Cardiopulmonary resuscitation.docx

Cardiopulmonary resuscitation.docx

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Cardiopulmonaryresuscitation

Cardiopulmonaryresuscitation

FromWikipedia,thefreeencyclopedia

"CPR"redirectshere.Forotheruses,see CPR（disambiguation）.

Cardiopulmonaryresuscitation

Intervention

CPRbeingperformedonamedical-trainingmanikin

ICD-9:

99.60

MeSH

D016887

OPS-301 code:

8-771

MedlinePlus

000010

Cardiopulmonaryresuscitation （CPR）isan emergencyprocedure performedinanefforttomanuallypreserveintactbrainfunctionuntilfurthermeasuresaretakentorestorespontaneousbloodcirculationandbreathinginapersonwhoisin cardiacarrest.Itis indicated inthosewhoareunresponsivewithnobreathingorabnormalbreathing,forexample, agonalrespirations.

Accordingtothe InternationalLiaisonCommitteeonResuscitation guidelines,CPRinvolveschestcompressionsatleast5 cm（2 in）deepandatarateofatleast100perminuteinanefforttocreateartificialcirculationbymanuallypumpingbloodthroughtheheartandthusthebody.Therescuermayalsoprovidebreathsbyeitherexhalingintothesubject'smouthornoseorusingadevicethatpushesairintothesubject'slungs.Thisprocessofexternallyprovidingventilationistermed artificialrespiration.Currentrecommendationsplaceemphasisonhigh-qualitychestcompressionsoverartificialrespiration;asimplifiedCPRmethodinvolvingchestcompressionsonlyisrecommendedforuntrainedrescuers.

CPRaloneisunlikelytorestarttheheart.Itsmainpurposeistorestorepartialflowofoxygenatedbloodtothe brainand heart.Theobjectiveistodelay tissuedeath andtoextendthebriefwindowofopportunityforasuccessfulresuscitationwithoutpermanent braindamage.Administrationofanelectricshocktothesubject'sheart,termeddefibrillation,isusuallyneededinordertorestoreaviableor"perfusing"heartrhythm.Defibrillationiseffectiveonlyforcertainheartrhythms,namely ventricularfibrillation or pulselessventriculartachycardia,ratherthanasystole or pulselesselectricalactivity.CPRmaysucceedininducingaheartrhythmthatmaybeshockable.Ingeneral,CPRiscontinueduntilthepatienthasa returnofspontaneouscirculation （ROSC）orisdeclared dead.

Contents

  [hide] 

∙1 Medicaluses

∙2 Methods

o2.1 Standard

o2.2 Compressiononly

o2.3 ProneCPR

o2.4 Pregnancy

o2.5 Other

∙3 Effectiveness

∙4 Pathophysiology

∙5 Complications

∙6 Adjunctdevices

o6.1 Timingdevices

o6.2 Manualassistdevices

o6.3 Automaticdevices

o6.4 Mobileapps

∙7 Prevalence

o7.1 ChanceofreceivingCPR

o7.2 ChanceofreceivingCPRintime

∙8 Societyandculture

o8.1 Portrayedeffectiveness

o8.2 StageCPR

o8.3 Self-CPRhoax

o8.4 CPRlearnedfrommoviesandtelevision

o8.5 Hands-OnlyCPRportrayedasmorepalatableversion

∙9 History

∙10 AdministeringCPRtoanimals

∙11 Seealso

∙12 References

∙13 Externallinks

Medicaluses[edit]

CPRisindicatedforanypersonunresponsivewithnobreathingorbreathingonlyinoccasional agonal gasps,asitismostlikelythattheyarein cardiacarrest.[1]:

S643 Ifapersonstillhasa pulse butisnotbreathing（respiratoryarrest） artificialrespirations maybemoreappropriate,but,duetothedifficultypeoplehaveinaccuratelyassessingthepresenceorabsenceofapulse,CPRguidelinesrecommendthatlaypersonsshouldnotbeinstructedtocheckthepulse,whilegivinghealthcareprofessionalstheoptiontocheckapulse.[2] Inthosewithcardiacarrestdueto trauma CPRisconsideredfutilebutstillrecommended.[3] Correctingtheunderlyingcausesuchasa pneumothorax or pericardialtamponade mayhelp.[3]

Methods[edit]

CPRtechniqueasdemonstratedonadummy.

CPRtraining:

CPRisbeingadministeredwhileasecondrescuerpreparesfor defibrillation.

In2010,the AmericanHeartAssociation and InternationalLiaisonCommitteeonResuscitation updatedtheirCPRguidelines.[1]:

S640[4] TheimportanceofhighqualityCPR（sufficientrateanddepthwithoutexcessivelyventilating）wasemphasized.[1]:

S640 Theorderofinterventionswaschangedforallagegroupsexcept newborns from airway,breathing,chestcompressions（ABC） tochestcompressions,airway,breathing（CAB）.[1]:

S642 Anexceptiontothisrecommendationisforthosebelievedtobeina respiratoryarrest （drowning,etc.）.[1]:

S642 ThemostimportantaspectofCPRare:

fewinterruptionsofchestcompressions,asufficientspeedanddepthofcompressions,completelyrelaxingpressurebetweencompressions,andnotventilatingtoomuch.[5]

Standard[edit]

Auniversalcompressiontoventilationratioof30:

2isrecommendedbytheAHA.[6]:

8 Withchildren,ifatleast2trainedrescuersarepresentaratioof15:

2ispreferred.[6]:

8 Innewbornsarateof3:

1isrecommendedunlessacardiaccauseisknowninwhichcasea15:

