INTRODUCTION:

According to the Center for Disease Control (CDC), "About 610,000 people die of heart disease in
the United States every year–that's 1 in every 4 deaths. Heart disease is the leading cause of death for both
men and women." Unfortunately, this statistic includes children and infants.

When someone's blood flow or breathing stops, seconds count. Permanent brain damage or death can
happen quickly. If you know how to perform cardiopulmonary resuscitation (CPR), you could save a life.
CPR is an emergency procedure for a person whose heart has stopped (called sudden cardiac arrest) or who
is no longer breathing. CPR can maintain the blood flow breathing until emergency medical
help arrives.Immediate CPR can double or triple chances of survival after cardiac arrest.

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many emergencies, such as a
heart attack or near drowning, in which someone's breathing or heartbeat has stopped. The American Heart
Association recommends starting CPR with hard and fast chest compressions. This hands-
only CPR recommendation applies to both untrained bystanders and first responders.
If you're afraid to do CPR or unsure how to perform CPR correctly, know that it's always better to try than to
do nothing at all. The difference between doing something and doing nothing could be someone's life.

Cardiopulmonary resuscitation (CPR) is a hands-on emergency intervention used to restore breathing and a
heartbeat in a person who has gone into cardiac arrest. Common causes of cardiac arrest are a heart attack or
near-drowning.

Arrhythmia prevents the heart from adequately pumping blood. As a result, the brain is put at risk along with
other organs of the body. The brain is the most sensitive of all to the deprivation of oxygen. Chest
compressions at 100-120 per minute serve to keep an artificial heartbeat going until the heart can be returned
to a normal sinus rhythm with an electric shock. The compressions rhythmically squeeze the heart thereby
keeping blood flowing through the aorta to protect the brain until the shock can be administered and the
heart returned to normal.

If someone lose consciousness and stop breathing normally, it is critical that someone performs CPR on the
person right away.CPR involves performing chest compressions and, in some cases, rescue ("mouth-to-
mouth") breathing. These techniques can keep blood flowing to the brain and other organs until medical help
arrives. When oxygen-rich blood cannot get to the brain, brain damage can occur within minutes.

DEFINITION:

Cardiopulmonar resuscitation (CPR) is a technique of basic life support for the purpose of oxygenating the
brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilatory
action. Management of foreign body airway obstruction or cricothyroidotomy may be necessary to open the
airway before CPR can be performed.

INDICATIONS:

1. Cardiac Arrest:

a. Ventricular fibrillation

b. Ventricular tachycardia

c. Asystole

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d. Pulseless electrical activity

2. Respiratory arrest:

a. Drowning

b. Stroke

c. Foreign body airway obstruction

d. Smoke inhalation

e. Drug overdose

f. Electrocution/injury by lightning

g. Suffocation

h. Accident/injury

i. Coma

j. Epiglottitis

ASSESSMENT:

Time is of the essence, but before you attempt CPR on someone, follow these steps:

1. Make sure the environment is safe. A fire, traffic accident, or other dangers could put your own
life at risk.
2. Try to wake the person. Tap on the person's shoulder firmly and ask "Are you OK?" in a loud
voice. Move on to the next steps after five seconds of trying to wake the patient.
3. Call 911. Anytime a patient won't wake up, call 911 immediately or ask a bystander to call. Even if
you will perform CPR on the spot, it's important to get paramedics to the scene as quickly as
possible.
4. Put the person on their back. If it's possible that the person may have had a spinal injury, turn them
carefully without moving the head or neck.
5. Check for breathing. Tilt the patient's head back to open the airway and determine if they are
breathing. If the patient doesn't take a breath after 10 seconds, start CPR.

STEPS of CPR:
The American Heart Association uses the letters C-A-B to help people remember the order to perform the
steps of CPR.

