Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that can be used to save lives in emergencies like drowning or heart attack, where the individual’s heartbeat and/or breathing have suddenly stopped. CPR can be performed anywhere when an individual develops cardiac arrest including areas outside the hospital like an airplane, swimming pool, or even a shopping mall. According to the American Heart Association (AHA), when you witness a cardiac arrest, CPR should be quickly started with fast and hard chest compressions. The ‘hands only’ CPR recommendations apply to both first responders and all untrained bystanders.

The AHA states that individuals who are unsure how to perform CPR or are afraid to initiate CPR should be aware that it is better to at least make an attempt- this is better than doing nothing at all; by doing even the most basic CPR- this can help save someone’s life.

Ample data show that CPR can keep oxygen-rich blood from the heart flowing to the brain and other body organs until emergency medical services can restore the heart’s natural rhythm. When the heart stops beating, the brain and other organs no longer receive the oxygen-rich blood. To prevent serious injury to the brain and other organs, it is vital to resume blood flow in a matter of minutes.

AHA recommendations

Untrained individuals: Even if you have not been trained in CPR or worry about giving rescue breaths, then at least perform hands-only CPR. To be effective, the chest compressions should be uninterrupted at a rate of 100-120 a minute until the first responders (paramedics) arrive. It is not absolutely necessary for untrained individuals to offer rescue breathing.

Trained individuals with up-to-date knowledge and skills: for those who have training in CPR and feel confident about their ability, the first task is to check if the person is breathing and has a pulse. If the individual is not breathing or there is no pulse, start chest compression ASAP. The goal is to initiate CPR with 30 chest compressions prior to giving two rescue breaths.

Trained individuals but not up to date with skills: for those individuals who have received CPR training some time ago and do not feel confident with their ability, the AHA recommends starting chest compressions at a rate of 100-120 a minute

The above recommendations only apply to infants, children, and adults who need CPR these recommendations do not apply to newborns- those less than 4 weeks of age.

Call 911

Individuals who are bystanders or those untrained in CPR should assist by calling 911 or the local emergency services as soon as possible before starting CPR. TIn many cases, the dispatcher can guide you on how to perform the procedure effectively until EMS arrives. To save a life, learn how to do CPR by taking an accredited first aid course that includes CPR and how to use an automatic external defibrillator (AED) 

CPR 101

Before you start CPR, you need to do the following:

1. Check if the area is safe for the individual who has arrested
2. Check if the individual is responsive or unresponsive?
3. If the individual appears unresponsive, shake or tap his upper body (shoulder) and ask loudly, ‘are you okay?’
4. When you discover a person who is not conscious, and if you are with another person who can assist, have him or her call the local emergency number or call 911.
5. If the individual has developed cardiac arrest in a mall, plaza, or another public place, ask if there is an AED available
6. While one person is communicating, the other person should start CPR- do not try to do everything on your own, especially when help is available. The key is to start CPR and avoid wasting time.
7. If you are alone and have access to a phone, call the local emergency number or 911 before starting CPR. Ask for an AED if available
8. As soon as the AED is available, deliver one shock as instructed by the device and then start CPR

Remember C-A-B

The AHA recommends that people who do CPR remember C-A-B in order to perform the sequence of CPR:

C: Chest compressions

A: Airway should be open

B: Rescue breathing

Compressions

The primary reason for the compressions is to restore blood flow to the brain and other organs. Compression requires the use of both hands. Place both hands over the mid chest and push down hard and fast. This is the most important maneuver in CPR and has to be done right to be effective. The technique of chest compressions is as follows:

1. The arrested individual has to be on his/her back against a solid/firm surface
2. Kneel on the right or left next to the individual’s shoulder and neck
3. Apply the heel of your hand over the center of the individual’s chest should be in between the two nipples
4. Place your other hand on top of the first hand. Maintain your elbows straight and position your shoulders directly above your hands
5. Push down with your hands on the chest. Compress the chest for at least 2 inches (5 centimeters) but not more than 2.5 inches. The compressions have to be performed using the entire body and not just the hands
6. Push hard and fast at a rate of 100-120 compressions a minute. After every compression, permit the chest to recoil back into its original position.
7. If you have had no CPR training, continue with chest compressions until medical personnel arrive or until you see signs of movement in the individual. If you have training in CPR, go to the mouth area and perform rescue breathing.

The Airway

The goal is to keep it open

For those individuals trained in CPR, once you have performed 30 chest compressions, go to the mouth and open the airway using the chin lift, head-tilt maneuver. To do this, place your palm of the left hand on the individual’s forehead and gently tilt the head back. Then with your right hand, gently raise the chin forward to open the airway

Start breathing for the individual

Rescue breathing can be done either via mouth to mouth or mouth to nose. The latter approach may be necessary if the individual’s mouth has an injury or if you are not able to open it. In the Covid-19 era, current recommendations for rescue breathing involve the use of a bag-mask device that has a high-efficiency particulate air filter.

1. After you open the airway using the chin lift and head tilt maneuver, pinch the nostrils with your left hand. At the same time cover the individual’s mouth with your mouth. For mouth-to-mouth breathing to be effective, the seal has to be good.
2. Next, give the first rescue breath that lasts 1-2 seconds and watch the chest to see if it rises. If the chest shows an upward motion, give the second rescue breath
3. If the chest fails to rise, repeat the chin lift, head tilt maneuver, and give the second rescue breath. Always be careful not to breathe with too much force or provide too many breaths.
4. One cycle of CPR involves 30 chest compressions followed by 2 rescue breaths.
5. After every 2 rescue breaths, resume chest compressions

Use AED

As soon as an AED is available, apply the paddles to the chest. The newer generation of AEDs are fully automatic, easy to use and provide voice prompts. Follow the prompts. Initially give one shock and then resume chest compressions for at least 120 seconds before administering a second shock. If you have no idea how to use an AED, the 911 operator or the local emergency services. Many times, these individuals can provide you with instructions. Continue CPR until the emergency medical personnel arrive.