Executive Summary
Cardio-pulmonary resuscitation should be given if the patient has a cardiac arrest, in which his heart stops beating. The purpose is to pump blood to the brain till medical help arrives since within a few minutes of the heart’s stopping, parts of the brain start failing permanently.
Cardio-pulmonary resuscitation (CPR) is a life-saving technique to push blood to the brain of a person whose heart has stopped beating. The procedure is performed until the emergency services reach the patient and take over his revival. I could have, instead, titled this article “How To Save A Life”.
Who Needs CPR?
CPR should be given to a person who has a cardiac arrest.
What is Cardiac Arrest?
There are various reasons why a person’s heart may stop beating. Misfiring electrical impulses in the heart muscle may cause abnormal heartbeat (arrhythmia). It can be triggered by heart blockages, an enlarged heart, blood loss in an accident, oxygen shortfall due to choking or drowning or an overdose of minerals like magnesium and potassium.
A heart that is fluttering or has stopped beating cannot pump blood to the body. This condition is called cardiac arrest, which necessitates CPR to be given to the person.
If the victim is facing any other problem such as chest pain (angina), heart attack or even normal fainting, CPR should not be given as the heart continues beating.
Why is CPR Given In Cardiac Arrest?
The body’s cells get oxygen and glucose for their functioning from the blood circulated by the pumping heart. When it stops beating, all cells and organs start going into oxygen deficit, but the damage to the brain is more consequential. As the cells in different brain regions start dying, body functions regulated by those parts fail, often irreparably. Here is a rough timeline for the brain after a cardiac arrest:
- 0 to 4 minutes: Brain damage is unlikely.
- 4 to 6 minutes: Some brain cells start dying and brain damage begins.
- 6 to 10 minutes: Many brain cells die and a few regions are damaged irreparably. Even if the person is revived now, he may not recover with full abilities.
- After 10 minutes: Most regions of the brain may be dead, with negligible chance of surviving. This is called brain death. Even if the heart is restarted at this stage, the patient cannot recover much and possibly will vegetate all his life.
A heart attack is different from a cardiac arrest. In the former, a part of the heart muscle does not function properly due to a blockage in the blood vessel supplying it with blood. However, the brain gets some blood supply as the heart keeps beating—even if inefficiently—and does not need external actions like CPR.
Why Should You Learn CPR?
In the emergency management world, the bystanders who can reach the victim quickly are called the first responders. The paramedics with a cardiac ambulance are the second responders. Finally, the medical team in the hospital is the third responder.
The first few minutes are critical after a cardiac arrest. However, emergency services may take a few minutes to reach the victim, especially outside a hospital. It is said that for every minute lost after a cardiac arrest, the chances of survival decrease by 10 per cent.
Even in countries with well-developed medical facilities like the USA and Canada, the survival rate of cardiac arrest patients is 10% and 7%, respectively. This is because many bystanders don’t know how to help a cardiac arrest patient immediately.
This ratio improves to between 24% and 40% if the patient is inside the hospital when he gets a cardiac arrest. This increase in survival chances by a factor of two to three suggests that CPR by a first responder in the outside world can make a difference.
If you happen to be with the victim in the first few minutes after his cardiac arrest, your knowledge of CPR can be the difference between life and death for him.
Do You Have To Be An Expert in CPR?
Many people trained in CPR are afraid that they may forget a few important CPR steps or techniques. So some freeze into inaction when needed. However, all experts agree that an incorrectly administered CPR is better than no CPR because, without an intervention, a cardiac arrest victim would have died anyway.
Some others are worried that they may cause harm during CPR. For example, a strong downward force is applied during CPR chest compression, which has its risks such as fracturing the ribs or the breastbone, especially in people with weaker (osteoporotic) bones. However, all those damages can be repaired, but severe brain damage or brain death cannot be reversed. It is better that you err on the side of going overboard.
