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cardiac attack

Introduction

Useful in emergency situations like heart attack or near drowning, as a life-saving technique, Cardiopulmonary Resuscitation (CPR) helps revive a person whose breathing or heartbeat has stopped. As recommended by the American Heart Association, everyone and anyone, including untrained bystanders or qualified medical practitioners, can perform the basic steps of CPR along with chest compressions.

In situations when someone stops breathing, every second counts as otherwise it can lead to permanent brain damage or even death. If one knows how to perform CPR, a life can be saved, until medical help arrives on the spot.

It is possible to perform hands-only CPR even if you haven’t undergone a professional training. Using the pressure created with chest compressions, CPR helps keep the blood circulating until emergency help arrives. Trained person can go a step further and perform the complete procedure starting from chest compressions, clearing the airway and doing the rescue breathing, which ensures the lungs receive oxygen supply.

Practicing CPR is essential to keep your skills sharp and hence must be performed every two years. Even if you are not confident of your skills to perform live CPR on a suffering person, it is important to carry out the action instead of standing and watching like a dummy and doing nothing.

Steps Involved in CPR

The person who performs the CPR is called the rescuer and has to follow three main steps, known as C-A-B:

C – Do Chest Compressions

In this step, the rescuer press the patient’s chest many times in a row to move blood out of the heart which has stopped breathing.

A – Check the Airway

The rescuer, after doing the 30 chest compressions, checks the airway by listening and looking to see if the person is breathing or not.

B – Do Rescue Breathing

The rescuer’s breathing helps move oxygen in the lungs down below in a person who is not breathing. You have to give TWO rescue breaths if the person is not breathing.

Why CPR?

CPR is important as it helps in keeping the blood flow active, even if it is partial during the emergency situation of blockage of blood flow and oxygen when a person’s heart and breathing have stopped. It extends the opportunity for a successful resuscitation once the trained the medical staff arrives on the site.

If the CPR is performed within the first six minutes of the heart stopping, it helps to keep someone alive until medical help arrives. Although CPR is unlikely to restart the heart, it restores partial flow of oxygenated blood to the brain and the heart. The motive is to delay tissue death and extend the opportunity for successful resuscitation without permanent brain damage or even death. Once an electric shock is administered, known as defibrillation, it is usually required to restore viable heart rhythm.

CPR will lead to inducing back the heart rhythm and hence should be continued until the patient starts breathing or is declared dead. In case no CPR is performed, it only takes three to four minutes for the person to become brain dead due to lack of oxygen.

CPR helps in circulating the blood so it can provide oxygen and helps the brain and other organs to stay alive even as you wait for the ambulance. Although the blood has enough oxygen to keep the brain and other organs alive for few more minutes, the oxygen wouldn’t circulate unless someone performs a CPR.

In case you are unsure if the patient is in a state of cardiac arrest, you should begin CPR nevertheless, even if not required as the person may respond to your attempts. CPR by no means is harmful to the patient even if they are not in a state of cardiac arrest.

Awareness on CPR in India

According to experts and research reports, approximately 98% of Indians are not aware about CPR. For thousands of Indians, cardiopulmonary resuscitation is pretty difficult to understand, let alone practice it or perform it live on a patient. CPR is presented as a mouth-to-mouth breathing, invoking humour or romance in movies.

This hampers the context of the life-saving medical help, and the technical nature of performing the act goes for a toss. However, this is the maximum sensibility which can be expected from celluloid.

CPR has much more to offer, as it not only saves a drowning victim but also when performed at the right time on the patient having a sudden cardiac arrest, it can even save lives. Despite being the capital of cardiac diseases, obesity and diabetes, printed information is not available in India. A surprising indifference towards cardiac health awareness means simply pushing each of us on road to a cardiac epidemic.

It is this indifference towards this life-saving support which has resulted in the appalling lack of campaigns in India. It is this gap between the academic knowledge and implementation which is preventing efficient implementation.

Around 98 per cent Indians are not trained in CPR which is to be provided when the sudden cardiac arrest occurs.

Before you begin

Preparation for CPR

Before you begin to give CPR, it is important to correctly assess the situation. The following factors are important to be analysed:

  • Is the person in a safe environment?
  • Is the person conscious or unconscious?
  • If the person appears unconscious, check by tapping or shaking their shoulder and ask out loud, “Are You Okay?”.
  • If the person doesn’t give an answer and two people are available, ask one person to call the emergency medical help. In case only one person is available, ask them to call and you can start performing the CPR.
  • In case you are alone, it is better to call for medical help before beginning the CPR.

How to perform CPR?

In order to ensure the patient’s condition is not deteriorating, it is important to perform the CPR in the right manner. Based on the patient’s condition, location, help and medical facilities available, along with their age, performing CPR demands certain rules which must be followed. Let us take a look at what are the methods to be kept in mind, steps and stages to be followed and critical things to be kept in mind when handling patients of different age brackets:

  1. On Adults

The age group being covered here is from puberty to adulthood. The overall condition must be assessed properly before beginning the CPR. In case a second rescuer is available, ask them to call for medical help and get the desired equipment or tools. You should also check the pulse for not more than 10 seconds while you look for normal breathing. There would be either of the two conditions – no breathing, or no normal breathing and no breathing or only gasping.