C: compressions

A: airway

B: breathing

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Compressions: Restore blood flow
Compressions means you'll use your hands to push down hard and fast in a specific way on the person's
chest. Compressions are the most important step in CPR. Follow these steps for
performing CPR compressions:

1. Put the person on his or her back on a firm surface.

2. Kneel next to the person's neck and shoulders.
3. Place the lower palm (heel) of your hand over the center of the person's chest, between the
nipples.
4. Place your other hand on top of the first hand. Keep your elbows straight and position your
shoulders directly above your hands.
5. Push straight down on (compress) the chest at least 2 inches (5 centimeters) but no more than
2.4 inches (6 centimeters). Use your entire body weight (not just your arms) when doing
compressions.
6. Push hard at a rate of 100 to 120 compressions a minute. The American Heart Association
suggests performing compressions to the beat of the song "Stayin' Alive." Allow the chest to
spring back (recoil) after each push.
7. If you haven't been trained in CPR, continue chest compressions until there are signs of
movement or until emergency medical personnel take over. If you have been trained in CPR, go
on to opening the airway and rescue breathing.

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Airway: Open the airway
If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the
head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with
the other hand, gently lift the chin forward to open the airway.

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Fig: Rescue breathing using a bag-mask device

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously
injured or can't be opened. Current recommendations suggest performing rescue breathing using a bag-mask
device with a high-efficiency particulate air (HEPA) filter.

1. After opening the airway (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for
mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.
2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and
watch to see if the chest rises.
3. If the chest rises, give a second breath.
4. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give a second breath.
Thirty chest compressions followed by two rescue breaths is considered one cycle. Be careful
not to provide too many breaths or to breathe with too much force.
5. Resume chest compressions to restore blood flow.

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 6. As soon as an automated external defibrillator (AED) is available, apply it and follow the
prompts. Give one shock, then resume chest compressions for two more minutes before giving
a second shock. If you're not trained to use an AED, a 911 operator or another emergency
medical operator may be able to give you instructions. If an AED isn't available, go to step 5
below.
7. Continue CPR until there are signs of movement or emergency medical personnel take over.

HIGH QUALITY CPR

High-quality CPR should be performed by anyone - including bystanders. There are five critical
components:

1. Minimize interruptions in chest compressions.

2. Provide compressions of adequate rate (100-120/ min) and depth (at least 2 inches).
3. Avoid leaning on the victim between compressions.
4. Ensure proper hand placement.
5. Avoid excessive ventilation.

6. .

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How to Do CPR

Once you have followed the above steps, here is how to perform CPR. Techniques vary slightly based on the
age of the person. How to do CPR on an adult is different from how to do CPR on a toddler, and a separate
technique is used for infants.

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Adult CPR

The following steps apply to adults and to children over 8 years old.

1. Place your hands on the person's chest. Imagine a line between the nipples and put the heel of one
hand directly on that line, in the center of the chest (i.e., the sternum). Place your other hand on top
of that hand. Center your weight directly over your hands.
2. Perform chest compressions. Push hard, to a depth of at least 2 inches (but no deeper than 2.4
inches) and fast—about twice per second until the person responds. Your hands shouldn't bounce, but
you should lift your entire body weight off the patient in between each compression.
3. Give rescue breaths. If you have had CPR training and feel comfortable performing the steps, push
on the chest 30 times, then give two rescue breaths.
4. Repeat. Repeat cycles in the CPR ratio of 30:2 (chest compressions and breaths) until help arrives or
the patient wakes up.

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1
CHECK the scene for safety, form an initial impression and use personal protective equipment (PPE)

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If the person appears unresponsive, CHECK for responsiveness, breathing, life-threatening bleeding or
other life-threatening conditions using shout-tap-shout

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If the person does not respond and is not breathing or only gasping, CALL 9-1-1 and get equipment, or
tell someone to do so

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Kneel beside the person. Place the person on their back on a firm, flat surface

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Give 30 chest compressions.
 Hand position: Two hands centered on the chest.
 Body position: Shoulders directly over hands; elbows locked.
 Depth: At least 2 inches.
 Rate: 100 to 120 per minute.
 Allow chest to return to normal position after each compression.

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Give 2 breaths
 Open the airway to a past-neutral position using the head-tilt/chin-lift technique.
 Pinch the nose shut, take a normal breath, and make complete seal over the person’s mouth
with your mouth.
 Ensure each breath lasts about 1 second and makes the chest rise; allow air to exit before
giving the next breath.
Note: If the 1st breath does not cause the chest to rise, retilt the head and ensure a proper seal before
giving the 2nd breath If the 2nd breath does not make the chest rise, an object may be blocking the
airway.

