CPR, AED, and Mechanical Compression

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What is meant by cardiopulmonary resuscitation (CPR)?

CPR is a lifesaving intervention performed when an individual’s heart stops beating in order to maintain blood flow and promote oxygen delivery to one’s vital organs. To most, “CPR” refers to basic life support (BLS), consisting of chest compressions and rescue breathing. To other healthcare providers, it can also encompass advanced cardiac life support (ACLS), pediatric advanced life support (PALS), and advanced trauma life support (ATLS).

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What are the indications to perform CPR?

In general, CPR should be started immediately on any patient who has become unconscious and is found to be pulseless. CPR is also indicated in any infant less than 12 months of age with a pulse rate of less than 60 beats per minute.

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Explain the difference between a heart attack and a cardiac arrest.

A heart attack is a problem with circulation , occurring when blood flow to one or more parts of the heart is blocked. A cardiac arrest is an electrical problem and occurs when the heart malfunctions and stops beating. While a heart attack can cause a cardiac arrest, they are not synonymous terms and should not be used interchangeably.

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What are the most common reversible causes of cardiac arrest?

The reversible causes of cardiac arrest can be remembered by the “6 H’s” and “6 T’s.” Table 73.1 describes the 6 H’s and 6 T’s and offers some basic considerations that may help prehospital providers identify the cause of an arrest and expedite reversal (when appropriate, amidst a multiprovider resuscitation scenario). The causes of cardiac arrest in infants and children differ from those in adults; these causes include but are not limited to sepsis, hemorrhage, overdose, hypoglycemia or other electrolyte derangement, arrhythmia or heart block secondary to myocarditis, congenital heart disease, and pulmonary hypertension.

5

List the various links in the cardiac chain of survival.

The six links of the adult chain of survival are recognition and activation of the emergency response system, immediate high-quality CPR, rapid defibrillation, basic and advanced emergency medical services, advanced life support, post–cardiac arrest care, and recovery. The six links of the pediatric chain of survival are arrest prevention, immediate high-quality CPR, prompt access to the emergency medical services system, advanced life support, and post–cardiac arrest care, and recovery. Strong chains increase the chances of survival for a victim of cardiac arrest—for every 1 minute that CPR and defibrillation are delayed, the victim’s survival rate drops by approximately 10%.

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What is the appropriate sequence for performing CPR?

The 2015 AHA guidelines replaced the traditional “airway, breathing, compressions (ABC)” sequence with “compressions, airway, breathing (CAB)” in an effort to avoid delays in initiation of compressions and thus improve patient outcomes. However, certain exceptions to this generally accepted sequence do exist (such as in drowning victims), and it is recommended that providers tailor their sequence based on the etiology of the arrest.

7

Are “pulse checks” still recommended? If so, how often, and in what anatomical location(s)?

Although BLS CPR courses traditionally teach a pulse check for no longer than 10 seconds before initiating CPR, the AHA has since deemphasized these “pulse checks.” Even experienced clinicians can have difficulty determining whether a pulse is present within 10 seconds, so it is better to initiate CPR on a patient who does in fact have a pulse than not provide or delay CPR to a truly pulseless patient. If you do check for a pulse, check in an appropriate location ( Table 73.2 ) for no more than 10 seconds. Of note, a patient with a palpable carotid pulse has a systolic blood pressure of at least 60 mm Hg.

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