if not practice, for many hundreds, if not thousands, of years; some claim it is even described in the Bible, discerning a superficial similarity to CPR in a passage from the Books of Kings (II 4:34), wherein the Hebrew prophet Elisha warms a dead boy's body and "places his mouth over his". In the 19th century, doctor H. R. Silvester described a method (The Silvester Method) of artificial respiration 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. The procedure is repeated sixteen times per minute. This type of artificial respiration is occasionally seen in movies made in the early part of the 20th century.
A second technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, described a form of artificial respiration where the person was laid on their front, with their head to the side, and a process of lifting their arms and pressing on their back was utilized, essentially the Silvester Method with the patient flipped over. This form is seen well into the 1950's (it's used in an episode of Lassie during the Jeff Miller era), and was often used, sometimes for comedic effect, in theatrical cartoons of the time (see Tom and Jerry's "The Cat and the Mermouse"). This method would continue to be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in 1979.
However it wasn't until the middle of the 20th century that the wider medical community started to recognise and promote it as a key part of resuscitation following cardiac arrest. Peter Safar 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. Early marketing efforts oversold the effectiveness of CPR in rescuing heart attack and other victims, and this misperception continues even today.
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Myths and popular culture
CPR is often portrayed in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation. A 1996 study by the New England Journal of Medicine showed that CPR success rates in television shows was 75% [3]. The real survival rate of an unwitnessed, out-of-hospital sudden cardiac arrest is in a range of 6% to admission and even less to hospital discharge
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