The purpose of CPR is to temporarily provide effective oxygenation
of vital organs, especially the brain and heart, through artificial
circulation of oxygenated blood until the restoration of normal
cardiac and respiratory activity occurs. The intended effect is
to stop the degenerative processes of ischemia and anoxia caused
by inadequate circulation and inadequate oxygenation.1 Immediate
high-quality CPR is crucial for optimal patient outcome.2 Furthermore,
even after defibrillation, most victims demonstrate asystole or
pulseless electrical activity for several minutes, and high-quality
CPR immediately following defibrillation can convert nonperfusing
rhythms to perfusing rhythms.2 The time sensitivity
of CPR in sudden cardiac death is emphasized in the American Heart Association
(AHA) “Chain of Survival” (Table
13-1 American Heart Association Chain of Survival |Favorite Table|Download (.pdf)
13-1 American Heart Association Chain of Survival
|Links in Chain||Comment|
|Early access||Phone 911.*|
|Early recognition of the emergency and activation of the
EMS or local emergency response system.|
|Early CPR||Immediate bystander CPR can double or triple the victim’s
chance of survival from ventricular fibrillation.|
|Early defibrillation||CPR plus defibrillation within 3 to 5 min of collapse can
produce survival rates as high as 49%–75%.|
|Early advanced care||Postresuscitation care delivered by health care providers.|
This chapter reviews basic CPR for adults (≥8 years old), including
the approach to an unresponsive patient; basic airway opening procedures, including
initial management of an obstructed airway; and the physiology and
mechanics of closed chest compression techniques. This chapter
is specifically directed toward health care providers.Table 13-2outlines the sequence of steps
to be taken when someone is found unresponsive.
13-2 Systematic Approach to CPR |Favorite Table|Download (.pdf)
13-2 Systematic Approach to CPR
|Step 1: Assess responsiveness.||If unresponsive, continue to step 2.|
|Step 2: Phone 911 and get AED.||If possible, call for an assistant to do so.|
|If no assistant is available and underlying etiology is asphyxia
(i.e., drowning), call 911.*|
|AED may be delayed to provide five cycles (or 2 min) of CPR.|
|Step 3: Position the patient and open the airway.||Maintain cervical spine immobilization if trauma likely.|
|Step 4: Assess breathing.||If no breathing is noted, go to step 5.|
|Step 5: Give two breaths.||Give each breath over 1 s.|
|Breaths should be of sufficient volume to cause visible chest
|Step 6: Assess circulation.||If no pulse, go to step 7.|
|Step 7: Begin closed chest compressions and
|“Push hard and fast.”|
|Compress 4–5 cm (~2 in.).|
|Allow for complete chest recoil and minimize
|Ratio of 30 compressions to two breaths.|
|Step 8: Use the defibrillator when available and indicated.||EMS to consider providing five cycles (or 2 min) of CPR ...|
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