Cardiopulmonary resuscitation

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For other meanings of CPR, see CPR (disambiguation).

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First Aid/CPR

Cardiopulmonary resuscitation (CPR), is emergency first aid for an unconscious person on whom breathing and pulse cannot be detected.

The medical term for this condition is cardiac arrest or, if the patient still has a pulse, respiratory arrest (the combined term cardiorespiratory arrest is also used). The most common treatable cause of cardiac arrest outside of a hospital is a heart attack leading to a heart rhythm disturbance. CPR can be used for cardiac or respiratory arrest due to drowning, drug overdoses and poisoning, electrocution and any other conditions featuring similar symptoms.

1 Importance
2 Effectiveness
3 History
4 CPR Training
5 Myths and popular culture
6 References
7 See also
8 External links
- 8.1 Downloads

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Importance

Image:CardiopulmonaryResuscitationAdult.jpg

CPR being performed on an adult

Heart action and respiratory effort are absolute requirements in transporting oxygen to the tissues. The main organ to suffer from oxygen starvation is the brain, which may sustain irreversible damage after about five minutes. The heart also rapidly loses the ability to maintain a normal rhythm. 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.

CPR is commonly taught to ordinary people who may be the only ones present in the crucial few minutes before emergency personnel are available.

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Effectiveness

CPR is almost never effective if started more than 15 minutes after collapse because permanent brain damage has probably already occurred. A notable exception is cardiac arrest occurring with exposure to very cold temperatures. A patient cannot be pronounced dead before he has been brought back to a normal temperature by appropriate means: Hypothermia seems to protect the victim somewhat. There are cases where CPR, defibrillation, and advanced warming techniques have revived hypothermia victims after over 30 minutes.

In respiratory arrest, when the victim still has a heartbeat, such as in drowning, choking, or drug overdose with opioids or sedatives, the Airway and Breathing part of CPR is relatively very effective. About 10% of those on which CPR has been performed will recover entirely.

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History

CPR was developed by Drs. James Elam and Peter Safar in the 1950s [1]. Safar wrote the book ABC of resuscitation in 1957. In the US, it was first promoted as a technique for the public to learn in the 1970s. Early marketing efforts oversold the effectiveness of CPR in rescuing heart attack and other victims. The standards for CPR in the United States are established by the American Heart Association. Rewritten every several years, most recently in 2000, these standards now have a more conservative view of the potential of bystander CPR and stress the importance of immediate defibrillation.

In the United Kingdom, the guidelines for CPR are written by the Resuscitation Council (UK). They are detailed in the current First aid manual (8th ed., Dorling Kindersley, ISBN 0751337048).

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CPR Training

CPR training is available through many commercial, volunteer and governmental organizations worldwide, including the American Red Cross, American CPR Training, the American Heart Association and St. John Ambulance.

CPR is a practical skill and needs to be regularly practiced on a resuscitation manikin to ensure full competency. Where knowledge of CPR is a job requirement, six monthly refresher courses are recommended.

CPR training should not be confined to just the medical professionals. Almost anyone is able to perform CPR: early CPR is essential in preventing brain damage during a cardiac arrest until a defibrillator or other medical help arrives.

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Myths and popular culture

Some people discern 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".

Several medical studies have indicated that CPR is inaccurately portrayed in the media: it is commonly described on television and movies as the definitive treatment of cardiac arrest and leads the general public to believe that CPR alone can have an extraordinary resuscitation save rate.

The truth remains that while CPR is an integral part of the resuscitation process, it cannot be used to replace other resuscitative adjuncts such as defibrillation, airway management and intravenous drug therapy. While CPR prevents brain damage by circulating oxygen throughout the body, it does not restart the heart, nor can it be done forever. Therefore, it is very unlikely for someone to resuscitate another person with CPR only, unless in very special circumstances. Usually if someone "regains" signs of circulation after only bystander CPR was performed, it is usually because the victim was not actually in true cardiac arrest.

Many rescuers who have performed CPR—healthcare provider and layperson alike—have indicated their surprise about what it is really like to perform CPR. Some note that they were unprepared for cartilage separation (considered to be normal in some cases) during chest compression, and believed that they were performing CPR incorrectly (when they were not). Others note that they were shocked when patients vomited, a stark contrast to the clean environment CPR was taught to them in classes. In some cases, rescuers blamed themselves when patients were not resuscitated, believing it was their fault for doing “CPR incorrectly” or “not doing CPR well enough”.

It is important to educate the general public and healthcare professionals that CPR is never guaranteed to save someone's life. People need to know that even if CPR is performed perfectly, the person in cardiac arrest may still not be resuscitated. The American Heart Association notes that "some hearts are too sick to be saved" and reflects the reality that CPR is not a cure-all but merely an important part of the resuscitation process. Rescuers who perform CPR should never be blamed for a patient's death because of "inadequate CPR": it is not CPR's goal to "save" someone, but only to maintain the heart and brain until more advanced medical help arrives to provide basic life support and advanced cardiac life support. CPR itself is an inexact and evolving science.

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