What is the procedure for Cardiopulmonary Resuscitation (CPR) in adults?

From the Guidelines

CPR for adults should be performed with a compression depth of at least 2 inches and a rate of 100-120 compressions per minute, with a 30:2 compression-to-ventilation ratio, as recommended by the 2020 American Heart Association guidelines 1. When performing CPR, it is essential to prioritize high-quality chest compressions, allowing full chest recoil after each compression and minimizing interruptions in chest compressions.

• The sequence of CPR should commence with chest compressions rather than ventilations.
• If the rescuer is untrained or uncomfortable with rescue breaths, compression-only CPR is still effective.
• The use of audiovisual feedback devices during CPR can help optimize CPR performance 1. Some key points to consider when performing CPR include:
• Checking responsiveness and calling for emergency help (911) immediately.
• Positioning the person on their back on a firm surface.
• Placing the heel of one hand on the center of the chest, with the other hand on top, to compress the chest.
• Allowing full chest recoil after each compression and minimizing interruptions in chest compressions.
• Providing ventilations with a compression-ventilation ratio of 30:2, if the rescuer is trained to do so. It is also important to note that CPR doubles or triples survival rates when performed immediately after cardiac arrest, as stated in the 2010 American Heart Association guidelines 1. Overall, the goal of CPR is to maintain blood circulation and oxygenation to vital organs, particularly the brain, until emergency services arrive or the person shows signs of life. The 2015 American Heart Association guidelines update also emphasizes the importance of high-quality CPR, with a goal of optimizing all measures of CPR quality, including adequate compression rate and depth, allowing full chest recoil after each compression, minimizing interruptions in chest compressions, and avoiding excessive ventilation 1. By following these guidelines and prioritizing high-quality chest compressions, rescuers can help improve survival rates and outcomes for adults who experience cardiac arrest.

From the Research

CPR for Adults

• The American Heart Association (AHA) has been working to improve cardiac arrest survival rates, with a goal of doubling out-of-hospital cardiac arrests survival by 2030 2.
• Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest, but its use has been questioned due to limited animal data and potential detrimental effects 3.
• The use of automated external defibrillators (AEDs) is crucial in cardiac arrest situations, but they are only used in 4% of out-of-hospital cardiac arrests in the United States 2.

Skills Retention

• A study found that the skills of lay responders in CPR and AED use do not deteriorate significantly over time, with 80% remaining competent in CPR and 90% in AED use up to 1 year after primary training/retraining 4.
• Longer intervals to further retraining were associated with a slightly lower likelihood of performing adequate CPR, but not with AED scores 4.

Treatment

• Epinephrine administration during CPR can increase short-term survival, but its effect on long-term survival and functional recovery is unclear, with some studies suggesting potential harm 3.
• The correct dose, timing, and patients for epinephrine in cardiac arrest are still to be determined, and prospective trials are needed to answer these questions 3.