Citizendia

"CPR" redirects here. For other uses, see CPR (disambiguation).
CPR being performed on a mannequin used for training
CPR being performed on a mannequin used for training

Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. Mannequin (alternately manikin, mannikin, manakin, dummy or lay figure) A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. [1] CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals. The term " layman " originated from the use of the term Laity, but over the centuries changed definition to mean a person who is a non-expert in a given field of [2]

CPR has for 50 years consisted of the combination of artificial blood circulation with artificial respiration (also known as mouth-to-mouth (MTM)),[1] i. Artificial respiration is the act of simulating respiration, which provides for the overall exchange of gases in the body by pulmonary ventilation external respiration and internal e. , chest compressions and lung ventilation. [3] However, in March 2008 the American Heart Association, in an historic reversal, endorsed the effectiveness of chest compressions alone--without artificial respiration--for adult victims who collapse suddenly in cardiac arrest (see Cardiocerebral Resuscitation below). [4] CPR is generally continued, usually in the presence of advanced life support, until the patient regains a heart beat (called "return of spontaneous circulation" or "ROSC") or is declared dead. Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred Death is the termination of the biological functions that define living Organisms It refers both to a specific

CPR is unlikely to restart the heart, but rather its purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. Brain damage, or Acquired brain injury, is the destruction or degeneration of Brain cells. Defibrillation and advanced life support are usually needed to restart the heart. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred

Contents

History

Main article: History of CPR
Sign showing old Silvester and Holger-Nielson methods of resuscitation
Sign showing old Silvester and Holger-Nielson methods of resuscitation

CPR has been known in theory, if not practice, for many hundreds or even thousands of years; some claim it is 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". Cardiopulmonary resuscitation is an important life saving first aid skill practised throughout the world Etymology According to the Online Etymology Dictionary, the word bible is from Latin biblia, traced from the same word through Medieval Latin and Late Latin The Books of Kings ( Sefer Melachim, ספר מלכים are a part of Judaism 's Tanakh, the Hebrew Bible. Elisha ( Greek el Ελισσαίος Elisaios) is a Biblical prophet 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. [5] The procedure is repeated sixteen times per minute. This type of artificial respiration is occasionally seen in films made in the early part of the 20th century.

A second technique, called the Holger Neilson 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. The Boy Scout Handbook is the official handbook of the Boy Scouts of America. This form is seen well into the 1950s (it is 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"). Lassie is an Emmy Award -winning American Television series that follows the adventures of a female rough collie named Lassie Tom and Jerry is a series of theatrical Short subjects (cartoons created by William Hanna and Joseph Barbera for Metro-Goldwyn-Mayer The Cat and the Mermouse is a 1949 one-reel Animated cartoon and is the 43rd Tom and Jerry short directed by William Hanna 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 was not until the middle of the 20th century that the wider medical community started to recognize and promote artificial respiration combined with chest compressions as a key part of resuscitation following cardiac arrest. A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude, Guy Knickerbocker and Peter Safar. Peter Safar ( April 12, 1924 &ndash August 2, 2003) was an Austrian physician of Czech descent Jude and Knickerbocker, along with William Kouwenhouen had recently discovered the method of external chest compressions, whereas Safar had worked with James Elam to prove the effectiveness of artificial respiration. James Otis Elam, (1918 &ndash 10 July 1995) was a US MD and respiratory researcher Their combined findings were presented at annual Maryland Medical Society meeting on September 16, 1960 in Ocean City, and gained rapid and widespread acceptance over the following decade, helped by the video and speaking tour they undertook. Events 1400 - Owain Glyndŵr is declared Prince of Wales by his followers Year 1960 ( MCMLX) was a Leap year starting on Friday (link will display full calendar of the Gregorian calendar. Peter Safar wrote the book ABC of resuscitation in 1957. Peter Safar ( April 12, 1924 &ndash August 2, 2003) was an Austrian physician of Czech descent In the U. S. , it was first promoted as a technique for the public to learn in the 1970s. [6]

Mouth-to-mouth ventilation was combined with chest compressions based on the assumption that active ventilation is necessary to keep circulating blood oxygenated, and the combination was accepted without comparing its effectiveness with chest compressions alone. However, research over the past decade has shown that assumption to be in error, resulting in the AHA's acknowledgment of the effectiveness of chest compressions alone (see Cardiocerebral resuscitation below). [4]

Use in cardiac arrest

CPR training: CPR is being administrated while a second rescuer prepares for defibrillation.
CPR training: CPR is being administrated while a second rescuer prepares for defibrillation. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia.