Learning the CPR Steps
CPR is best learned by watching it performed live and practising the steps on a mannequin under expert supervision. Also, there are many good websites and resources to read the steps of the procedure:
- Medical News Today: CPR steps: A visual guide
- NorthWest Career College: What are the 7 steps of CPR in order?
- UTHealth Houston: CPR: Just do it
It makes no sense to repeat the same CPR protocol information in this article; instead, you can read the first article above. A six-step summary of the CPR steps is in Exhibit 1 below.
A thoroughly trained CPR professional needs to know many details. However, people like you and I, the typical bystanders, should know about some practical trade-offs:
- CPR involves hands-only CPR (pumping the chest), rescue breaths (mouth-to-mouth resuscitation) and the use of AED (Automated External Defibrillator)—a machine that gives shocks to the chest but works only if the cardiac arrest is due to certain arrhythmias.
- In a country like India, people don’t prefer to give mouth-to-mouth resuscitation to strangers on the road. So for practical reasons, as a layperson, it is adequate if you learn just hands-only CPR. Leave the other two to better-trained and equipped teams or second responders.
- Before starting CPR, call out loudly and ask for help. Someone else needs to contact secondary responders and fetch an ambulance; you will be busy with the victim.
- Always administer CPR in a safe area. It may be dangerous to do it where you put yourself in danger, such as on a highway or at a calamity site.
- Clear out the crowds standing around the victim. Have at least a few feet of open space around the patient.
- CPR is best given with the victim lying on the ground. Don’t try to shift the patient onto an elevated platform; you can use your body weight better for CPR when the person is on the ground.
- If the victim has a spinal injury in an accident, moving him can worsen it further and potentially paralyse him. Don’t move such a person more than needed.
- Do not panic as four minutes is a long and adequate time to set up for CPR. Stay calm; you do not need to rush things.
- While the heart is deviated to the left, most of it is centrally located under the breastbone. So CPR is given at the centre of the chest in line with the nipples.
- Ensure the person is response-less, not breathing and without pulse before giving CPR.
- Response-less: Give two hard slaps on both the collarbones and see if the person grunts or responds.
- No breathing: Put your cheek and ear close to the patient’s nose to feel or hear the breath. Simultaneously, look at the patient’s chest and see if it is rising and falling with breath.
- No pulse: Check the pulse by placing two fingers on the carotid artery on the side nearer to you. One carotid artery passes on either side of the windpipe; best to check the pulse by pressing two fingers on the artery around the Adam’s Apple level. A wrist pulse will not be felt if the systolic blood pressure falls below 80 mmHg, while a neck pulse needs BP below 60 mmHg before you cannot feel it. Always check the pulse on the neck, as it is the last pulse to stop and systolic BP below 60 mmHg means that the brain is getting no blood.
- When giving compression, use the base of your dominant hand. Keep elbows locked, not bent. The force should originate from your hips and not arms or shoulders, or else you will tire out fast.
- Give between 100 and 120 pumps per minute.
- It is best to have a two-person team, with each one doing CPR for 2 minutes and then the other person taking over. Giving CPR is very tiring and you may need to continue it for a long duration, even up to 30 minutes if a cardiac ambulance does not arrive.
- Instead of checking the watch continuously to alternate every 2 minutes, you may count to 200 pumps and then switch.
- If you get tired and cannot sustain deep and fast pumps, continue with a slower beat but don’t reduce the depth of compression (5 cm deep), which is needed for the blood to be pumped to the brain.
- If the person does not revive and you don’t get any secondary responder coming in 30 minutes, you may reluctantly have to call off the CPR and let the person pass away.
- CPR for children and infants is somewhat different from that for adults.
- CPR in choking or drowning instances needs using rescue breaths (mouth-to-mouth resuscitation).
- In countries like India, getting an ambulance in time is difficult during rush hours. One practical solution is to use any available car to get the person to a hospital. Lay the patient in the rear seat of the car, with his head on the passenger side. The person giving CPR should get into the front passenger seat after reclining it fully and face the patient. Kneeling on the seat, he should keep administering CPR.
