The simple, magical world of CPR

When her mother-in-law was found unconscious in 2018, a 32-year-old nurse from Delhi sensed that the former had no detectable pulse. She got into action immediately and performed cardiopulmonary resuscitation (CPR), an emergency lifesaving procedure. She continued CPR till the ambulance arrived at her doorstep and took the patient under emergency medical care.

The emergency-response technicians attended to the woman and used an automated external defibrillator, a device that analyses the heart’s rhythm and provides an electric shock or defibrillation if necessary. The woman, who was taken to a private hospital, survived. All in about 30 minutes — and amidst Delhi traffic.

“I was working in a private hospital in Delhi in 2018 then and treated the patient in the emergency room,” says Dr B Bharath Kumar Reddy, emergency medicine and critical care, assistant professor, Narayana Medical College, Nellore, Andhra Pradesh. “I later learnt that the daughter-in-law was a nurse working in the same hospital and she immediately conducted CPR, saving her mother-in-law. When the woman was brought to the hospital’s emergency section, the doctors conducted 10 more cycles of CPR. The woman regained her consciousness and was later given a heart stent. She recovered completely and was discharged with no further complication.”

Though heart attacks are common across the globe, few people are aware how performing CPR can help in saving lives.

What is CPR(cardiopulmonary resuscitation)?

CPR is an emergency lifesaving procedure performed when the heart stops beating. According to American Heart Association, immediate CPR can double or triple chances of survival after cardiac arrest. Keeping the blood flow active, even partially, extends the opportunity for a successful resuscitation once trained medical staff arrive on site.

CPR is a very important first-aid tool which is performed as a part of basic life support when a patient is in cardiac arrest, says Dr Aslesha Vijaay Sheth, consultant & clinical lead, department of emergency medicine, Kauvery Hospital, Chennai. “Cardiopulmonary resuscitation or cardiac massaging can be provided by anybody, and it does not have to be a trained paramedic personnel/nurse or a doctor,” she says. “Even a non-medical lay bystander can also perform this technique if they have been trained in CPR as it is easy to use.”

According to Dr Reddy, in a country like India, where sudden cardiac arrest kills lakhs of people, it is rare that a person survives with the help of CPR given at the right time by the common public. “A majority of sudden cardiac deaths happen at home and unfortunately most [people don’t] know the simple technique which can become a life saviour. If CPR is given immediately and effectively, it increases the chance of survival,” Dr Reddy said.

How to respond to a cardiac arrest

Dr Sheth lists the following steps to respond to cardiac arrest:

1. Recognise somebody in cardiac arrest. Tap over their shoulders and shout aloud asking them if they are okay. Subsequently, if there is no response, we check for a pulse. The pulse is the carotid pulse, which is in the neck. Use two fingers on either the left or right side of the neck and count from one to 10. Simultaneously, look at the chest to see if there is a rise and you can hear for any breath sound or any sign of respiratory effort from the person. If there is no pulse and no breathing or respiratory effort for those 10 seconds, then that person is supposed to be in cardiac arrest
2. Call for help as one cannot do much when alone. Call for help, ask for an ambulance and the health care staff to bring the defibrillator
3. Expose the patient’s bare chest and make them lie flat on the surface. Place your dominant hand and interlock it with the other hand. Place it over the centre of the chest between the nipples and start compressing down over the chest wall. These compressions will keep the blood flowing to the vital organs and the brain, thereby preventing any brain damage. While performing CPR, one need to ensure that their wrist, their elbow and their shoulder is in one straight line at 90 degrees over the patient’s chest wall and then they need to push hard and push fast. Dr Reddy says push at the rate of 100 to 120 bpm and ensure that at least about 5cm of depth of the chest wall is compressed. Allow full-chest recoil and minimise interruption before going in for the second one

For how long should CPR(cardiopulmonary resuscitation) be performed?

Dr Sheth says that in one set of CPR, one must count from one to 30 for an adult where they perform 30 compressions and to give oxygen to the person, they must give two rescue breaths of mouth-to-mouth breathing after every 30 compressions to complete a cycle. “The 30 compressions with two rescue breaths must be given in five sets which is equivalent for two minutes and every two minutes, check for the pulse to see whether the person is having a pulse or not. If the person doesn’t have a pulse, continue doing CPR until help arrives or the AED (automated external defibrillator) machine arrives,” she says.

She says that once the AED is attached to the patient’s bare chest, it will indicate the next steps to be performed. If it is a shockable rhythm, then deliver shock and if it is non shockable rhythm, then it will direct you to continue CPR.

Dr Reddy says that while giving rescue breaths, one must remember to pinch the person’s nose and close it before giving them the rescue breaths. “Lift the chin slightly to open the airways. Each rescue breath should last for one second.”

For infants and children

• Access responsiveness by slightly shaking/tapping on the foot and look at the chest for movements. If unresponsive, start CPR
• For infants place two fingers in the middle of the chest – one between the nipples and the other 1cm below it. Start compression with less pressure
• For children older than one year to puberty, use a single hand for compression with less pressure
• Rescue breathes are the same as for adults