The time sensitivity of CPR in sudden cardiac death is emphasized in the American Heart Association Chain of Survival (Table 22-1).1,2 This chapter reviews basic CPR for adults and children ≥8 years old, including the approach to an unresponsive patient; the physiology and mechanics of closed chest compression techniques; and basic airway opening procedures, including initial management of an obstructed airway. This chapter is specifically directed toward healthcare providers, although key updates for lay rescuers are noted, given the healthcare provider’s role in layperson education. Table 22-2 outlines the sequence of steps to be taken when someone is found unresponsive.
TABLE 22-1American Heart Association Chain of Survival1-4 |Favorite Table|Download (.pdf) TABLE 22-1 American Heart Association Chain of Survival1-4
|Links in Chain ||Comment |
|Recognition and activation of the emergency response system (EMS) || |
Early recognition of the emergency and activation of the EMS or local emergency response system are vital.
Phone the local emergency medical telephone number.*
|Immediate high-quality CPR ||Immediate bystander CPR can double or triple the victim’s chance of survival. |
|Rapid defibrillation ||CPR plus defibrillation within 3 to 5 min of collapse can produce improved survival rates. |
|Basic and advanced emergency medical services ||High-quality resuscitative care is provided by EMS personnel. |
|Advanced life support and postarrest care ||High-quality, integrated post–cardiac arrest clinical care by healthcare providers. |
TABLE 22-2Systematic Approach to CPR |Favorite Table|Download (.pdf) TABLE 22-2 Systematic Approach to CPR
|CPR Steps ||Comments |
|Step 1: Recognition ||Assess for responsiveness, lack of breathing, or presence of abnormal breathing/gasping. |
|Step 2: Activate the emergency medical response system and get an automatic external defibrillator (AED) || |
If possible, call for an assistant to activate EMS and obtain an AED.
It is recommended that dispatchers help determine if there is presence of a cardiac arrest and help initiate dispatcher-guided CPR if indicated.
|Step 3: Assess circulation (healthcare provider only) ||If no pulse after 10-second maximum check, go to step 4. (Pulse checks are for healthcare providers only.) |
|Step 4: Begin cycle of 30 closed chest compressions || |
Compressions: “Push hard and fast.”
Compress 2–2.5 in. (5–6 cm).
Allow for complete chest recoil, <10-second compression interruption.
Ratio of 30 compressions to 2 breaths.
Alternate compressors every 2 minutes or when the compressor becomes fatigued if an assistant is available.
|Step 5: Use the defibrillator when available and indicated || |
A defibrillator should be used as soon as available.
It is recommended that while the AED is being retrieved and applied CPR is initiated and continued until the device is ready for use.
|Step 6: Continue high-quality CPR ||Continue CPR between rhythm checks, while the defibrillator is being applied and immediately restart compressions after defibrillation. This is to maximize ...|