How To Perform CPR?

Cardiology | by Dr. Ashok B Malpani | Published on 28/03/2023

Introduction

CPR or cardiopulmonary resuscitation is a lifesaving technique that is performed when the heart stops beating. You may have seen in a movie, a person giving mouth-to-mouth to an individual who loses consciousness. While you may have wondered how people know when to perform CPR or how it is performed, this blog can provide you with step-by-step information to help you familiarise yourself with how CPR works. 

Anyone including children can perform CPR if the proper technique is known. If you are wondering about the need to know CPR, it becomes crucial if anyone around you suffers from a cardiac arrest, even at home. Please note that this blog is only for informational purposes and does not replace the significance of a cardiologist's consultation. You can book your consultation with  a cardiologist in Kolkata at the BM Birla Heart Research Centre, the only cardiac hospital in the Eastern region with the best cardiologists, cardiac surgeons, and other healthcare professionals. 

What is CPR?

CPR or cardiopulmonary resuscitation refers to the emergency procedure that can be done to save a person’s life if their breathing stops. There are several reasons which can result in sudden malfunction in the heart and thus, may require immediate resuscitation. Such individuals if do not receive help from the bystanders before the ambulance arrives, can lead to serious health hazards. 

CPR keeps the blood flow active, even partially until medical help arrives. A timely CPR can increase the chances of survival in many patients. There are two commonly known versions of CPR - Conventional CPR for trained healthcare professionals and Compression-only CPR for anyone who witnesses an individual sudden collapsing. 

How To Perform CPR?

The primary aim of CPR is to resuscitate the victim or maintain the blood flow until the emergency medical team arrives. Before beginning CPR, it is important to call an ambulance as soon as possible. CPR procedure is done in different methods depending on whether the individual is a bystander or a trained professional. You don’t need formal training or special certification to perform CPR. Compression-only CPR or Hands-only CPR is done without mouth-to-mouth breaths. You must push hard and fast in the center of the chest at a rate of 100 to 120 pushes a minute. If that confuses you, some heart associations recommend timing the pushes to the beat of the song “Stayin’ Alive by Bee Gees”. 

Conventional CPR can be performed using chest compressions and mouth-to-mouth at a ratio of 30:2 compressions-to-breath. In the case of adult victims, medical professionals usually perform chest compressions at a ratio of 100 to 120/min to a depth of at least 5cm. In case there is an AED (Automated External Defibrillator) available, the machine can provide an electrical shock to the heart and cause it to begin beating again. However, it should be done by trained medical personnel.

Understanding CAB in CPR Procedure

A simple concept that can help you remember the basic steps during the CPR procedure is called C-A-B. 

Compression

C stands for compression and is done using your hands to push down hard in a specific area of the chest. This is one of the most crucial steps during CPR. Here is how to do compression: 

• Put the individual on their back on a flat surface and kneel next to their neck and shoulders.
• Place the lower palm of your hand over the center of the individual’s chest.
• Place the other hand on top of the first hand while keeping your elbows straight.
• Position your shoulders directly above your hands to ensure effective compressions.
• Push straight down on the chest at least 5 cm using your entire body weight when doing compressions.
• Avoid pushing down on the chest more than 6 cm. Push hard at a rate of 100 to 120 compressions a minute and allow the chest to recoil after each push.
• In case you do not know the proper technique of CPR, continue chest compressions until there are signs of movement or until emergency medical care arrives. If you know the proper technique of CPR, then go on to open the airway and rescue breathing.

Airway

A Stands for airway and is the passage from where you can provide mouth-to-mouth if you are trained in CPR procedures. After completing 30 chest compressions, you can open the person’s airway using the head-tilt, chin-lift maneuver. Put your palm on the individual’s forehead and gently tilt the head backward. Using the other hand, lift the chin gently to open the airways to proceed with the mouth-to-mouth maneuver.

