Even after the advancements in emergency cardiac care, the sudden cardiac arrest still remains as one of the top causes of death in India and worldwide. One of the most common reasons for a cardiac arrest includes disturbance in the electrical rhythm, also known as ventricular fibrillation, which can be treated with an electrical shock to the chest. In emergency situations, when an electrical shock cannot be immediately given to the patient, CPR comes in very handy and can help to keep the blood and oxygen running in the body. If CPR is not initiated timely, at least in the first 6 minutes, a person can die in less than 10 minutes. Moreover, CPR buys more time until a defibrillator becomes available. Also, keeping the blood flow active – even partially – improves the chances of successful resuscitation. 

Cardiopulmonary resuscitation is an emergency lifesaving technique that is performed when the heart stops beating. This procedure is performed immediately to keep the flow of blood and oxygen running through the body when the person’s heart and breathing have stopped due to various reasons such as heart attack or drowning. CPR can be initiated by any person – a bystander or medical personnel – and involves basic chest compressions and rescue breathing. CPR has to be initiated in the order of CAB – Compressions, Airway and Breathing. 

How to do CPR when the heart suddenly stops?

CPR can be performed via two methods – Hands-only and mouth-to-mouth resuscitation. It is recommended that an untrained person performs only a hands-only CPR. 

Hands-only CPR

Hands-only CPR is the primary recommendation for untrained people. It involves the following steps:

Surveying the scene: Foremost, the person willing to help should assess if it is safe to help and reach the person in need. 

Open airways and ask for a response: Shake the shoulders of the concerned person and enquire if they are okay. In case of a child or infant, check the reaction by tapping the foot. In case the person is not responsive, immediately call an ambulance. However, if the person in question is a child between 1-8 years or is a victim of drowning, it is critical to begin CPR first and then call for an emergency.

Assess the heart with an automated external defibrillator (AED): In case an automated external defibrillator is readily accessible, use it to check the rhythm of the heart. An AED machine will also guide you to deliver one electric shock before performing chest compressions. But in case of children between ages 1 to 8, it is best to perform chest compressions for the first two minutes before using the AED machine. For infants and children under the age of one year, AED is not recommended, and only CPR should be followed. In case, AED is not available, chest compressions should be immediately started irrespective of the age or condition.

Place hands appropriately: In case of an adult, put the heel of one of your hands in the middle of the chest, while placing the other hand on top of the other. Once firm, interlock your raise the hands up while keeping the heels intact between the nipples on the chest. In the case of children till the age of 8, only one hand should be used to give chest compressions. In the case of infants, mere two fingers should be applied. 

Begin CPR: In case of an adult, push down on the chest at least 2 inches by using your upper body for force. These compressions should be performed at a rate of 100 to 120 compressions per minute while giving time to the chest to recoil between compressions. In the case of children between 1 to 8 years, the same procedure should be followed but with one hand placed between the nipples on the chest. However, for an infant, use your upper body and one finger placed in the centre of the chest to push straight down at 1.5 inches at the rate of 100 to 120 compressions per minutes, meanwhile allowing the chest to recoil between compressions. 

Continue Compressions: Keep up with the compressions until the person starts to breathe or medical help is received. 

Mouth-to-Mouth CPR

The foremost step to save lives in an emergency should be to provide chest compressions immediately, enabling the oxygen in the lungs and bloodstream to flow to the brain and heart without delay. Once, the chest compressions as per the method above are followed, you need to go a step further and provide mouth-to-mouth CPR in the following ways:

Open the airway: Place your palm on person’s forehead and gently tilt the head slightly backwards; then lift the chin forward while keeping the hand on the forehead. For infants and children, mere tilting the head slightly will open the airways.

Provide rescue breaths: Once the airways are open, you have to close the nostrils of the person and close/seal the person’s mouth with a CPR face mask. In the case of infants, both the mouth and nose should be covered with a CPR mask. In case a CPR mask is not readily available, you need to cover the person’s mouth with yours and provide two rescue breaths for about one second each. With each rescue breath, the chest of the person should rise. 

Alternate rescue breathing along with chest compressions: Continue to perform 30 compressions followed with two rescue breaths till the time a person begins to breathe normally or medical help is received. 

In all, CPR can effectively help save lives provided it is initiated timely and carried out appropriately. Moreover, a lot of hospitals, education institutions, government agencies, etc. provide training on CPR. 

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