Cardiopulmonary Resuscitation (CPR): You Could Save a Life
CPR, Cardio Pulmonary Resuscitation, is a term most of us have heard of, usually on TV. But what exactly is it, what does it really mean, and, does it really work?
In a nutshell, it is a procedure where we try to maintain blood circulation in an unconscious person whose heart may have stopped working. It is something we do only when someone is unconscious, not responding in any way, and is not breathing. If they are conscious, or even semi-conscious, or they are breathing, then for sure their heart is still working and the blood is still flowing to vital organs. However, if these three things are absent, especially breathing, then there is a very high chance that their heart is also not working.
Once the heart stops working, the window before brain damage will occur is only about 4-6 minutes. The response time for an ambulance, depending on where you are, can be as long as 20 minutes. This means we, as first-aiders, must do something to sustain the person until the ambulance arrives, and this is CPR.
Do not waste time checking for a pulse. The reason is an error can easily occur. You may not be able to find it even though there is one, or you may think you found it when in fact there isn't a pulse. So, if the person isn't breathing then assume there is also no pulse/heart beat and start CPR right away. Always err on the side of doing CPR.
CPR is a process of applying compressions on someone's chest in an attempt to squeeze their heart (between the back bone and the breast bone). By squeezing the heart the blood that is inside it will get pushed out. And, when the compression is released the heart will fill up with blood again. Repeating this quickly and forcefully will mimic the heart's own function, circulating blood to vital organs. It is estimated that doing CPR is about 25% as good as the heart working on its own. Which is good enough to sustain life for several minutes.
Does it work? This depends. On TV it almost always works. In real life things are not quite so rosy. However, if no attempt is made at all then for sure it will not work. The rate of success will depend on how quickly CPR efforts are started; how soon an ambulance arrives; whether or not a defibrillator is used; and of course the cause of the person collapsing.
If CPR is started immediately there will be a greater chance the person will respond to CPR, as there will have been less tissue damage from the lack of oxygen. If the ambulance arrives quickly they will be able to provide advanced medical care and get the person to the hospital quicker. A defibrillator is used to 'shock' the heart in an attempt to 'restart' the electrical system of the heart. The sooner this takes place the more likely it is that the heart will respond. If the person has simply fainted and hit their head on the way down their chance of revival is higher compared to if the person has suffered a major heart attack. But keep in mind, we are not in a condition to be able to determine their chance of survival, so we do our best to help.
Because the brain and other vital organs live only for a few minutes after the heart stops it is important to be able to perform cardiopulmonary resuscitation (CPR) so that blood flow and oxygen supply can be maintained.
In addition to performing compressions the person also needs air. This is where rescue breathing into their mouth comes in. This air will go into their lungs where the oxygen will be picked up by the circulating blood and carry it to the organs. However, if for whatever reason you cannot give them air, still do the compressions. It will not be as effective but it is still be better than nothing, as at least the blood is circulating.
Even exhaled air (by the rescuer) contains enough of a percentage of oxygen to assist the unconscious person. Air around us is about 25% oxygen, once we inhale it and use up a bit of oxygen the exhaled air is still about 21% oxygen. We don't use all the oxygen we inhale. Therefore, this exhaled air can still benefit the casualty.
When doing CPR expect some ribs to break, especially if the casualty is elderly. Don't concern yourself with this though as bones will heal if the person is revived and survives.
The basics of chest compressions involve:
- Positioning the person flat on their backs on a firm surface. Doing this on a soft surface, like a bed, will just be compressing the surface not their chest.
- Kneeling beside the person midway between the chest and the head. This position is important since you will be alternating between chest compressions and breaths.
- Leaning over the chest and placing your hands in the correct position over the lower half of the sternum.
- Compressing the chest by about 4-5cm (1.5 to 2 inches) by alternately pressing straight down and releasing in a smooth, uniform pattern.
- After 30 compressions give the person 2 breaths. In a child compress less, about 2-3cm.
- Repeat 30 compressions and 2 breaths without stopping until help arrives.
- Stop only if the person starts to respond, or the situation becomes dangerous.
- If you become fatigued ask someone else to take over for you.
- If there is an AED available, and someone knows how to use it, do so as soon as possible.
While you are performing CPR do not expect the person to wake up and walk away. This is a TV myth. Just keep doing your job and leave the rest up to the paramedics or the doctors.