2ratioisreasonable.[1]:

S647 Ifanadvancedairwaysuchasan endotrachealtube or laryngealmaskairway isinplace,artificialventilationshouldoccurwithoutpausesincompressionsatarateof8–10perminute.[7] Therecommendedorderofinterventionsischestcompressions,airway,breathingorCABinmostsituations,[1]:

S642 withacompressionrateofatleast100perminuteinallgroups.[6]:

8 Recommendedcompressiondepthinadultsandchildrenisatleast5 cm（2 inches）andininfantsitis4centimetres（1.6 in）.[6]:

8 Asof2010the ResuscitationCouncil（UK） stillrecommendsABCforchildren.[8] Asitcanbedifficulttodeterminethepresenceorabsenceofapulse,thepulsecheckhasbeenremovedforlayprovidersandshouldnotbeperformedformorethan10secondsbyhealthcareproviders.[6]:

8 Inadults,rescuersshouldusetwohandsforthechestcompressions,whileinchildrentheyshoulduseone,andwithinfantstwofingers（indexandmiddlefingers）.[9]

Compressiononly[edit]

Compression-only（hands-onlyorcardiocerebralresuscitation）CPRisatechniquethatinvolveschestcompressionswithout artificialrespiration.[1]:

S643 Itisrecommendedasthemethodofchoicefortheuntrainedrescuerorthosewhoarenotproficientbecauseitiseasiertoperformandinstructionsareeasiertogiveoveraphone.[1]:

S643[6]:

8[10] Inadultswithout-of-hospital cardiacarrest,compression-onlyCPRbythelaypublichasahighersuccessratethanstandardCPR.[10] Theexceptionsarecasesof drownings, drugoverdose andarrestinchildren.Childrenwhoreceivecompression-onlyCPRhavethesameoutcomesasthosehavingreceivednoCPR.[1]:

S646 Themethodofdeliveringchestcompressionsremainsthesame,asdoestherate（atleast100perminute）.Itishopedthattheuseofcompression-onlydeliverywillincreasethechancesofthelaypublicdeliveringCPR.[11] Asperthe AmericanHeartAssociation,thebeatofthe BeeGeessong"Stayin'Alive"providesanidealrhythmintermsofbeatsperminutetouseforhands-onlyCPR.[12] Onecanalsohum Queen's"AnotherOneBitesTheDust",whichisexactly100beats-per-minuteandcontainsamemorablerepeatingdrumpattern.[13] Forthosewithnoncardiacarrestandpeoplelessthan20yearsofage,standardCPRissuperiortocompression-onlyCPR.[14][15]

ProneCPR[edit]

Simultaneousmaintenanceofbloodcirculationandventilationcanbeobtainedbycompressingthebackifthevictimisinproneposition,byturningtheheadtothesideandcompressingtheback.Duetothehead'sbeingturned,theriskofvomitingandcomplicationscausedby aspirationpneumonia issignificantlyreduced,andthemethodmeansthepatientcontinuestogetairintotheirlungswithouttheneedformouth-to-mouthrespiration.[16]

Pregnancy[edit]

During pregnancy whenawomanislyingonherback,the uterus maycompressthe inferiorvenacava andthusdecreasevenousreturn.[3] Itisthereforerecommendedthattheuterusbepushedtothewoman'sleft;ifthisisnoteffective,eitherrollthewoman30°orhealthcareprofessionalsshouldconsideremergency Caesareansection.[3]

Other[edit]

Interposedabdominalcompressionsmaybebeneficialinthehospitalenvironment.[17] Thereisnoevidenceofbenefitpre-hospitalorinchildren.[17]

Internalcardiacmassageismanualsqueezingoftheexposedheartitselfcarriedoutthroughasurgical incision intothe chestcavity,usuallywhenthechestisalreadyopenforcardiacsurgery.

Effectiveness[edit]

TypeofArrest

ROSC

Survival

Source

WitnessedIn-HospitalCardiacArrest

52%

19%

[18]

UnwitnessedIn-HospitalCardiacArrest

33%

8%

[18]

Out-of-HospitalCardiacArrestOverall

59%

10%

[19]

UnwitnessedOut-of-HospitalCardiacArrest

21%

4%

[19]

WitnessedOut-of-HospitalCardiacArrest

41%

15%

[19]

Witnessedand"Shockable"withBystanderCPR

53%

37%

[19]

BystanderCompression-only Resuscitation

-

13%

[20]

BystanderConventionalCPR

-

8%

[20]

CPRservesasthefoundationofsuccessfulcardiopulmonaryresuscitation,preservingthebodyfor defibrillation and advancedlifesupport.Eveninthecaseofa"non-shockable"rhythm,suchas PulselessElectricalActivity （PEA）wheredefibrillationisnotindicated,effectiveCPRisnolessimportant.Usedalone,CPRwillresultinfewcompleterecoveries,thoughtheoutcomewithoutCPRisalmostuniformlyfatal.[21]

StudieshaveshownthatimmediateCPRfollowedbydefibrillationwithin3–5minutesofsudden VF cardiacarrestdramaticallyimprovessurvival.IncitiessuchasSeattlewhereCPRtrainingiswidespreadanddefibrillationbyEMSpersonnelfollowsquickly,thesurvivalrateisabout20percentforallcausesandashighas57percentifawitnessed"shockable"arrest.[22] IncitiessuchasNewYork,withoutthoseadvantages,thesurvivalrateisonly5percentforwitnessedshockablearrest.[23]

Compression-onlyCPRmaybelesseffectiveinchildrenthaninadults,ascardiacarrestinchildrenismorelikelytohavea non-c