Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is an emergency procedure employed in medicine and cardiology to sustain brain function manually until further measures can be taken to restore spontaneous blood circulation and breathing in individuals experiencing cardiac arrest. It is indicated for those who are unresponsive and not breathing, or displaying abnormal breathing patterns like agonal respirations, both within and outside hospital settings.

CPR involves administering chest compressions at least 5 cm deep and at a rate of at least 100 per minute to create artificial circulation by manually pumping blood through the heart. Additionally, the rescuer may provide breaths by either exhaling into the subject's mouth or utilizing a device to push air into the subject's lungs, a process known as artificial respiration. Recent recommendations prioritize high-quality chest compressions over artificial respiration, with simplified CPR methods focusing solely on chest compressions for untrained rescuers.

CPR alone is unlikely to restart the heart; its primary aim is to restore partial oxygenated blood flow to the brain and heart, delaying tissue death and extending the window of opportunity for successful resuscitation without permanent brain damage. Defibrillation, the administration of an electric shock to the heart, is often necessary to restore a viable heart rhythm. However, defibrillation is only effective for certain heart rhythms, such as ventricular fibrillation or pulseless ventricular tachycardia. CPR may induce a shockable heart rhythm, making defibrillation possible. CPR is typically continued until the return of spontaneous circulation (ROSC) or until the patient is declared deceased.

CPR is indicated for any unresponsive individual with absent or abnormal breathing patterns, presuming they may be in cardiac arrest. The presence or absence of a pulse is not typically assessed by laypersons, though healthcare professionals may choose to do so. In cases of cardiac arrest due to trauma, CPR may be futile in the absence of a pulse but is still recommended for correctable causes of arrest.

The American Heart Association and International Liaison Committee on Resuscitation updated CPR guidelines in 2010, emphasizing the importance of high-quality CPR and altering the sequence of interventions to prioritize chest compressions before airway and breathing. Compression to ventilation ratios vary by age group and circumstances, with compression-only CPR recommended for untrained rescuers or those not proficient in CPR delivery.

While compression-only CPR is simpler and more effective for laypersons in adult out-of-hospital cardiac arrest, it may not be as beneficial for certain cases like drownings, drug overdoses, or pediatric arrests. However, for cardiac arrests in children, conventional CPR with rescue breathing may yield better outcomes, especially in cases of non-cardiac arrest causes.