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Continue giving sets of 30 chest compressions and 2 breaths. Use an AED as soon as one is available!
Minimize interruptions to chest compressions to less than 10 seconds.

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CPR in Children 1 to 8 years old
The procedure for giving CPR to a child between 1 to 8 is essentially the same as that for an adult.

1. Place your hands on the child's chest. Place two hands (or one hand if the child is very small) on
the child's sternum.
2. Perform chest compressions. Push hard, to a depth of at least 2 inches (but no deeper than 2.4
inches) and fast—about twice per second until the person responds.
3. Give rescue breaths. If you have had CPR training and feel comfortable performing the steps, push
on the chest 30 times, then give two rescue breaths.
4. Repeat. Repeat cycles of 30 chest compressions and two breaths until help arrives or the patient
wakes up.
Infants

1. Flick the bottom of the foot to elicit a response. This takes the place of shaking the shoulders of an
older person.
2. Place two fingers of one hand in the center of the chest.
3. Give chest compressions. Gently use your fingers to compress the chest about 1.5 inches deep.
Perform two compressions per second, just as you would when giving an adult CPR.
4. Perform rescue breathing. If you are comfortable giving rescue breaths, give two of them between
each series of 30 chest compressions, just as you would with an older person.

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RELATED JOURNAL ARTICLES:

Abrams, D., MacLaren, G., Lorusso, R. et al. Extracorporeal cardiopulmonary resuscitation in adults:
evidence and implications. Intensive Care Med 48, 1–15 (2022). https://doi.org/10.1007/s00134-
021-06514-y

ECPR offers the promise of significantly improving the low rates of survival with functional and
neurological recovery among patients suffering cardiac arrest. At present, there are sufficient data to support
the initiation of ECPR in select individuals with reversible etiologies of cardiac arrest in whom low-flow
time is minimized—and even in certain circumstances with more prolonged low-flow time—with greater
potential benefit in IHCA than OHCA. These conditions assume that the healthcare system in which ECPR
is offered is designed to deliver the intervention efficiently and effectively.

Yan, S., Gan, Y., Jiang, N. et al. The global survival rate among adult out-of-hospital cardiac arrest patients
who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit
Care 24, 61 (2020). https://doi.org/10.1186/s13054-020-2773-2

A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of
spontaneous circulation (ROSC) was 29.7% (95% CI 27.6–31.7%), the rate of survival to hospital admission
was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%),
the pooled 1-month survival rate was 10.7% (95% CI 9.1–13.3%), and the 1-year survival rate was 7.7%
(95% CI 5.8–9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among
OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS)
(10.5%; 95% CI 9.2–11.7%), who received bystander CPR (11.3%, 95% CI 9.3–13.2%), and who were
living in Europe and North America (Europe 11.7%; 95% CI 10.5–13.0%; North America: 7.7%; 95% CI
6.9–8.6%). The survival to discharge (8.6% in 1976–1999 vs. 9.9% in 2010–2019), 1-month survival (8.0%
in 2000–2009 vs. 13.3% in 2010–2019), and 1-year survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019)
rates of OHCA patients who underwent CPR significantly increased throughout the study period. The
Egger’s test did not indicate evidence of publication bias for the outcomes of OHCA patients who
underwent CPR.

Bartos, J. A., Grunau, B., Carlson, C.,et al. (2020). Improved survival with extracorporeal cardiopulmonary

resuscitation despite progressive metabolic derangement associated with prolonged resuscitation.

