…the man suddenly slumped, the ladies around shrieked and screamed, the party came to a sudden halt, people milling around wondering what could have happened, speculation filled the air. It took a while before someone could organise a car and they lifted him in speeding off to the nearest ER, where he was confirmed dead on arrival!
Could anything have been done to save that life, and indeed many others? YES!
CPR is an emergency procedure (a form of first aid), performed in an effort to manually preserve brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest (a sudden cessation of heart activity).
The heart is a muscular organ located in the chest, encased within a bony ring formed by the vertebral column (spine) behind, the ribs at the sides and the sternum in front. The heart’s normal pumping action is a continuous, uninterrupted series of contraction and relaxation phases. During contraction (systole), blood is pumped out of the heart into the blood vessels while during relaxation (diastole) blood returns to the heart through passive refilling. It is this rhythmic sequence that CPR attempts to mimic and thus maintain tissue perfusion during a cardiac arrest. By compressing the heart muscle between the sternum and the spinal column, blood is forced out into the vessels while releasing this compression allows the heart to refill.
CPR must be performed with patient lying flat on a firm/rigid surface in order to ensure that the compressive force is transmitted onto the heart directly rather than simply dissipated as woul occur when CPR is attempted on a soft bed or cushions. So if a cardiac arrest occurs while a patient is sitting in a cushioned chair or in a bed, the patient should be rolled over onto the floor or a hard board slipped under the patient in the bed.
CPR alone is unlikely to restart the heart; its main purpose is to restore partial flow of blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage.
CPR guidelines have been repeatedly modified/revised over the years to ensure best outcome for the majority of patients. The current protocol seeks to reduce precious time wasted in checking for peripheral pulses and places more emphasis on effective chest compressions.
CPR is generally continued until the subject regains spontaneous circulation or is confirmed dead. CPR involves chest compressions at least 5 cm deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart. In addition, the rescuer may provide breaths by either exhaling into the subject’s mouth or nose or utilizing a device that pushes air into the subject’s lungs. This process of externally providing ventilation is termed artificial respiration.
Current recommendations place emphasis on high-quality chest compressions over artificial respiration. Compression-only (hands-only or cardio-cerebral resuscitation) CPR is a technique that involves chest compressions without artificial respiration. It is recommended for the untrained rescuer who may not be inclined to provide mouth-to-mouth ventilation in the absence of appropriate adjunct devices for ventilation. Children who receive compression-only CPR have the same outcomes as those who received no CPR hence a need to ensure proper and effective ventilation for children (and indeed for all) during CPR.
CPR, like other essential first aid skills, should be learnt by everyone and taught in schools and routinely practiced as drills using appropriate dummies/models where necessary. It’s also imperative that government and other well-meaning organisations provide Automated External Defibrillators (AED), as well as functionally equipped first aid boxes, in strategic public places for prompt use in the event of a cardiac arrest. These small, portable devices have greatly contributed to increased chances of survival from cardiac arrests.
There are very many useful web-based resources (including videos) that are designed to help everyone acquire basic CPR skills. These include;