- If you bring a patient with cardiac arrest to a hospital, take him directly to the Casualty area. You don’t need to waste time on any paperwork. The hospital should activate a Code Blue—All available medical personnel are expected to respond quickly to that life-or-death emergency.
- By law, all government or private hospitals in India have to accept any cardiac arrest patient for initial stabilisation. This was the Supreme Court of India’s verdict in a famous case called Parmanand Katara vs. Union of India. The hospitals that aren’t equipped to handle a cardiac arrest can refuse to accept such a patient. For example, an eye hospital may not have the wherewithal to deal with a cardiac arrest. However, no hospital can refuse a cardiac arrest patient based only on the paying capacity of the patient.
- The laws in other countries may be different. In countries like the USA, there may be different laws even in different states.
CPR Rhythm
CPR is given in adults with a rhythm of 100 to 120 compressions per minute in cycles of two minutes each, after which the patient’s breathing and pulse should be checked. If there is no improvement, the CPR is to be resumed for another two minutes.
Since CPR is very tiring for the responder, most people end up giving it at a rate slower than 100 beats per minute. It is also difficult to figure out the pumping frequency while you are administering compressions.
A simple way is to sing a popular song that has a rhythm similar to the one recommended for CPR. Here are a few popular songs in Hindi and English–Hum them and pump the chest on their beats. Choose the one from your generation or that you are familiar with:
Hindi CPR Songs
- 1959 (Anadi): Kisiki Muskurahton Pe Ho Nisar—किसी की मुस्कुराहटों पे हो निसार
- 1993 (Baazigar): Baazigar O Baazigaar—बाज़ीगर ओ बाज़ीगर
- 2011 (Double Dhamaal): Jalebi Bai—जलेबी बाई
English CPR Songs
- 1970 (Bridge Over Troubled Waters): Simon and Garfunkel: Cecilia
- 1973 (Second Helping): Lynyrd Skynyrd: Sweet Home Alabama
- 1977 (Saturday Night Fever) Bee Gees: Stayin’ Alive
- 1983 (She’s So Unusual) Cindi Lauper: Girls Just Wanna Have Fun
- 1986 (The Final Countdown) Europe: The Final Countdown
- 1993 (A Mí Me Gusta) Los Del Rio: La Macarena
- 1996 (Spice) Spice Girls: Say You’ll Be There
- 1999 (Rainbow) Mariah Carey: Heartbreaker
- 2005 (Oral Fixation Vol. 2) Shakira: Hips Don’t Lie
- 2011 (21) Adele: Rumour Has It
- 2015 (Purpose) Justin Bieber: Sorry
- 2023 (Endless Summer Vacation) Miley Cyrus: Flowers
It may appear odd that you are humming a song in an emergency. But, in case you miss it, you are just singing the sacred anthem of life.
A famous neurosurgeon was taken to court in a medical negligence case and the plaintiff told the judge, “This doctor is very arrogant and often thinks that he is the God.” The defendant responded, “When my patient is on the operating table, his skull is opened and the swollen tumour is pressing on his brain, then if I have a scalpel in my hand, I don’t have to think I am the God. At that moment, I AM the God.”
When you are administering CPR, for those few minutes, you are the God.
To Read More
- Mayo Clinic: Cardiac Arrest
- American Heart Association: What is CPR?
- Clevland Clinic: CPR
- Healthline: Cardiopulmonary Resuscitation (CPR)
- Medical News Today: CPR steps: A visual guide
- NorthWest Career College: What are the 7 steps of CPR in order?
- UTHealth Houston: CPR: Just do it
- Mayo Clinic: Cardiopulmonary resuscitation (CPR): First aid
- CPR Select: CPR Success Rate: How Effective Is CPR?
- AHA Journals (Circulation): Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
- On this Website: How omega-3 fish oil helps after a heart attack
First Published on: 22nd February 2024
Image Credit: stefamerpik on Freepik
Last Updated on: 28th February 2024