Circulation, 141(11), 877–886. https://doi.org/10.1161/circulationaha.119.042173

Neurologically favorable survival was significantly higher in UMN-ECPR patients versus ALPS patients
(33% versus 23%; P=0.01) overall. The mean duration of CPR was also significantly longer for UMN-
ECPR patients versus ALPS patients (60 minutes versus 35 minutes; P<0.001). Analysis of the effect of
CPR duration on neurologically favorable survival demonstrated significantly higher neurologically
favorable survival for UMN-ECPR patients compared with ALPS patients at each CPR duration interval
<60 minutes; however, longer CPR duration was associated with a progressive decline in neurologically
favorable survival in both groups. All UMN-ECPR patients with 20 to 29 minutes of CPR (8 of 8) survived
with neurologically favorable status compared with 24% (24 of 102) of ALPS patients with the same
duration of CPR. There were no neurologically favorable survivors in the ALPS cohort with CPR ≥40
minutes, whereas neurologically favorable survival was 25% (9 of 36) for UMN-ECPR patients with 50 to
59 minutes of CPR and 19% with ≥60 minutes of CPR. Relative risk of mortality or poor neurological
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function was significantly reduced in UMN-ECPR patients with CPR duration ≥60 minutes. Significant
metabolic changes included decline in pH, increased lactic acid and arterial partial pressure of carbon
dioxide, and thickened left ventricular wall with prolonged professional CPR.

Wyckoff, M. H., Wyllie, J., Aziz,et al. (2020). Neonatal Life Support: 2020 International Consensus on

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment

recommendations. Circulation, 142(16_suppl_1). https://doi.org/10.1161/cir.0000000000000895

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular

Care Science With Treatment Recommendations (CoSTR) for neonatal life support includes evidence from 7
systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force
generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence
updates followed consultation with International Liaison Committee on Resuscitation member resuscitation
councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if
appropriate, reiterations of existing statements when the task force found they remained valid.

Evidence review topics of particular interest include the use of suction in the presence of both clear and
meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial
oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine
(adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of
drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation
efforts after significant efforts have failed.

All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to
postresuscitation care. This document now forms the basis for ongoing evidence evaluation and
reevaluation, which will be triggered as further evidence is published.

Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-

projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to
more than 7 million newborn infants every year. However, in terms of early care of the newborn infant,
some of the topics addressed are relevant to every single baby born.

CONCLUSION:

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In 2020, any-mention sudden cardiac arrest mortality in the US was 436,852. CPR, especially if
administered immediately after cardiac arrest, can double or triple a person’s chance of survival. According
to 2021 US data for adult OHCA only, survival to hospital discharge was 9.1% for all EMS-treated non-
traumatic OHCA cardiac arrests.
The location of Out of Hospital Cardiac Arrests (OHCA) most often occurs in homes/residences (73.4%),
followed by public settings (16.3%), and nursing homes (10.3%).
If performed immediately, CPR can double or triple the chance of survival from an out of hospital cardiac
arrest.

CardioPulmonary Resuscitation (CPR) is an effective procedure that helps blood flow through vital organs,
even after you suffer a heart attack. This procedure allows the brain functions to remain fully intact.

An automated external defibrillator (AED) is a device that can be used to help you if you experience sudden
cardiac arrest.

If someone suffers cardiac arrest and CPR or an AED is performed in a timely fashion, the chances of
having a full recovery increase significantly.

It is important that businesses and public entities which have AED equipment on-site have the training and a
plan in place to ensure that staff knows where the equipment is and how to use it because every second
counts during a cardiac arrest event.

The best outcome for a victim is contingent on early recognition, quick action and notification of medical
professionals. Compression depth and recoil should be monitored along with proper ventilation rates and
technique to increase survival chances. AED can be life saving, so attempt to have one available as quickly
as possible. CPR can be a scary process, but YOU are able to assist the victim. Remember C-A-B.

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BIBLIOGRAPHY:

Basheer.P.S., Khan.Y.S. (2022).A Concise Textbook of Advanced Nursing Practice.EMMESS Medical

Publishers.

Brar.K.N., Rawat.C.H.(2015). Textbook of Advanced Nursing Practice.The Health Sciences Publishers.

Hinkle, J. L., & Cheever, K. H. (1996). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.

http://ci.nii.ac.jp/ncid/BB15317023

Lewis, S. M., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-surgical Nursing:

Assessment and Management of Clinical Problems. Mosby.

Nettina, S. M. (2020). Lippincott Manual of Nursing Practice. Lippincott Williams & Wilkins.

https://cpr.heart.org/en/resources/what-is-cpr

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