Introduction

Cardiopulmonary resuscitation (CPR)

It is a combination of mouth-to-mouth resuscitation and chest compressions that delivers oxygen and artificial blood circulation to a person who is in cardiac arrest. It can be life-saving first aid.
A ‘heart attack’ occurs when the heart is starved of oxygen.

A heart attack can ‘stun’ the heart and interrupt its rhythm and ability to pump. If the heart stops pumping, it is known as a cardiac arrest. This is because the heart does not receive enough oxygen and cannot pump blood around the body. There is no heartbeat because the heart is not working. When the blood stops circulating, the brain is starved of oxygen and the person quickly becomes unconscious and stops breathing. Without treatment, the person will die.

Causes of cardiac arrest

A cardiac arrest can be caused by:

1. Heart disease – is the most common cause of cardiac arrest and is the leading cause of death.
2. Drowning
3. Suffocation
4. Poisonous gases
5. Head injury
6. Drug overdose
7. Electric shock.

Cardiopulmonary resuscitation (CPR) can be life-saving first aid and increases the person’s chances of survival if started soon after the heart has stopped beating. If no CPR is performed, it only takes 3–4 minutes for the person to become brain dead, due to lack of oxygen. By performing CPR, you provide the needed oxygen and circulate the blood, so that the brain and other organs can stay alive while you wait for the ambulance. CPR does not guarantee that the person will survive but it does give that person a chance when otherwise there would have been none.

 Procedure

 CPR is most successful when administered as quickly as possible. It should only be performed when a person shows no signs of life; that is when they are:

• Unconscious
• Unresponsive
• Not breathing normally
• Not moving.

The basic steps for performing CPR can be used for adults, children, and infants. They are based on guidelines updated in 2010 to be easier to follow and remember. However, they are only a guide and not a substitute for attending a CPR course.

Step 1 Chest compressions

 If the person is not breathing normally, make sure they are lying on their back on a firm surface and neck management.

• Place the heel of one hand on the lower half of the person’s breastbone.
• Place the other hand on top of the first hand and interlock your fingers.
• Press down firmly and smoothly (compressing to 1/3 of chest depth) 30 times.

 Step 2 Airway Management

 Tilt the head backward and lift the chin so as to elongate the airway.

• Look inside for any obstruction present if present removes it.

 STEP 3 Mouth-to-mouth breathing

• Open the airway by tilting the head back and lifting their chin.
• Close their nostrils with your finger and thumb. Put your mouth over the person’s and blow into their mouth.
• Give 2 full breaths to the person (this is called ‘rescue breathing).
• Make sure there is no air leak and the chest is rising and falling.
• If their chest does not rise and fall, check that you’re pinching their nostrils tightly and sealing your mouth to theirs.
• If still no luck, check their airway again for any obstruction.

Repeat the cycle of 30 compressions then 2 breaths, until professional help arrives. This can be tiring – ask if anyone else knows CPR and can help you.

CHILD CPR

CPR steps for children aged eight years or younger are the same as for adults and older children, but the technique is slightly different.
Children aged 1–8 years

• Use the heel of one hand only for compressions, compressing to 1/3 of chest depth.
• Follow the basic steps for performing CPR described above.

INFANT CPR

Infants (up to 12 months of age)

1. Place infants on their backs. Do not tilt their head back or lift their chin (this is not necessary as their heads are still large in comparison to their bodies).
2. Perform mouth-to-mouth by covering the infant’s nose and mouth with your mouth – remember to use only a small breath.
3. Do chest compressions, using two fingers of one hand, to about 1/3 of chest depth.
4. Follow the basic steps for performing CPR described above.

CPR may revive the person before the ambulance arrives.

1. Review the person’s condition if signs of life return i.e. coughing, movement or normal breathing. If the person is breathing on their own, stop CPR and place those on their side with their head tilted back.
2. If the person is not breathing, continue full CPR until the ambulance arrives.
3. Be ready to recommence CPR if the person stops breathing or becomes unresponsive or unconscious again. Stay by their side until medical help arrives. Talk reassuringly to them if they are conscious.
4. It is important not to interrupt chest compressions or stop CPR prematurely to check for signs of life – if in doubt, continue full CPR until help arrives.
5. It is unlikely you will do harm if you give chest compressions to someone with a beating heart.
6. Regular recovery (pulse) checks are not recommended as they may interrupt chest compressions and delay resuscitation.

Generally, CPR is stopped when

• The person revives and starts breathing again on his own.
• Medical help, such as ambulance paramedics, arrive to take over.
• The person performing the CPR is forced to stop from physical exhaustion.

Things to remember

• Always call 102 for an ambulance in an emergency.
• Cardiopulmonary resuscitation (CPR) combines mouth-to-mouth resuscitation and cardiac compressions to deliver oxygen and artificial circulation to an unresponsive person until medical help arrives.
• CPR is a life-saving skill that everyone should learn.