Cardiopulmonary Resuscitation (CPR)

Heart disease is the number 1 killer in the United States. Each year, almost 330,000 Americans die from heart disease. Half of these will die suddenly, outside of the hospital, because their heart stops beating.

• The most common cause of death from a heart attack in adults is a disturbance in the electrical rhythm of the heart called ventricular fibrillation.
  • Ventricular fibrillation can be treated, but it requires applying an electrical shock to the chest called defibrillation.
  • If a defibrillator is not readily available, brain death will occur in less than 10 minutes.
• One way of buying time until a defibrillator becomes available is to provide artificial breathing and circulation by performing cardiopulmonary resuscitation, or CPR.
  • The earlier you give CPR to a person in cardiopulmonary arrest (no breathing, no heartbeat), the greater the chance of a successful resuscitation.
  • By performing CPR, you keep oxygenated blood flowing to the heart and brain until a defibrillator becomes available.
• Because up to 80% of all cardiac arrests occur in the home, you are most likely to perform CPR on a family member or loved one.
• CPR is one link in what the American Heart Association calls the "chain of survival." The chain of survival is a series of actions that, when performed in sequence, will give a person having a heart attack the greatest chance of survival.
  • When an emergency situation is recognized, the first link in the chain of survival is early access. This means activating the emergency medical services, or EMS, system by calling 911 (check your community plan, some communities require dialing a different number).
  • The next link in the chain of survival is to perform CPR until a defibrillator becomes available.
  • In some areas of the country, simple, computerized defibrillators, known as automated external defibrillators, or AEDs, may be available for use by the lay public or first person on the scene. If available, early defibrillation becomes the next link in the chain of survival.
  • Once the EMS unit arrives, the next link in the chain of survival is early advanced life support care. This involves administering medications, using special breathing devices, and providing additional defibrillation shocks if needed.

There is no substitute for learning cardiopulmonary resuscitation (CPR), but emergencies don't wait for training. These instructions are for conventional adult CPR. If you've never been trained in CPR and the victim collapsed in front of you, use hands-only CPR.
For kids, use the following guidelines:

• Infant CPR for kids under 1 year.
• Child CPR for kids 1-8 years old.

Not every CPR class is the same. There are CPR classes for healthcare professionals as well as CPR classes for the layperson. Before you take a CPR class, make sure the class is right for you.

 

These are the steps to perform adult CPR:

Difficulty: Easy

Time Required: CPR should start as soon as possible
Here's How:

1. Stay Safe! The worst thing a rescuer can do is become another victim. Follow universal precautions and wear personal protective equipment if you have it. Use common sense and stay away from potential hazards.
2. Attempt to wake victim. Briskly rub your knuckles against the victim's sternum. If the victim does not wake, call 911 and proceed to step 3. If the victim wakes, moans, or moves, then CPR is not necessary at this time. Call 911 if the victim is confused or not able to speak.
3. Begin rescue breathing. Open the victim's airway using the head-tilt, chin-lift method. Put your ear to the victim's open mouth:
   • look for chest movement
   • listen for air flowing through the mouth or nose
   • feel for air on your cheek
   If there is no breathing, pinch the victim's nose; make a seal over the victim's mouth with yours. Use a CPR mask if available. Give the victim a breath big enough to make the chest rise. Let the chest fall, then repeat the rescue breath once more. If the chest doesn't rise on the first breath, reposition the head and try again. Whether it works on the second try or not, go to step 4.
4. Begin chest compressions. Place the heel of your hand in the middle of the victim's chest. Put your other hand on top of the first with your fingers interlaced. Compress the chest about 1-1/2 to 2 inches (4-5 cm). Allow the chest to completely recoil before the next compression. Compress the chest at a rate equal to 100/minute. Perform 30 compressions at this rate.
5. Repeat rescue breaths. Open the airway with head-tilt, chin-lift again. This time, go directly to rescue breaths without checking for breathing again. Give one breath, making sure the chest rises and falls, then give another. Remember, if the chest doesn't rise on the first breath, reposition the head before you give the second breath.
6. Perform 30 more chest compressions. Repeat steps 5 and 6 for about two minutes.
7. After 2 minutes of chest compressions and rescue breaths, stop compressions and recheck victim for breathing. If the victim is not breathing, continue chest compressions and rescue breaths.
8. Keep going until help arrives.

