A B C D E F G H I J K L M N O P R S T U V W

CARDIAC RESUSCITATION - CARDIOPULMONARY RESUSCITATION

What is Cardiac Resuscitation ?

Cardiopulmonary resuscitation (called CPR) is a way of maintaining the pumping function of the heart and the breathing function of the lungs, when they fail. Although medical expertise may be needed to restore normality, the circulation of the blood (using external cardiac massage) and artificial breathing (using mouth-to-mouth respiration) can be undertaken by anyone with simple basic training. They may keep heart attack victims alive long enough until expert help is available.

Why is Cardiac Resuscitation needed ?

Two different problems may cause collapse after a heart attack (properly called a myocardial infarction). Firstly, the heart may fail to pump because of mechanical weakness; this is uncommon, as the heart has a large pumping reserve which it calls on when damaged. The second type of failure is electrical; the heart's function is controlled by an electrical system, just as a car engine is controlled by a battery, sparking plugs, etc. After a heart attack, the heart's electrical system may be disorganized. These two problems may both cause the pulse to be lost, but with CPR the circulation can be maintained, whichever fault has occurred. When the circulation fails, the blood flow to the brain also fails. After a few seconds this causes loss of consciousness and collapse. After a minute or two, the breathing also stops because this is controlled by the brain. CPR is therefore designed to keep both the circulation and the breathing going artificially.

When is Cardiac Resuscitation needed ?

There are many causes for loss of consciousness. Some, such as epilepsy or strokes, do not cause the circulation or breathing to stop. Before starting CPR, therefore, it is important to check that the circulation and the breathing have been lost. It is usually easy to see if breathing has stopped. To check if the circulation has ceased you must first learn to feel for a pulse. This can be felt in many places in the body, not only the wrist, but also the neck (probably the easiest place), the front of the elbow, and the groin. You should practise on a relative or friend. If the circulation stops for more than a few seconds, the pupils of the eyes become big and the lips and ears become blue; these are serious signs of an absent or inadequate circulation, and it may prove too late to help the heart to recover.

What should you do ?

If you are alone when someone collapses, you may be uncertain whether to get help or start resuscitation. Ideally shout for someone else to call for an ambulance: if you delay resuscitation for more than a minute or two whilst calling for help, the resuscitation will be useless.

How do I do Cardiac Resuscitation ?

There are three possible scenarios : (1) If unconscious but still breathing and with a pulse , turn the patient on his side so that any vomiting will not prevent breathing. (2) If you can feel a pulse but breathing has stopped , mouth-to-mouth artificial respiration is all that is needed; there is enough oxygen for a patient in the air that you breathe out. The patient should be on his back and anything in the mouth such as vomit or false teeth must be removed. Take a deep breath and, kneeling at the side, pinch the patient's nose with one hand. Place your lips over the patient's mouth and forcibly breathe out. You also need to pull the chin up with your other hand; this keeps his or her tongue out of the way. (3) If there is no pulse , you must also do cardiac massage . Still kneeling at the side, place your hands one on top of the other with your fingers interlocked over the lower end of the patient's breast bone. Press down about an inch fairly sharply, keeping your elbows straight and bringing the weight of your body directly over your hands. Then release the pressure and repeat this movement about 70 times per minute. If you are on your own, you will need to do two mouth-to-mouth respirations after every ten compressions . This is hard work and is best shared between two people who can exchange their jobs every few minutes.

How do I check if Cardiac Resuscitation is working ?

To check if respiration is adequate, look to see if the patient's chest moves outwards whilst you are breathing out. If it doesn't, you are either not sealing the patient's nose or your lips around the mouth. The tongue may block the air flow: pulling the chin up is important. Other things, such as false teeth may block the air flow. Take them out. The person doing the respiration should also check if the cardiac massage is working by feeling for a pulse. If there is none, either the cardiac massage is not being done properly or it is another form of cardiac arrest which is not likely to respond to CPR.

How good is Cardiac Resuscitation ?

Basic CPR can be remembered as ABC : A for airway making sure that the mouth and air passages are not blocked; B for breathing artificial breathing mouth-to-mouth; C for circulation cardiac massage. This can be effective enough to maintain life for at least half an hour, if done properly. It should be long enough for trained staff to arrive, or to get the patient to hospital for advanced resuscitation. CPR does need proper training, however, and cannot really be mastered only by reading guidelines like this. Courses are undertaken in many hospitals and by organizations such as the British Red Cross and St John's Ambulance. Saving a life is a remarkable achievement. If enough people learn it, many lives would be saved. Most people who die from heart attacks do so within minutes because there is often no one around who has learned the ABC of resuscitation.