CPR

CPR should be initiated on patients who are unconscious or unresponsive and no signs of normal breathing (absent breathing effort or agonal breathing).

• look, listen, feel for breathing making sure to spend less than 10 seconds for this (this time can also be spend to simultaneously assess carotid pulse, but is not necessary for diagnosis) (1,2)
• when there is a doubt whether the patient is breathing normally, act as if it is not normal
• checking for signs of circulation (mainly, but not exclusively by non-healthcare professionals) by palpating the carotid pulse is no longer necessary for the diagnosis of cardiac arrest due to it being time consuming and unreliable (1,2).

If the patient does not respond:

• turn the patient onto his back
• open airway - tilt the head and lift the chin (1) – If suspecting Cervical spine trauma then use jaw thrust
• keeping the airway open determine if the victim is breathing normally (should not take more than 10s)
• if he is not breathing normally
  • start chest compression: (1,2)
    • place the heel of one hand on the lower half of the patients sternum (correlates with the centre of the chest).
    • position the heel of your other hand on top of the first hand.
    • place the heel of your first hand on top of the other hand. Interlock the fingers of both hands. This ensures that pressure is not applied over the ribs.
    • keep your arms straight and then lean over the casualty and press down vertically on the sternum. The downward pressure should depress the sternum roughly 5-6cm. Release the pressure and then repeat. A rate of about 100 - 120 compressions per minute should be aimed for.
  • combination of ventilation and compression: (1)
    • if undertaking CPR on an adult and with no assistance then:
      • after 30 compressions tilt the head, lift the chin, and give two inflations.
      • the two rescue breaths should not take more than 5 seconds
      • return hands to position described for chest compression and then give a further 30 compressions
      • the ratio of 30 compressions to 2 ventilations is then maintained
    • if undertaking CPR on an adult with assistance then a ratio of 30 compressions to 2 ventilation is still maintained.

Notes:

• The Resuscitation Council (UK) now recommends (1):
• for adults:
  • CPR with a chest compression to ventilation ratio of 30:2
  • no initial ventilations before starting compressions
  • when professional help is delayed for more than 4-5 minutes, one option is to give compressions for up to three minutes before attempting defibrillation
  • compressions for two minutes after defibrillation - assist the recovery of effective cardiac contractions, even before checking cardiac rhythm
  • if coordinated rhythm is not restored by defibrillation, second and further shocks should be given only after additional cycles of chest compressions
  • if an advanced airway is required, only rescuers with a high tracheal intubation success rate should use tracheal intubation. The expert consensus is that a high success rate is over 95% within two attempts at intubation.

CPR should only be stopped if there are signs of regaining consciousness such as (1,2)

• coughing
• opening eyes
• speaking
• breathing normally
• moving purposefully

References:

1. Resuscitation Council (UK). Resuscitation Guidelines 2021.
2. Perkins G et al. European Resuscitation Council Guidelines 2021. Resuscitation. 2021.