  1. Compressions: Restore blood circulation

Once you start the compressions, the blood circulation begins to restore to normal rate and hence one must continue to perform the action as per the guidelines. At least 100/120 minute on the lower half of the breastbone is the ideal rate of compressions. The depth of the compressions should be strictly between 2 inches (5cm) and 2.4 inches. While performing the compressions, the chest wall recoil must also be noted. Allow complete recoil between compressions and one must rotate compressors every 2 minutes to reduce the fatigue caused due to CPR. Another important aspect to be taken into consideration is to minimize the interruptions in the chest compressions, and an attempt must be made to minimize or limit the interruptions to <10 seconds.

  1. Airway: Open the airway

In order to ensure the airway passage is not blocked and the patient is able to inhale and exhale through a clean and clear airway, it is important to check the functioning of the same. One of the best ways one can do it is to tilt the head, lift the chin and avoid excessive ventilation. The compression ventilation ratio must be kept in mind at all times. A ratio of 30 compressions with two ventilations is suggested when there is only one or two rescuer available.

  1. Breathing: Breathe for the person

Once the above mentioned steps have been performed, it is suggested to carry out the following steps which involve ventilation with advanced airway. Under this method, one breadth should be given every 6 seconds. Asynchronous with chest compressions, (at least 100/120 min) should be given. This has to be followed by about 1 second per breadth with a visible chest rise.

Attach and use the Automated External Defibrillator (AED) as soon as possible. Minimize interruptions in the chest compressions before and after the shock. You should then resume CPR by beginning with the compressions immediately after each shock.

  • On ChildsCompressions: Restore blood circulation

Once you start the compressions, the blood circulation begins to restore to normal rate and hence one must continue to perform the action as per the guidelines. At least 100/120 minute on the lower half of the breastbone is the ideal rate of compressions.

Compression must be at least 1/3 AP diameter, and about 2 inches (5cm). While performing the compressions, the chest wall recoil must also be noted. Allow complete recoil between compressions and one must rotate compressors every 2 minutes to reduce the fatigue caused due to CPR. Another important aspect to be taken into consideration is to minimize the interruptions in the chest compressions, and an attempt must be made to minimize or limit the interruptions to <10 seconds.

  1. Airway: Open the airway

In order to ensure the airway passage is not blocked and the patient is able to inhale and exhale through a clean and clear airway, it is important to check the functioning of the same. One of the best ways one can do it is to tilt the head, lift the chin and avoid excessive ventilation. The compression ventilation ratio must be kept in mind at all times. A ratio of 30 compressions with two ventilations is suggested when there is only one rescuer available. In case there are two rescuers available, a ratio of 15:2, meaning 15 compressions followed by two breaths.

  1. Breathing: Breathe for the child

Once the above mentioned steps have been performed, it is suggested to carry out the following steps which involve ventilation with advanced airway. Under this method, one breadth should be given every 6 seconds. Asynchronous with chest compressions, (at least 100/120 min) should be given. This has to be followed by about 1 second per breadth with a visible chest rise.

Attach and use the Automated External Defibrillator (AED) as soon as possible. Minimize interruptions in the chest compressions before and after the shock. You should then resume CPR by beginning with the compressions immediately after each shock.

  • On Baby of 4 weeks or olderCompressions: Restore blood circulation

Once you start the compressions, the blood circulation begins to restore to normal rate and hence one must continue to perform the action as per the guidelines. At least 100/120 minute on the lower half of the breastbone is the ideal rate of compressions.

Compression must be at least 1/3 AP diameter, and about 1.5 inches (4 cm). While performing the compressions, the chest wall recoil must also be noted. Allow complete recoil between compressions and one must rotate compressors every 2 minutes to reduce the fatigue caused due to CPR. Another important aspect to be taken into consideration is to minimize the interruptions in the chest compressions, and an attempt must be made to minimize or limit the interruptions to <10 seconds.

  1. Airway: Open the airway

In order to ensure the airway passage is not blocked and the patient is able to inhale and exhale through a clean and clear airway, it is important to check the functioning of the same. One of the best ways one can do it is to tilt the head, lift the chin and avoid excessive ventilation. The compression ventilation ratio must be kept in mind at all times. A ratio of 30 compressions with two ventilations is suggested when there is only one rescuer available. In case there are two rescuers available, a ratio of 15:2, meaning 15 compressions followed by two breaths.

  1. Breathing: Breathe for the child

Once the above mentioned steps have been performed, it is suggested to carry out the following steps which involve ventilation with advanced airway. Under this method, one breadth should be given every 6 seconds. Asynchronous with chest compressions, (at least 100/120 min) should be given. This has to be followed by about 1 second per breadth with a visible chest rise.