Breathing

Breathing can be mouth-to-mouth or mouth-to-nose in case the mouth is seriously injured. The CPR procedure for children is very similar and the C-A-B technique can be used. In the case of 4-week-old babies or older, cardiac arrest may be due to a lack of oxygen. Check for any blockage in the airway and perform first aid for choking. If you do not figure out the reason why the child is not breathing, perform CPR. Here are some steps to follow during rescue breathing - 

• Pinch the nostrils shut for mouth-to-mouth breathing after opening the airway using the head-tilt, chin-lift maneuver.
• Cover the individual’s mouth with yours and make a seal.
• Provide simultaneous rescue breaths. The first rescue breath lasts one second. Wait to see if the chest rises. If the chest rises, give a second breath.
• In case the chest does not rise, repeat the head-tilt, and chin-lift maneuver and again give a second breath. 
• Remember to give thirty chest compressions followed by two rescue breaths (considered one cycle). Avoid too many breaths or breathing with too much force. Resume chest compressions to restore blood flow.
• In case an automated external defibrillator (AED) is available, apply it to give one shock, then resume chest compressions for around 90 seconds before giving another shock. Do not use the AED if you are not trained. 
• Continue CPR until there are signs of movement or emergency medical personnel take over.

What are the seven steps to perform the CPR procedure?

It is vital to keep calm during emergency situations like heart-related emergencies. The tension is high in times of emergencies, but it is important to stay calm and confident. If you find yourself in a life-and-death situation and immediate medical assistance is unavailable, the victim’s only hope may be you. The seven steps for CPR: 

• Situation assessment: It is important to ensure that the patient is lying down on a firm surface. Make sure to tap on the should and offer the assistance that is needed at that time. 

• Call for assistance: Make sure to find someone who would be able to provide an automated external defibrillator, probably at the nearest emergency clinical care center. If you don’t find any AED nearby, don’t leave the victim alone and call 102 immediately. 

• Open the airway: Try laying down the patient on their back and tilting their head back. It will help in help in lifting their chin. As a result, it will remove the nose and mouth blockages through blood, vomit, or loose teeth. 

• Look for breathing sounds: In an emergency situation, it is important to listen to the breathing sounds for around ten seconds at least. If you are not able to hear breathing noises, make sure to start CPR. 

• Begin chest compressions: To start CPR, ensure kneeling to the patient’s neck and shoulders. Then, position your lower palms on the patient’s chest, and start chest compression at least two inches but make sure it doesn’t go above 2.4 inches. You need to put complete body weight to create pressure on the chest. After each push, give a few seconds and then start again once the chest springs back. 

• Rescue breaths: In this step, ensure tilting the patient’s head back, lifting the chin, pinching the nose, and placing your mouth over the patient’s mouth to create a seal. Once there is mouth-to-mouth contact, ensure blowing air so that the patient’s chest rises. After the chest rises, ensure to blow a second breath and continue the compressions. 
• Continue CPR steps: Lastly, ensure continuing the cycles of chest compression including breathing till the time the patient begins to show signs of life such as breathing. Once the patient gets back to life, take them to the AED, emergency medical services for professional assistance.

Conclusion

Immediate CPR can double or even triple the chances of survival if the heart stops beating. Every year millions of people die because of cardiac arrest which can be prevented by taking adequate steps on time. People who are aware of the technique of CPR can prevent the chances of fatalities. 

A recent study has shown the potential of children performing hands-on CPR. With proper training and hand-only CPR, the majority of children can help save lives and reduce fatalities at home. In the end, it is all about the bystanders’ quick decision and awareness, that the CPR procedure can be effective.

FAQs

 

What is the full form of CPR?

CPR stands for cardiopulmonary resuscitation

When do you stop CPR?

CPR should be stopped once the patient starts to show signs of life like moving, breathing, coughing, and opening the eyes. 

When to give CPR?

CPR is given to someone when he/she has stopped breathing and is not showing any signs of life due to cardiac arrest.

How long should you check for breathing while performing CPR?

You should look for breathing while performing CPR for around ten seconds.