CPR - is there a better way

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CPR Procedures and Actions

This document presents the consensus view of the Basic Life Support working group of the International Liaison Committee on Resuscitation (ILCOR) It is presented without any implied warranties and does not represent the official guidelines of any of the member organisations.

The scientific basis for treatment of cardiac arrest can be bound to a "series of actions" that carried out in the correct manner may result in a prolonging of heart VF/VT activity that can be acted on by external defibrillation. In addition the actions may result in sufficient quantity of oxygen being passed around the cardiopulmonary system to offer a reduction in brain and heart damage in the immediate moments following cardiac arrest.
Basic CPR as practised today in many cases is based on historical 'preferences' and has little bearing on modern research.

Procedures Outline

Ensure SAFETY of rescuer and others
Check the victim for Response (conscious level)Shake by shoulders and ask positive question - can you hear me?, open your eyes.
In the case of response - DO NOT move victim unless there is immediate danger, carry out search for non-obvious injury or illness. Assess for change in condition at regular intervals.
If NO Response immediately send for help - if alone consider going for help.
Open airway by lifting chin straight up and tilting head back without moving victim from original position.
Victim MAY be turned on side if warranted - avoid head tilt if spinal trauma suspected.
Examine airway for blockage, vomit etc Look for chest movement-listen for breaths-
If NOT breathing give TWO steady breaths, sufficient to make the chest rise visibly - breath over about 1-2 seconds.
Pulse check is now deleted
Locate lower half of breastbone (sternum) and place the HEEL of one hand there (no pressure on ribs or below sternum)press straight down for about one third of chest wall. Release pressure and repeat actions at rate of 100 per minute.(30 consecutive compressions - revised upwards from 15)
Continue resuscitation until
The victim shows signs of response
Qualified help arrives
You become exhausted

The above is more or less traditional practice in most countries-ILCOR advises as follows

Studies indicate that location of carotid pulse by laypersons often takes considerably longer than 10 seconds at a time when seconds are invaluable.Therefore NO pulse check
A collapsed victim in the street is likely to have hypotension, vasoconstriction, or worse.
As a result ILCOR considers the carotid pulse check should be de-emphasised in training, other criteria should be used to determine if chest compression is warranted. "Look for signs" is advocated and in the absence of obvious signs (chest movement for example)not necessarily absence of pulse, should be sufficient indication chest compression should be initiated.
Pulse checks still remain an integral important part of patient assessment however.

Volume and Rate of Ventilation

Rescue breathing has been an accepted technique since the early 1960's and the volume of air has been quoted at 800 to 1200 mL. ILCOR questions the validity of these figures.
Over inflation carries a high risk of gastro-inflation (air in stomach leading to regurgitation)
Regurgitation depends on the proximal airway pressure (tidal volume)alignment of neck and patency of airway and the opening pressure of the lower aesophageal sphincter (approx 20 cm H2O)
Modern research shows that a tidal volume of just 400-500 mL is sufficient to ventilate an adult victim (even 300-400 is mooted) because CO2 production is low during cardiac arrest. A steady ventilation time of 1.5 to 2 seconds diminishes the risk of exceeding this pressure.
Therefore optimum results can be achieved with a compression rate of 100 per minute with 30 cardiac compressions and 6 seconds for two rescue breaths.

Call First - Call Fast

The first link in the chain of survival is to gain access to early EMS (emergency medical service) Several factors are involved in deciding when to leave a victim in order to call for help.
The importance of early defibrillation in the treatment of sudden cardiac arrest is now accepted. As early as 1992 it was advised that, if no other help was available, an adult victim should be left as soon as non-response was detected in order to call for EMS. It is now agreed that life support measures (CPR should be delivered for one minute before going for help. (It is accepted that this procedure may not find favour in all countries.)

Automated External Defibrillators

The use of AED is now considered to be within the domain of BLS, in fact learning to use AED is considered probably easier than learning CPR! It is believed these devices should be widely distributed in the public area. It is worth noting that large public bodies such as QANTAS airline has already initiated this procedure. Consideration should be given to the inclusion of AED training programs within the public list offered by First Aid Providers. For flow chart and data use this link flow chart

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