Introduction
Cardiopulmonary Resuscitation (CPR) is a critical emergency procedure used when a person’s heart stops beating or breathing suddenly ceases. CPR helps maintain blood circulation and oxygen delivery to the brain and vital organs until advanced medical assistance becomes available.
CPR is considered one of the most important first-aid and emergency medical interventions because immediate action can significantly improve survival rates and reduce permanent brain damage.
What Happens During Cardiac Arrest?
Cardiac arrest occurs when the heart suddenly stops pumping blood effectively. Without circulation, the brain and other organs begin to lose oxygen within minutes.
If CPR is not started quickly:
- Brain damage may occur within 4–6 minutes
- Permanent organ damage can develop
- Death may occur within minutes
CPR temporarily replaces the pumping action of the heart and supports oxygen circulation.
Causes of Cardiac Arrest Requiring CPR
Cardiac arrest can occur due to several medical emergencies.
1. Coronary Artery Disease
Blocked coronary arteries reduce blood supply to the heart muscle and may trigger sudden cardiac arrest.
2. Heart Attack (Myocardial Infarction)
A severe heart attack can disrupt the electrical activity of the heart.
3. Abnormal Heart Rhythms (Arrhythmias)
Dangerous arrhythmias such as:
- Ventricular fibrillation
- Ventricular tachycardia
can stop effective heart pumping.
4. Respiratory Failure
Conditions causing severe oxygen deprivation:
- Drowning
- Choking
- Severe asthma
- Drug overdose
- Pulmonary embolism
5. Trauma and Severe Injuries
- Chest trauma
- Massive bleeding
- Head injuries
- Electric shock
6. Metabolic and Medical Conditions
- Electrolyte imbalance
- Severe dehydration
- Sepsis
- Hypothermia
- Poisoning
Signs That CPR is Needed
Immediate CPR is required if a person:
- Suddenly collapses
- Is unconscious
- Has no normal breathing
- Shows gasping breaths only
- Has no detectable pulse
- Develops bluish lips or skin
Objectives of CPR
The main goals of CPR include:
- Maintaining blood circulation
- Delivering oxygen to the brain
- Preventing brain injury
- Supporting organ function
- Increasing survival chances until advanced care arrives
Adult CPR Procedure: Step by Step
Ensure Scene Safety
Before approaching:
- Check surroundings carefully
- Ensure no electrical, traffic, or environmental danger exists
Assess Responsiveness
- Tap the patient gently
- Ask loudly:“Are you okay?”
If there is no response:
- Call emergency medical services immediately
- Ask someone to bring an AED (Automated External Defibrillator)
Check Airway and Breathing
Open the airway using:
- Head tilt–chin lift maneuver
Check breathing for no longer than 10 seconds.
If the patient is not breathing normally:
Begin CPR immediately.
Chest Compressions
Chest compressions are the most important component of CPR.
Hand Placement
- Place the heel of one hand at the center of the chest
- Place the second hand over the first
- Interlock fingers
Compression Technique
Compression Depth
- Approximately 5–6 cm in adults
Compression Rate
- 100–120 compressions per minute
Important Principles
- Push hard and fast
- Allow full chest recoil
- Minimize interruptions
Rescue Breathing
After 30 chest compressions:
- Give 2 rescue breaths
Technique
- Open airway
- Pinch the nose closed
- Seal your mouth over patient’s mouth
- Deliver breath for about 1 second
The chest should visibly rise.
CPR Compression to Breath Ratio
Adults
- 30 compressions : 2 breaths
Continue cycles continuously until:
- Medical help arrives
- AED becomes available
- Patient regains consciousness
- Rescuer becomes exhausted
Automated External Defibrillator (AED)
An AED is a portable device used to restore normal heart rhythm.
AED Steps
- Turn on device
- Attach electrode pads
- Follow audio instructions
- Deliver shock if advised
AED use combined with CPR greatly increases survival rates.
CPR in Children and Infants
CPR technique differs slightly in pediatric patients.
Child CPR
- Use one or two hands
- Compression depth should be one-third of chest depth
Infant CPR
- Use two fingers
- Gentle compressions
- Smaller rescue breaths
Advanced Medical Management After CPR
Once the patient reaches hospital, advanced treatment begins.
Immediate Hospital Care
- Oxygen therapy
- Cardiac monitoring
- Ventilator support
- Intravenous fluids
- Blood investigations
- Defibrillation if required
Medications Used During CPR
Several emergency medications may be administered during cardiac arrest management.
1. Epinephrine (Adrenaline)
Purpose
- Improves blood flow to heart and brain
- Supports circulation during arrest
Common Use
- Administered every 3–5 minutes during CPR
2. Amiodarone
Used For
- Ventricular fibrillation
- Pulseless ventricular tachycardia
Helps stabilize dangerous arrhythmias.
3. Lidocaine
Alternative antiarrhythmic medication used in certain cardiac arrests.
4. Atropine
Used primarily for severe bradycardia (abnormally slow heart rate).
5. Magnesium Sulfate
Used in:
- Torsades de pointes
- Severe electrolyte disturbances
Post Resuscitation Care
Successful CPR is followed by intensive monitoring.
Monitoring Includes
- Heart rhythm
- Blood pressure
- Oxygen saturation
- Neurological assessment
Additional Treatments
- Coronary angiography
- Cardiac surgery
- Intensive care unit admission
- Therapeutic hypothermia
Possible Complications of CPR
Although CPR is life-saving, complications can occur:
- Rib fractures
- Chest wall injury
- Lung injury
- Vomiting
- Internal bleeding
These complications are generally acceptable compared to the risk of death without CPR.
When CPR May Not Be Appropriate
CPR may not be initiated in:
- Patients with valid DNR (Do Not Resuscitate) orders
- Irreversible signs of death
- Unsafe environments
Importance of Early CPR
Early CPR:
- Doubles or triples survival chances
- Preserves brain function
- Maintains circulation before hospital care
Immediate action saves lives.
Easy CPR Memory Rule
CAB Approach
- C → Compressions
- A → Airway
- B → Breathing
Conclusion
Cardiopulmonary Resuscitation (CPR) is an essential emergency procedure that can save lives during cardiac arrest and respiratory emergencies. Early recognition, immediate chest compressions, rescue breathing, and rapid defibrillation are crucial for improving patient outcomes. Proper CPR knowledge and timely intervention can significantly increase survival and reduce long-term complications.
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