The purpose of CPR is to temporarily provide effective oxygenation of vital organs, especially the brain and heart, through artificial circulation of oxygenated blood until the restoration of normal cardiac and respiratory activity occurs. The intended effect is to stop the degenerative processes of ischemia and anoxia caused by inadequate circulation and inadequate oxygenation.1 A key component of the 2005 American Heart Association guidelines was the recognition that immediate high-quality CPR is crucial for optimal patient outcome after sudden cardiac arrest.2 However, the 2010 American Heart Association guidelines identify several barriers to providing immediate high-quality CPR and address them.3 Furthermore, even after defibrillation, most victims demonstrate asystole or pulseless electrical activity for several minutes, and high-quality CPR immediately following defibrillation can convert nonperfusing rhythms to perfusing rhythms.2,3 The time sensitivity of CPR in sudden cardiac death is emphasized in the American Heart Association "Chain of Survival" (Table 12-1).
Table 12-1 American Heart Association Chain of Survival |Favorite Table|Download (.pdf)
Table 12-1 American Heart Association Chain of Survival
|Links in Chain||Comment|
|Immediate recognition/early access|
Phone 911 (or local emergency medical telephone number).*
Early recognition of the emergency and activation of the EMS or local emergency response system.
|Early CPR||Immediate bystander CPR can double or triple the victim's chance of survival from ventricular fibrillation.|
|Early defibrillation||CPR plus defibrillation within 3 to 5 min of collapse can produce survival rates as high as 49%–75%.|
|Early advanced care||Postresuscitation care delivered by healthcare providers.|
|Postarrest care||High-quality, integrated post–cardiac arrest clinical care.|
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.
"Look, listen, and feel" has been removed from all algorithms. Simply put, subjectivity plays too large a role in this step and has been shown to lead to delays. Immediate high-quality CPR is strongly emphasized, and should begin in any person who is unresponsive without respirations or with abnormal breathing.
Lone rescuers no longer follow the "ABCs." The sequence "CAB" has been adopted instead. Two rescue breaths are no longer recommended prior to initiating chest compressions.
Compression rate should be at least 100/minute, not approximately 100/minute.
Compression depth should be at least 2 inches, not 1½ to 2 inches.
Untrained bystanders should begin "compression only" CPR, "hard and fast" in the center of the chest. They may be directed to do so by EMS or by a healthcare provider. This effectively removes ...