The medical term for the condition in which a person's heart has stopped is cardiac arrest[7] (also referred to as cardiorespiratory arrest). A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of CPR is used on patients in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Oxygenation refers to the amount of Oxygen in a medium In Blood it may be taken to be synonymous with Saturation, which describes the degree to which Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute

Blood circulation and oxygenation are absolute requirements in transporting oxygen to the tissues. Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Brain damage, or Acquired brain injury, is the destruction or degeneration of Brain cells. If blood flow ceases for 1 or 2 hours, the cells of the body die unless they get an adequately gradual bloodflow, (provided by cooling and gradual warming, rarely, in nature [such as in a cold stream of water] or by an advanced medical team). Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. Because of that CPR is generally only effective if performed within 7 minutes of the stoppage of blood flow. [8] The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures as sometimes seen in drowning prolong the time the brain survives. 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. Brain death is a legal definition of death that emerged in the 1960s as a response to the ability to resuscitate individuals and mechanically keep the heart and lungs working Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia.

If the patient still has a pulse, but is not breathing, this is called respiratory arrest and artificial respiration is more appropriate. In Medicine, a person's pulse is the throbbing of their arteries. Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. Artificial respiration is the act of simulating respiration, which provides for the overall exchange of gases in the body by pulmonary ventilation external respiration and internal However, since people often have difficulty detecting a pulse, CPR may be used in both cases, especially when taught as first aid (see below).

Guidelines

In 2005, new CPR guidelines[9][10] were published by the International Liaison Committee on Resuscitation, agreed at the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The International Liaison Committee on Resuscitation ( ILCOR was formed in 1992 to provide an opportunity for the major organizations in Resuscitation to work together on [11][12] The primary goal of these changes was to simplify CPR for lay rescuers and healthcare providers alike, to maximise the potential for early resuscitation. The important changes for 2005 were:[13]

Research[9] has shown that lay personnel cannot accurately detect a pulse in about 40% of cases and cannot accurately discern the absence of pulse in about 10%. The pulse check step has been removed from the CPR procedure completely for lay persons and de-emphasized for healthcare professionals.

Alternative methods

Compression only (cardiocerebral) resuscitation

The traditional International Liaison Committee on Resuscitation (ILCOR) approach described above has been challenged in recent years by advocates for compression only CPR, also known as cardiocerebral resuscitation (CCR). The International Liaison Committee on Resuscitation ( ILCOR was formed in 1992 to provide an opportunity for the major organizations in Resuscitation to work together on This technique is simply chest compressions without artificial respiration. Artificial respiration is the act of simulating respiration, which provides for the overall exchange of gases in the body by pulmonary ventilation external respiration and internal The respiration component of CPR has been a topic of major controversy over the past decade. The CCR method has been championed by the University of Arizona's Sarver Heart Center, and a study by the university,[16] claimed a 300% greater success rate over standard CPR. The University of Arizona (also referred to as UA, U of A, or Arizona) is a Land-grant and space-grant public institution [17] The exceptions were in the case of drowning or drug overdose. Drowning is Death as caused by suffocation when a liquid causes interruption of the body's absorption of oxygen from the air leading to Asphyxia. The term drug overdose (or simply overdose or OD) describes the Ingestion or application of a Drug or other substance in quantities

In March 2007, a Japanese study in the medical journal The Lancet presented strong evidence that compressing the chest, not mouth-to-mouth (MTM) ventilation, is the key to helping someone recover from cardiac arrest. This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. [18] An editorial by Gordon Ewy MD (a proponent of CCR) in the same issue of The Lancet called for an interim revision of the ILCOR Guidelines based on the results of the Japanese study, but the next scheduled revision of the Guidelines was not until 2010. However, on March 30, 2008, the American Heart Association broke away from the ILCOR position and stated that compression-only CPR works as well as, and sometimes better than, traditional CPR. [19]

The method of delivering chest compressions remains the same, as does the rate (100 per minute), but the rescuer delivers only the compression element which, the University of Arizona claims, keeps the bloodflow moving without the interruption caused by MTM respiration.

