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Chest compression is a critical component of Cardiopulmonary Resuscitation (CPR), a basic life-saving technique used during emergency medical situations involving cardiac arrest Learning how to perform effective chest compressions properly significantly increases the chances of survival for someone experiencing cardiac arrest. This guide explores on what is chest compressions, why they are vital, and how to perform them correctly.
Chest compressions manually pump blood through the heart when it has stopped beating effectively. During chest compressions, a rescuer pushes down on the center of the victim's chest, specifically on the lower half of the sternum (breastbone), to create pressure that helps circulate blood to vital organs like the brain and heart.
The goal is to mimic the heart's natural pumping action, ensuring that oxygen-rich blood reaches the brain and other organs until professional medical help arrives or the heart can be restarted. Proper chest compressions involve pushing hard and fast, typically at a rate of 100 to 120 compressions per minute and a depth of about 2-2.4 inches (5-6 cm) for adults. The quality of compressions is critical for increasing the chances of survival during cardiac arrest.
CPR began in the second century with Galen's unsuccessful attempt to inflate a dead animal's lungs using a bellows. Progress was limited until the eighteenth century when rising drowning incidents spurred renewed interest in resuscitation methods. Historically, techniques varied from bellows and abdominal pressure to warming the body and using tobacco smoke. Despite these changes, the goal has always been to maintain circulation and sustain life. Today, the effectiveness of chest compression and rescue breaths represents the evolution of these life-saving practices.
Chest compressions are important because they ensure a continuous flow of oxygenated blood to the brain and vital organs. Pushing hard and fast at a rate of 100-120 compressions per minute is crucial for preventing severe damage and increasing the chances of recovery during cardiac emergencies. The absence of circulation causes brain damage in just a few minutes of being deprived of oxygen, potentially leading to brain death if circulation is not restored promptly.
Performing chest compressions correctly is vital for High Quality CPR to increase the chances of survival for someone experiencing cardiac arrest. Here's a step-by-step guide:
Begin by locating the lower half of the sternum (breastbone). This is the solid, flat bone in the center of the chest. The correct spot for compressions is in the middle of the chest, on the lower half of the sternum, avoiding the xiphoid process, which is the small, pointed cartilage at the bottom of the sternum.
Make sure your shoulders are directly over your hands, with your elbows locked, so your body weight aids in performing the compressions.
The depth of compressions is crucial for ensuring that blood is effectively circulated through the body:
Quick Tips:
Perform chest compressions at a rate of 100 to 120 compressions per minute. This rate of compressions is crucial because it balances the need for effective circulation without overwhelming the rescuer or causing the heart to struggle with an unrealistic rhythm.
Tips for Maintaining Rate:
Chest Compression Fraction (CCF) measures the percentage of time spent performing chest compressions during CPR. A high CCF, ideally between 60% to 80%, is crucial because it ensures continuous blood flow to the heart and brain, improving the chances of successful resuscitation. To maintain a high CCF, interruptions in compressions should be minimized, making it a key factor in effective CPR.
To achieve a high chest compression fraction, focus on minimizing interruptions. Keep pauses for rhythm checks, defibrillation, or ventilation as brief as possible—ideally under 10 seconds. Use efficient techniques and equipment, such as automated defibrillators and feedback devices, to streamline the process. Switching with another rescuer regularly help maintain effective compressions by reducing fatigue, ensuring that chest compressions are continuous and effective throughout the resuscitation effort.
Neonatal resuscitation requires additional care. Use two fingers for compression, aiming for a depth of 4-5 cm (1.5-2 inches). Compress at the same rate of 100-120 per minute. For neonates, use the thumbs for compressions with the hands encircling the chest.
In the context of the Neonatal Resuscitation Program (NRP), chest compressions are necessary if the baby's heart rate remains below 60 beats per minute after 30 seconds of positive pressure ventilation (PPV). To ensure appropriate lung inflation, the chest should move visibly during this ventilation. Manual compressions are performed to restore electrical activity and cardiac output keeping blood flow and ensuring that the baby receives enough oxygen during resuscitation efforts.
The American Heart Association (AHA) 2020 Guidelines for CPR and Emergency Cardiovascular Care reflect a global collaboration with the International Liaison Committee on Resuscitation (ILCOR) and provide a comprehensive approach to life-saving measures. These guidelines, updated every five years, provide healthcare professionals and the public with evidence-based practices designed to increase the survival rates of cardiac arrest victims. Here are the Key Updates in the 2020 AHA Guidelines:
Staying updated with the latest CPR guidelines is not just recommended but essential for healthcare providers and first responders. CPR techniques and best practices evolve as new research and data become available, leading to more effective resuscitation efforts. Regularly renewing CPR certification and consistent training sessions ensure that practitioners are familiar with the most current methods and deliver the highest standard of care.
Advancements in technology, such as real-time CPR feedback devices and CPR dashboards, are increasingly integrated into CPR education. These tools help reinforce proper technique, improve skill retention, and ultimately enhance patient outcomes.
A chest compression feedback device monitors the depth, rate, and quality of compressions, providing real-time feedback to rescuers. The device helps ensure that compressions are deep enough at the correct rate (100 to 120 compressions per minute), and with full chest recoil between compressions. By offering immediate feedback, these devices help improve the quality of CPR and enhance the chances of a successful resuscitation.