Attach and use the Automated External Defibrillator (AED) as soon as possible. Minimize interruptions in the chest compressions before and after the shock. You should then resume CPR by beginning with the compressions immediately after each shock.

Conclusion

 The role of training in learning CPR and to perform it properly is by far the most aspect of this entire process. Chest compressions-only CPR is very attractive because it is easier to teach than the conventional CPR and is still beneficial to the victim. There are online courses available, and instructor-led courses will often include training on delivery of airways and breathing maneuvers which may be extremely crucial for the patient, depending on their condition. Instructor led-courses usually provide feedback devices like the use of a mini mannequin which helps in practicing with more clarity.

Within a span of 3-6 months, skills related to CPR begin to deteriorate and therefore refresher training is strongly recommended. The training intervals of 12 to 24 months are not adequate and hence the refresher courses may be required every 6 months to stay updated and sharpen the skills.

FAQs

  1. What is the duration for which CPR should ideally be performed?

Paediatric Cardiopulmonary Resuscitation (CPR) for >20 minutes has been considered as not beneficial after the paediatric in-hospital cardiac arrests. The concept has been recently questioned, although the effect of CPR duration on the outcome has not recently been described. The main aim is to determine the relation between CPR duration and outcome after the paediatric in-hospital cardiac arrests.

  • What are the key skills that one needs to learn in order to perform CPR properly?

A short form for Cardiopulmonary Resuscitation is a well-known emergency technique used for helping someone suffering from a cardiac arrest, a condition where in the heart suddenly stops functioning or beating. Cardiac arrest can cause brain damage or even death within minutes if a person doesn’t receive immediate help.

You should immediately start CPR if someone is lying on ground and is not responsive or do not have a pulse. It may work in favour and help save someone’s life. When you perform hands-on CPR on someone, it involves manually compressing the chest to pump the blood to vital organs even though the heart has stopped. Contrary to what is shown on the television, effective CPR does not require mouth-to-mouth (rescue breaths) and instead prioritizes consistent, repeated chest compressions. Although rescue breaths are also important, most important is circulating the blood. As the blood circulates, some amount of passive air exchange takes place in the lungs.

The basics of knowing the correct method of CPR involves 100 to 120 compressions per minute. There are guidelines for depth as well – you have to compress at least 2 inches into the adult chest.

  • When do the results of CPR begin to show?

Prolonged CPR can produce favourable results when carried out promptly and effectively, by utilizing all the available resources including intra-arrest PCI and ECMO. When CPR is performed for a shorter duration, the neurological outcome is better in survivors of cardiac arrest however a cut-off beyond which resuscitation is likely to lead to unfavourable outcomes could not be determined and is unlikely to exist.

  • How does one know if CPR is to be performed or not?

When someone is unconscious or is lying lifeless, there is a high chance they may need help. There could be number of medical issues which could be at play, and CPR may not be the only reason or solution. Breathing and pulse are the two key factors in determining in case someone needs CPR or not. The warning signs of heart attack, stroke and cardiac arrest must be taken into consideration as every second counts.

If the person has suddenly collapsed, it is important to check for the breathing and the pulse. You should try to wake the person and if unsuccessful, it is important to check for the breathing and the pulse. Trouble with breathing in terms of no breathing or breathing problems may call for CPR. In case a pulse cannot be felt, the heart may have stopped working in which case a CPR may be needed. If the pulse of the person cannot be felt, it is sign CPR is immediately required.

In case you witness the patient has been electrocuted, try and not touch the victim. Try and remove the source of the power or remove the victim from the electrical contact. However, it is important to ensure that you use something which doesn’t conduct electricity, like a wooden broom or stick.

The person may have been under the influence of drugs, smoke, inhalants or may have drowned. In which case, it is important to check for breathing and pulse. This may require a combination of rescue breathing and chest compressions.

  • Are there any side effects of CPR?

The common CPR side effects include aspiration and vomiting which is dangerous for the victim. As the victim is unconscious, he is not able to clear the vomit from the mouth and is likely to inhale the same into the lungs, blocking the airway and leading to possible infection.

The force of chest compressions is likely to break the ribs. In case of elderly, this is significantly common due to the brittleness and weakness of the bones. Broken ribs present the dangers as a broken rib could possibly puncture or lacerate a lung, spleen or liver.

Internal brain injuries could be possible as CPR leaves the brain receiving 5% less oxygen than normal. The brain damage takes place within 4 to 6 minutes from the time the brain is deprived of oxygen, and post 10 minutes can lead to long term side effects.

As a result of the air being forced into the lungs, the abdomen usually becomes bloated and full of air during CPR. This makes ventilation more difficult and an increased chance of vomiting.

The result of the vomit and foreign objects like a person’s own teeth, being inhaled into the lungs etc. can lead to aspiration pneumonia, which can be very dangerous to a victim’s health.

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