Rhythmic abdominal compressions

Rhythmic abdominal compression-CPR works by forcing blood from the blood vessels around the abdominal organs, an area known to contain about 25 percent of the body's total blood volume. This blood is then redirected to other sites, including the circulation around the heart. Findings published in the September 2007 issue of the American Journal of Emergency Medicine using pigs found that 60 percent more blood was pumped to the heart using rhythmic abdominal compression-CPR than with standard chest compression-CPR, using the same amount of effort. There was no evidence that rhythmic abdominal compressions damaged the abdominal organs and the risk of rib fracture was avoided. Avoiding mouth-to-mouth breathing and chest compressions eliminates the risk of rib fractures and transfer of infection. [20]

Self-CPR

A form of "self-CPR" termed "Cough CPR" was the subject of a hoax chain e-mail entitled "How to Survive a Heart Attack When Alone" which wrongly cited "ViaHealth Rochester General Hospital" as the source of the technique. Cough CPR is a resuscitation technique described in an email that began circulating around 1999 in which by coughing and deep breathing every 2 seconds a person suffering a Cardiac A hoax is a deliberate attempt to Dupe, Deceive or trick an audience into believing or accepting that something is real when in fact it is not or that A typical chain letter consists of a Message that attempts to induce the recipient to make a number of copies of the letter and then pass them on to as many recipients Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Rochester is a city in Monroe County, New York State, south of Lake Ontario in the United States. Rochester General Hospital has denied any connection with the technique. [21][22]

Rapid coughing has been used in hospitals for brief periods of cardiac arrhythmia on monitored patients. Dysrhythmia redirects here For the American band see Dysrhythmia (band. One researcher has recommended that it be taught broadly to the public. [23][24]

However, “cough CPR” cannot be used outside the hospital because the first symptom of cardiac arrest is unconsciousness[25] in which case coughing is impossible. Further, the vast majority of people suffering chest pain from a heart attack will not be in cardiac arrest and CPR is not needed. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply In these cases attempting “cough CPR” will increase the workload on the heart and may be harmful. When coughing is used on trained and monitored patients in hospitals, it has only been shown to be effective for 90 seconds. [26]

The American Heart Association (AHA) and other resuscitation bodies,[27] do not endorse "Cough CPR", which it terms a misnomer as it is not a form of resuscitation. The American Heart Association (AHA is a Non-profit organization in the United States that fosters appropriate The AHA does recognize a limited legitimate use of the coughing technique:

"This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital, particularly during cardiac catheterization. Dysrhythmia redirects here For the American band see Dysrhythmia (band. Cardiac catheterization ( heart cath) is the insertion of a Catheter into a chamber or vessel of the Heart. In such cases the patients ECG is monitored continuously, and a physician is present. "[28]

Prevalence and effectiveness

Chance of receiving CPR

Various studies suggest that in out of home cardiac arrest, bystanders, lay persons or family members attempt CPR in between 14%[29] and 45%[30] of the time, with a median of 32%. This indicates that around 1/3 of out-of-home arrests have a CPR attempt made on them. However, the effectiveness of this CPR is variable, and the studies suggest only around half of bystander CPR is performed correctly. [31][32]

There is a clear correlation between age and the chance of CPR being commenced, with younger people being far more likely to have CPR attempted on them prior to the arrival of emergency medical services. [29][33] It was also found that CPR was more commonly given by a bystander in public, than when an arrest occurred in the patient's home, although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts. [30] This is supported by further research, which suggests that people with no connection to the victim are more likely to perform CPR than a member of their family. [34]

There is also a correlation between the cause of arrest and the likelihood of bystander CPR being initiated. Lay persons are most likely to give CPR to younger cardiac arrest victims in a public place when it has a medical cause; victims in arrest from trauma, exsanguination or intoxication are less likely to receive CPR. [34]

Chance of receiving CPR in time

CPR is only likely to be effective if commenced within 6 minutes after the blood flow stops,[35] because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4-6 minutes in an oxygen deprived environment and the cells are unable to survive the reintroduction of oxygen in a traditional resuscitation. Research using cardioplegic blood infusion resulted in a 79. 4% survival rate with cardiac arrest intervals of 72±43 minutes, traditional methods achieve a 15% survival rate in this scenario, by comparison. New research is currently needed to determine what role CPR, electroshock, and new advanced gradual resuscitation techniques will have with this new knowledge[36] 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 tissues' need for oxygen. Hypothermia is a condition in which an organism's temperature drops below that required for normal Metabolism and bodily functions Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. Human physiology is the science of the mechanical physical and biochemical functions of Humans in good health their organs and the cells of which they are composed [37] There are cases where CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia. [38]

Chance of surviving

Used alone, CPR will result in few complete recoveries, 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. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred [39] However, in the case of "non-shockable" rhythms such as Pulseless Electrical Activity (PEA), defibrillation is not indicated, and the importance of CPR rises. Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the On average, only 5%-10% of people who receive CPR survive. [40] The purpose of CPR is not to "start" the heart, but rather to circulate oxygenated blood, and keep the brain alive until advanced care (especially defibrillation) can be initiated. As many of these patients may have a pulse that is impalpable by the layperson rescuer, the current consensus is to perform CPR on a patient that is not breathing. A pulse check is not required in basic CPR since it is so often missed when present, or even felt when absent, even by health care professionals.