Hands-Only CPR (compressions-only CPR) is a simplified method of cardiopulmonary resuscitation that focuses solely on chest compressions without including rescue breaths. This technique is designed for bystanders who are not trained in or comfortable with providing rescue breaths. It involves performing continuous chest compressions at a rate of 100 to 120 compressions per minute.
Hands-Only CPR is recommended primarily for adults who suddenly collapse and experiencing a cardiac arrest. It is effective in maintaining blood flow to the heart and brain until professional medical help arrives. The absence of rescue breaths makes it easier for untrained individuals to perform, thereby increasing the likelihood that someone will take action during a cardiac emergency.
The maximum interval for pausing chest compressions should be no more than 10 seconds. This is to minimize interruptions in blood circulation and maintain effective CPR.
When an advanced airway, such as an endotracheal tube or supraglottic airway, is in place, chest compressions should still be performed according to standard CPR guidelines. Continue compressing at a rate of 100 to 120 compressions per minute and ensure adequate depth of compression and chest recoil. With an advanced airway, rescue breaths are delivered at a ratio of 1 breath every 6 seconds (10 breaths per minute) without pausing chest compressions. This method helps maintain continuous circulation while providing effective ventilation through the advanced airway.
After giving 30 chest compressions to an unconscious choking person, the rescuer should open the airway and check the mouth for any visible object. If an object is seen, try to remove it carefully. After checking, attempt to give two rescue breaths. If the breaths do not go in, resume manual compressions and continue the cycle.
The ratio of chest compressions to rescue breaths in adults during CPR is 30:2. This means you should perform 30 manual compressions followed by 2 rescue breaths.
You should check for breathing in an unresponsive person for no more than 10 seconds. If the person is not breathing or only gasping, begin chest compressions immediately.
The common mistakes to avoid during chest compressions are:
Effective chest compressions play a crucial role in the success of defibrillation. By maintaining continuous blood flow to vital organs, particularly the heart and brain, compressions keep the heart tissue oxygenated and responsive. When an Automated External Defibrillator (AED) is used, the heart is more likely to respond to the shock and return to a normal rhythm if compressions have been consistent and effective. This combination of high-quality compressions and timely defibrillation increases the chances of survival in a cardiac arrest situation.
CPR techniques vary significantly between adults, children, and infants due to differences in their physiology.
These variations ensure that CPR is both effective and safe for the different age groups.
CPR should be administered in several critical situations, primarily when a person is in cardiac arrest—meaning the heart has stopped beating effectively, leading to a sudden loss of consciousness and no detectable pulse. Other situations include when a person is unresponsive and not breathing or only gasping, such as in the case of drowning, where CPR restores circulation and oxygenation. It is crucial in cases of drug overdose where respiratory arrest leads to unresponsiveness. Additionally, if someone is choking and becomes unconscious, CPR should be started immediately to help remove the obstruction and maintain oxygenated blood flow.
Minimizing interruptions during CPR is essential for maintaining continuous blood circulation, which is critical for delivering oxygen to the brain and other vital organs. Pausing compressions for more than 10 seconds reduce the effectiveness of CPR, as it disrupts the flow of blood, decreasing the chances of a successful resuscitation. To ensure the best possible outcome, any interruptions should be kept as short as possible, whether for airway checks, rescue breaths, or the application of an AED, always prioritizing continuous chest compressions to maintain the pressure needed to sustain life.
The integration of an AED with chest compressions during CPR is vital for increasing the chances of survival in cardiac arrest. As soon as an AED becomes available, it should be applied to the patient without delaying manual compressions. The AED will prompt you to pause briefly to analyze the heart’s rhythm, but compressions should be resumed immediately after the shock is delivered or if no shock is advised. This seamless transition between AED use and ongoing compressions ensures that the heart receives the necessary electrical stimulus while maintaining consistent blood flow, which together maximize the effectiveness of resuscitation efforts.
A chest compression machine known as a mechanical CPR device, is a device designed to automate chest compressions during CPR. It provides consistent and high-quality compressions at the recommended depth and rate, reducing the variability that can occur with manual compressions. These devices can be especially useful in situations where consistent compression quality is critical or when rescuers are unable to perform manual CPR effectively. The machine operates using various mechanisms, such as a piston or belt system, to deliver compressions automatically, allowing rescuers to focus on other aspects of the resuscitation process.
CPR certification is essential for performing effective chest compressions because it provides the knowledge and skills needed to perform CPR correctly. Certified individuals learn the proper techniques for chest compressions, including the correct depth, rate, and hand placement, as well as how to minimize interruptions and manage other aspects of CPR. CPR training and certification ensures that rescuers understand and apply the latest guidelines and best practices, which improves the chances of a successful resuscitation. By receiving formal training, individuals are better prepared to respond confidently and effectively in emergencies, making a critical difference in life-threatening situations.
To maintain proficiency in chest compressions and other CPR techniques, it is recommended to renew CPR certification every two years. Regular renewal helps ensure that individuals stay updated with the latest guidelines and standards, refresh their skills, and continue to perform CPR effectively. Some organizations may offer more frequent training or refresher courses to help maintain skills, but biennial certification renewal is generally considered the standard to ensure ongoing competence and preparedness in emergency situations.
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