Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) is a lifesaving procedure used when a person experiences cardiac arrest, characterized by the absence of a heartbeat and insufficient blood circulation to vital organs. In such situations, time is critical, as brain and organ function can deteriorate within minutes due to lack of oxygen. CPR involves two key components: chest compressions and artificial breathing. Chest compressions help circulate blood, while mouth-to-mouth breathing provides essential oxygen. This technique is crucial in cases of various emergencies, including heart attacks, drowning, and suffocation.
Training in CPR is highly recommended, as it significantly increases the chances of survival from sudden cardiac arrest. Organizations like the American Heart Association and the American Red Cross offer certification courses, and automated external defibrillators (AEDs) are often made available in public spaces to assist in emergencies. Although CPR can sometimes cause minor injuries to the recipient, the benefits of performing it during cardiac arrest far outweigh the risks. Overall, prompt action and proper training in CPR can dramatically improve outcomes during life-threatening situations.
Cardiopulmonary resuscitation (CPR)
- ANATOMY OR SYSTEM AFFECTED: Circulatory system, heart, lungs, respiratory system
DEFINITION: A procedure that combines chest compressions and artificial breathing for a person whose breathing and heart contractions have stopped.
Indications and Procedures
Cardiopulmonary resuscitation (CPR) is generally performed on a person who is in cardiac arrest. In the United States, someone dies from sudden cardiac arrest (SCA) every two minutes. Cardiac arrest occurs when a person has no heartbeat or an insufficient heartbeat to pump blood to the brain and other vital organs. Without sufficient blood flow, these organs do not receive enough oxygen to function normally; after about four minutes, they begin to die. This life-threatening situation requires immediate attention to keep the person alive. If medical personnel are not immediately available, then emergency medical services (EMS) should be called and CPR should be initiated.
Cardiac arrest can have many causes. The most common is a severe heart attack. Many heart attacks do not require CPR, but if a person is unconscious with no pulse, then CPR should begin as soon as possible. Other causes of cardiac arrest that may require CPR are drowning, suffocation, drug overdose, electrocution, stroke, and other types of brain damage. In each of these situations, the heart is not contracting and pumping blood.
CPR includes two distinct operations, breathing air into the person’s lungs and compressing the chest. In mouth-to-mouth breathing, sometimes called artificial respiration, the rescuer breathes air into the person’s lungs, causing the chest to rise and fall with each breath. The rescuer’s expired air is 16 percent oxygen, as compared with 21 percent oxygen in room air. This expired air has enough oxygen to maintain life. It is recommended that an individual providing mouth-to-mouth breathing use a protective device, such as a CPR mask or shield, to avoid transmission of potentially infectious body fluids. The mask or shield devices can be purchased for a small cost online or from uniform stores or university medical bookstores.
Chest compressions involve the application of pressure to the lower half of the breastbone. The external pressure increases the pressure in the chest, pushing blood to the brain and the rest of the body. Although this procedure circulates only 25 to 33 percent of normal blood flow, it is sufficient to keep the person alive when used in conjunction with mouth-to-mouth breathing.
In an emergency situation, CPR can be administered by one or two people. One person can alternate mouth-to-mouth breathing and chest compressions. Performing CPR for several minutes, however, can be exhausting. If two certified rescuers are present, one can do the mouth-to-mouth breathing while the other performs chest compressions. Two people can do the procedure more efficiently and for longer periods of time.
Uses and Complications
Cardiopulmonary resuscitation should be used only if a person is suffering from cardiac arrest. There are no other applications. Even when CPR is correctly performed by experienced, certified medical personnel, injury can occur to the individual receiving CPR. These injuries may include broken ribs, bruising of the heart, and tearing of the liver and/or the spleen. However, these injuries should not deter an individual from performing CPR. Cardiopulmonary resuscitation is only performed when a person is clinically dead, without a pulse or respiration. Individuals should take a course and become certified to learn the most effective and safest techniques.
Effective CPR sends oxygen to the vital organs to prevent permanent tissue death, but it cannot alter abnormal electrical energy that may be occurring in the heart muscle. This abnormal electrical energy does not allow the heart to pump blood adequately throughout the body. Medical attention is generally needed to restart the heart contractions, and CPR must be continued until EMS personnel arrive. Emergency medical personnel will defibrillate the heart by sending an electric shock through the chest in an attempt to correct the abnormal electrical energy in the heart so that it can resume normal contractions.
Almost anyone can become certified in CPR. The American Heart Association and the American Red Cross offer classes with certification. These organizations are also involved in campaigns to have as many people certified as possible because CPR doubles a victim’s chances of sudden cardiac arrest survival. Therefore, the more people who are certified, the more likely it is that someone can perform CPR in an emergency and the more likely it is the victim will survive.
Another program to reduce deaths from sudden cardiac arrest includes the use of automated external defibrillators (AEDs). These units are computerized and allow a person with minimal training to defibrillate a heart. An AED unit has simple steps to follow with voice and print instructions. The machine has built-in safety features to prevent a person from receiving defibrillation that is not needed. AED units have been placed in work sites, stadiums, airports, and other places where large numbers of people are found. Designated people in these areas are trained to use the AEDs. If the first defibrillation shock is administered within six minutes, then the victim has an approximately 45 percent chance of survival.
Perspective and Prospects
Mouth-to-mouth breathing dates to biblical times, when it was used by midwives to resuscitate newborns. It fell out of practice until the 1950s, when it was rediscovered by James Elam and Peter Safer. In 1960, other physicians found that chest compressions could attain sufficient circulation, and these compressions were combined with mouth-to-mouth breathing to create a CPR procedure similar to what is used today.
Literature on CPR indicates that a prompt response to a cardiac arrest incident can be critical for the person's ultimate survival. A technology that has had a relatively recent impact on CPR and patient survival is smart devices. With the proliferation of smart smartphones and watches, applications are available to monitor a person before a cardiac incident occurs. These apps collect biodata from a wearer and the app detects early warnings of an impending event. This app can alert both the at-risk individual and first responders if the data indicates a high-probability of a cardiac event. If a cardiac arrest is already in progress, smartphone apps such as Rescue Me CPR! can direct emergency response efforts from untrained individuals. Other apps are now available that provide feedback on whether a responder is providing CRP at an adequate depth and rates. PulsePoint Respond is an app on smartphones that is connected to 911 responders and can alert bystanders of a CPR incident happening in their proximity.
Bibliography
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