Cardiac arrest is an abrupt medical emergency that leaves bystanders with mere seconds to react. When the heart abruptly ceases to pump blood effectively, circulation halts and oxygen stops reaching the brain and other vital organs. In these urgent moments, cardiopulmonary resuscitation serves as a temporary lifeline. This emergency intervention manually forces blood through the body until definitive medical care arrives. Outlining the correct application of this procedure, Dr. Malarvizhi Sanjeevi, Head, Department of Emergency Medicine, Fortis Hospital, Bannerghatta Road, Bengaluru, has detailed the steps and cautions required during such emergencies.
Recognising the Need for Immediate Intervention
When an individual collapses without warning and shows no reaction when addressed or gently tapped on the shoulder, the situation warrants immediate action. The initial step is assessing the person for normal respiration. It is critical to note that victims of sudden cardiac arrest may occasionally exhibit irregular breathing or agonal gasps. Such abnormal sounds and movements must never be mistaken for regular, healthy breathing.
Before approaching, confirm that the immediate surroundings pose no danger to the rescuer or the patient. Swiftly check for a pulse to confirm circulatory failure. Contact the emergency assistance number 112 immediately. If bystanders are present, instruct someone to place that emergency call and locate an automated external defibrillator, commonly known as an AED, if one is available nearby. While waiting for emergency medical personnel to arrive at the scene, chest compressions should commence without any hesitation.
Technique, Speed, and Depth for Adult Compressions
Performing CPR on an adult requires a distinct physical posture to deliver effective compressions. The rescuer should place the heel of one hand directly over the center of the individual's chest. Position the second hand over the first, interlocking the fingers securely. Keep both elbows straight and align your shoulders directly over your hands so that upper body weight can drive the downward force.
Rhythm and measurement are essential to sustaining blood flow. Compressions must be delivered firmly and rapidly at a frequency of 100 to 120 beats every minute. Each push must depress the chest cavity to a depth of approximately 5 to 6 centimeters. Crucially, allow complete chest recoil between each compression so the heart can refill with blood before the next downward push.
For individuals trained in the complete procedure who feel comfortable giving artificial respiration, provide two rescue breaths following every set of 30 chest compressions. However, if you lack formal training or feel uneasy performing mouth-to-mouth resuscitation, continuous chest compressions alone remain highly beneficial. Administering hands-only compressions without pauses still circulates residual oxygen and significantly boosts survival chances.
Circumstances Where Chest Compressions Must Be Avoided
Administering CPR is not universally applicable to all medical crises, and applying it inappropriately can cause unnecessary harm. If a patient is conscious, responds to queries, and breathes normally, chest compressions are strictly unnecessary. In such instances, identify the symptoms causing their distress and seek standard medical evaluation.
Similarly, when an unresponsive individual is found to be breathing normally with an intact and palpable pulse, you must not push on their chest. Instead, summon urgent emergency transport and monitor their respiratory pattern continuously. Provided there are no traumatic injuries and movement is safe, position the individual onto their side in the standard recovery position. This posture keeps the airway clear and prevents breathing obstructions while help is en route.
The distinction between a heart attack and full cardiac arrest is equally critical. If someone is suspected of having a heart attack but remains awake and breathes normally, CPR is not indicated. They require immediate emergency hospital care rather than resuscitation. However, should their condition deteriorate rapidly into unconsciousness and respiratory arrest, chest compressions must begin immediately.
