When is CPR indicated for a patient?

When is CPR Indicated for a Patient?

CPR is indicated for any patient who is unresponsive with absent or abnormal breathing (including agonal gasps), as these patients should be presumed to be in cardiac arrest. 1

Primary Indications for CPR

• Unresponsiveness: Patient does not respond to verbal or tactile stimulation
• Absent or abnormal breathing: No breathing or only gasping respirations
• No definitive pulse within 10 seconds: For healthcare providers only 1, 2

Assessment Algorithm

1. Check for responsiveness

   • Tap the victim's shoulder
   • Shout at the victim
   • If no response, proceed to next step

2. Activate emergency response system

   • Call 911 or institutional emergency number
   • Get AED/emergency equipment (or send someone to do so) 1

3. Check breathing and pulse (simultaneously for healthcare providers)

   • Look for no breathing or only gasping
   • Healthcare providers: Check carotid pulse for no more than 10 seconds
   • If no normal breathing and no definitive pulse felt within 10 seconds, start CPR 1, 2

Special Scenarios

For Lay Rescuers

• Untrained: Provide compression-only CPR until trained help arrives 1
• Trained: Provide chest compressions and ventilations in a 30:2 ratio 1
• Important: Lay rescuers should not attempt to check for a pulse, as this leads to delays and inaccurate assessments 3

For Healthcare Providers

• Witnessed arrest with shockable rhythm: Prioritize early defibrillation 1
• Suspected opioid overdose: For patients with a pulse but no normal breathing, administer naloxone while providing standard care 1
• For patients in cardiac arrest: Begin CPR immediately, then consider naloxone if opioid overdose is suspected 1

Key Points About CPR Performance

• Compression depth: At least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm) 1
• Compression rate: 100-120 compressions per minute 1, 2
• Allow complete chest recoil between compressions 1
• Minimize interruptions in chest compressions 1, 2

Common Pitfalls to Avoid

1. Delayed initiation of CPR: Healthcare providers often take too long checking for a pulse, which delays critical interventions 1

   • Solution: Limit pulse checks to 10 seconds maximum; if no definitive pulse is felt, begin CPR

2. Misinterpreting agonal gasps as normal breathing: Gasping is a sign of cardiac arrest, not adequate breathing 2

   • Solution: Begin CPR for any patient who is unresponsive with abnormal breathing patterns

3. Inaccurate pulse assessment: Studies show that even trained providers have difficulty accurately determining pulse status 3

   • Solution: When in doubt, begin CPR as the risk of harm to a patient not in cardiac arrest is low 1

4. Excessive interruptions in compressions: Any pause reduces perfusion pressure 2

   • Solution: Coordinate team activities to minimize pauses; resume compressions immediately after necessary interruptions

Evidence Quality Considerations

The recommendations for CPR indications are based on strong evidence from the American Heart Association guidelines. The 2020 AHA guidelines (Class I, Level C-LD) clearly state that laypersons should initiate CPR for presumed cardiac arrest because the risk of harm to patients not in cardiac arrest is low compared to the benefit for those who are 1. Studies have shown that even trained healthcare providers cannot reliably determine the presence or absence of a pulse within 10 seconds 3, supporting the recommendation to begin CPR promptly when a pulse is not definitely felt.

CPR should be initiated promptly as it is the single most important intervention for a patient in cardiac arrest, with chest compressions being the most critical component 1.