Studies have shown the importance of immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest improve survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York City, without those advantages, the survival rate is only 1-2 percent. [41]

Type of Arrest ROSC Survival Source
Witnessed In-Hospital Cardiac Arrest 48% 22% [42]
Unwitnessed In-Hospital Cardiac Arrest 21% 1% [42]
Bystander Cardiocerebral Resuscitation 40% 6% [43]
Bystander Cardiopulmonary Resuscitation 40% 4% [43]
No Bystander CPR (Ambulance CPR) 15% 2% [43]
Defibrillation within 3-5 minutes 74% 30% [39][41]

ROSC - Return of spontaneous circulation

Chest compression adjuncts

Several different devices have become available in order to help facilitate rescuers in getting the chest compressions completed correctly. These devices can be split in to three broad groups - timing devices, those that assist the rescuer to achieve the correct technique, especially depth and speed of compressions, and those which take over the process completely.

Timing devices

They can feature a metronome (an item carried by many ambulance crews) in order to assist the rescuer in getting the correct rate. A metronome is any device that produces a regulated aural visual or tactile pulse to establish a steady Tempo in the performance of music The CPR trainer cited here has timed indicators for pressing on the chest, breathing and changing operators.

Manual assist devices

These items can be devices to placed on top of the chest, with the rescuers hands going over the device, and a display giving information on depth or force. [44] Several published evaluations of one particular product, known as CPREzy, with these features show that the device can improve the performance of chest compressions. [45][46] More recently, these features have also been combined in to a wearable format, as a glove. [47] This glove also has additional features such as a basic electro-cardiogram device. This device was developed by students as part of their thesis, and has been named as one of the top ten inventions of 2007 in Popular Science magazine. [48]

Certain ZOLL defibrillation pads are capable of performing similar function, in that they may display rate and depth of compressions. Additionally, a certain algorithm allows them to monitor electrical activity even during CPR ("see-thruCPR").

Automatic devices

There are also some devices available which take over the chest compressions for the rescuer. These devices use techniques such as pneumatics to drive a compressing pad on to the chest of the patient. One such device, known as the LUCAS, was developed at the University Hospital of Lund, is powered by the compressed air cylinders or lines available in ambulances or in hospitals, and has undergone numerous clinical trials, showing a marked improvement in coronary perfusion pressure[49] and return of spontaneous circulation. [50]

Another system called the AutoPulse is electrically powered and uses a large band around the patients chest which contracts in rhythm in order to deliver chest compressions. The AutoPulse is an automated Cardiopulmonary resuscitation machine created by Revivant and subsequently purchased by ZOLL This is also backed by clinical studies showing increased successful return of spontaneous circulation. [51][52]

Place in film and television

CPR is often severely misrepresented in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation. A 1996 study published in the New England Journal of Medicine showed that CPR success rates in television shows was 75%. [53]

It is important to note that CPR techniques portrayed on television and in film are purposely incorrect. Actors performing simulated CPR will keep their elbows bent, to prevent force from reaching the fictional victim's heart. As well as causing significant local trauma, in theory performing CPR on healthy persons may disrupt heart rhythms. In medical terminology blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of Physical trauma [54]

Application on animals

It is entirely feasible to perform CPR on animals like cats and dogs. The principles and practices are virtually identical to CPR for humans. One is cautioned to only perform CPR on unconscious animals to avoid the risk of being bitten[55] and that animals, depending on species, have a smaller bone density than humans causing bones to become weakened after performed.

References

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See also

External links

A pocket mask, or pocket face mask or CPR mask, is a device used to safely deliver rescue breaths during a Cardiac arrest or Respiratory Resusci Anne, also known as Rescue Anne or CPR Annie, is a training mannequin used for teaching Cardiopulmonary resuscitation (CPR to both emergency workers Face shield refers to a variety of devices used to protect a medical professional during a procedure that might expose the worker to blood or other potentially infectious fluid Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred

Dictionary

cardiopulmonary resuscitation

-noun

  1. A first aid procedure for cardiac arrest involving compression of the chest wall alternating with artificial respiration.
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