Tips:

1. If you have acces to an automated external defibrillator, attach it to the victim after approximately one minute of CPR (chest compressions and rescue breaths).
2. Chest compressions are extremely important. If you are not comfortable giving rescue breaths, still perform chest compressions!
3. It's normal to feel pops and snaps when you first begin chest compressions - DON'T STOP! You aren't going to make the victim any worse. Cardiac arrest is as bad as it gets.
4. When performing chest compressions, do not let your hands bounce. Let the chest fully recoil, but keep the heel of your hand in contact with the sternum at all times.
5. For more information on these steps go to the Emergency Cardiac Care (ECC) Guidelines

Cardiac Arrest

When a person develops cardiac arrest, the heart stops beating. There is no blood flow and no pulse. With no blood flowing to the brain, the person becomes unresponsive and stops breathing normally.

• When you discover a person whom you believe is experiencing a medical emergency, the first thing to do is check for responsiveness. Gently shake the victim and shout, "Are you OK?"
• If the person does not respond to your voice or touch, they are unresponsive. If the victim is unresponsive and you are alone, leave the victim and immediately call 911. If someone is with you, tell him or her to call 911 and then return to help you.
• If an AED is available, bring it back to the person's side. The moment an AED becomes available, IMMEDIATELY press the "on" button. The AED will begin to speak to you. Follow its directions to use the AED.

Rescue Breathing

You now need to check to see if the person is breathing normally.

• You do this by first opening the person's airway. Tilt the victim's head back by lifting the chin gently with one hand, while pushing down on the forehead with the other hand.
• Next, place your ear next to the victim's mouth and nose and look, listen, and feel: Look to see if the chest is rising, listen for any sounds of breathing, and feel for any air movement on your cheek. Taking no more than 5-10 seconds, if you do not see, hear, or feel any signs of normal breathing, you must breathe for the victim.
• While keeping the victim's head tilted back, place your mouth around the victim's mouth and pinch the victim's nose shut. Give 2 slow breaths, making sure that the person's chest rises with each breath.

Chest Compressions

 

After giving 2 breaths immediately begin chest compressions.

• Place the heel of one hand on the center of the chest, right between the nipples. Place the heel of your other hand on top of the first hand. Lock your elbows and position your shoulders directly above your hands. Press down on the chest with enough force to move the breastbone down about 2 inches. Compress the chest 30 times, at a rate of about 100 times per minute (slightly faster than once every second).
• After 30 compressions, stop, open the airway again, and provide the next 2 slow breaths. Then, position your hands in the same spot as before and perform another 30 chest compressions. Continue the cycles of 30 compressions and 2 breaths until an AED becomes available or until EMS providers arrive.
• This technique of performing CPR may be used on anyone older than eight years of age.

CPR in Children

Sudden cardiac arrest is less common in children than it is in adults. It usually happens when there is a lack of oxygen caused by a breathing problem such as choking, near-drowning, or respiratory infections. Because oxygen often corrects the problem in a child, when an unresponsive, non-breathing child is found, CPR is performed for 1 minute before activating the EMS system. This may reverse the lack of oxygen and revive the child.
In order to use an AED on a child from one year of age through eight years of age a special pediatric cable is used to reduce the amount of energy provided by the electrical shock.
Doing CPR on children aged one year to eight years is similar to doing CPR on adults. However, there are some minor differences. Most are due to the child's smaller size.

• When compressing the chest, the heel of only 1 hand is used instead of 2 hands, and the chest is pressed down about ½ of its depth.
• Perform 5 cycles of 30 chest compressions followed by 2 breaths, then use an AED to evaluate the heart rhythm if available.. If an AED is not available, and the child is still not breathing normally, coughing, or moving, continue cycles of 30 compressions to 2 breaths until help arrives.

CPR in Infants

An infant is defined as a child younger than one year of age. Because an infant is smaller than a child, the CPR technique for infants contains further changes.

• Even smaller breaths are given-enough to just get the chest to rise. Only 2 fingers are used to compress the chest down about 1 inch.
• Otherwise, the CPR sequence is the same as for the child.
• There are no recommendations for the use of AEDs in children less than one year of age.