Narayana Health Care

Cardiopulmonary resuscitation (CPR) is an emergency procedure. You can give CPR when a person stops breathing or has a cardiac arrest. Basic knowledge of emergency first aid and CPR is crucial for everyone, as it can maintain circulation and oxygen levels until emergency care arrives. Even though receiving CPR doesn’t guarantee survival, it does increase the chance of survival. The CPR technique uses a combination of:

• Chest compression
• Mouth-to-mouth rescue breathing

What are the indications of CPR?

Cardiopulmonary resuscitation is the sequence of prompt measures. These measures restore the oxygenated blood flow to the brain and other organs before an emergency treatment team arrives. Without CPR, people can lose consciousness or have irreversible brain damage in only a few minutes due to oxygen deprivation in the brain. The following are a few life-threatening signs, which seek emergency help:

• Difficulty breathing
• Ceased breathing
• Loss of consciousness
• Unresponsive to taps, movements, or instructions
• No identifiable pulse

One cannot afford to wait until someone has completely stopped breathing before giving them CPR, as cardiac arrest victims may grunt, snort, or hyperventilate, which is not normal breathing.

CPR steps are similar in older children and adults except for hand placement for cardiac compression and sequence of artificial breathing and chest compression. But, in infants, the compression pressure and depth should be one-third of adult ones.

What are the steps of CPR?

By performing CPR, you can increase a patient’s probability of survival by as much as three times. Only a professionally trained person should give CPR to a patient who is not breathing normally or is unresponsive. The following are the basic preparatory steps of CPR:

• Clear the area around the person.
• Stimulate a response from a person by patting the shoulder or asking questions.
• If there is no response, call the emergency helpline number 102 or 108, or you can ask someone nearby to call the number.
• Lay the person on their back and check their airway. Remove any blockage in the nose or mouth, such as blood, vomit, or food.
• Check the breathing for at least 10 seconds. If a person is breathing normally, maintain him in a recovery position and observe and wait for the help to arrive.
• If the person experiences difficulty breathing, gasping for air, or not breathing, start CPR as soon as possible.
• If you have access to a defibrillator, ask someone to bring it, don’t leave the CPR in between to fetch it.

How to perform CPR in adults and older children?

After the preparatory steps, start CPR as soon as possible. The following are the CPR methods:

• Chest compression: The following are step-by-step chest compression methods:
• Clinch your hands together by placing one on the other and kneeling down beside the patient.
• Place the heel of your interlocked hand on the lower half of the person’s breastbone, in the center of the chest.
• After positioning yourself on top of the person and keeping your arms straight, put one-third of your body weight and press at least two inches straight down.
• You can compress the chest at least 100 times per minute but ensure the chest should return to the normal position between compressions.
• Release the pressure. Ensure you should perform 30 chest compressions in one cycle. After giving compressions, perform rescue breathing.
• Artificial or rescue breathing: After 30 compressions, perform two rescue breathing. After ensuring the airway is clear, tilt the patient’s head backwards slightly and lift their chin. Pinch their nose closed and opens their mouth with your thumb and fingers. Put your mouth over their mouth to cover it and blow in the mouth to make their chest rise.

Re-tilt the head and give a second breath if the chest doesn’t rise on the first breath.

• Repeat the cycle: You should repeat this cycle of 30 chest compressions and two rescue breathings (30:2). The goal of CPR is to perform five sets of 30:2 in about two minutes until the person starts breathing or a paramedic takes over or tells you to stop.

How to perform CPR in younger children and infants?

CPR steps in younger children and infants are similar to the adult ones. The difference is the degree of compression and pressure. The following are the steps of CPR in infants and younger children after performing the preparatory ones:

• Rescue breathing: If the child is not breathing or having difficulty breathing, perform two rescue breathing. In children, you should pinch their noses and place your mouth on their mouth to blow the air. But in infants, you can put your mouth over their mouth and nose and blow the air.

If the child or infant has not started breathing even after mouth breathing, begin chest compressions.

• Chest compression: After kneeling down beside a child, place the heel of one hand at the center of the child’s chest, between and slightly below the nipples. Compress the chest around two inches deep at 100 times per minute.

While giving CPR to an infant, you should use two fingers at the center of the infant’s chest, between and slightly below the nipples. Compress the chest around 1.5 inches deep 30 times.

• Repeat the cycle: You should repeat these two rescue breathing and 30 chest compressions cycles until the child or infant starts breathing or help arrives.

CPR is a life-saving emergency first aid procedure and is easy to learn. It increases the chances of surviving a heart attack or breathlessness after trauma or an accident.

Dr. Sajal Gupta | Consultant – Cardiology | Dharamshila Narayana Superspeciality Hospital, Delhi