- Clinical science
Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that maintains circulation in patients with sudden cardiac arrest until cardiac function can be restored. Sudden cardiac arrest presents with unconsciousness, apnea, and pulselessness. There are two protocols for CPR: Basic Life Support (BLS) for lay rescuers and professionals alike and Advanced Cardiac Life Support (ACLS) for medical professionals. BLS includes checking the patient's responsiveness, calling for help, performing chest compressions and rescue breaths, and, if available, the use of an automated external defibrillator (AED). Advanced Cardiac Life Support includes additional procedures performed by medical professionals, such as drug therapy (especially epinephrine), securing the airways (e.g., endotracheal intubation), and finding and treating reversible causes of cardiac arrest. Immediate initiation of high-quality chest compressions is the most important factor in the success of CPR.
Chain of survival
- Check responsiveness and call for help
- Immediate cardiopulmonary resuscitation (CPR)
- Early defibrillation
- Early advanced life support
Immediate initiation of high-quality chest compressions, minimizing interruption of chest compressions, and early defibrillation are the most important factors in improving patient survival! Minimizing the time elapsed prior to CPR is crucial for avoiding long-term complications!
Basic Life Support (BLS)
|What to do||Details|
Check responsiveness and call for help
CAUTION: Make sure that everyone stays clear of the patient before defibrillation!
|Continue CPR||Continue CPR until professional help arrives or the patient shows clear signs of life.|
Early cardiac arrest often presents as gasping respiration, which should be interpreted as abnormal respiration and is therefore an indication for CPR!
|Call for help|
|Chest compressions|| |
Treat reversible causes
- Further management
All comatose patients who achieve ROSC (return of spontaneous circulation) after cardiac arrest should be subjected to mild hypothermia therapy for at least 24 hours (32–36°C target core temperature)!
|Shockable rhythm||Nonshockable rhythms|
|Explanation|| || || || |
|Consequence|| || |
Newborns and children
Ventilation is more important in children and newborns than in adults, as respiratory distress is a common cause of cardiac arrest in children!
5 initial rescue breaths → CPR
- Compression rate: 100–120/min
- Compression-to-ventilation ratio → 3:1
- Technique of chest compressions: tip of two fingers; (one emergency rescuer) or two-thumb-encircling hands (≥ 2 emergency rescuers)
Children older than 1 year
5 rescue breaths→ CPR
- Compression rate: 100-120/min
- Medical professionals: 15:2
- Lay rescuers: 30:2
- Further management should follow the guidelines for adults.
- 5 rescue breaths→ CPR
- Defibrillation: : monophasic and biphasic waveforms: 2–4 J/kg of body weight
- In observed cardiac arrest, a precordial thump may be attempted.