What is the proper procedure for performing Cardiopulmonary Resuscitation (CPR) in cases of cardiac arrest?

Proper Procedure for Performing CPR in Cases of Cardiac Arrest

For adult cardiac arrest patients, perform high-quality chest compressions at a rate of 100-120 compressions per minute to a depth of at least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm), allowing for complete chest wall recoil between compressions, with minimal interruptions. 1

Initial Assessment and Response

• Check for responsiveness by shouting and tapping the victim 1
• If unresponsive, activate emergency response system and get an AED if available 1
• Look for no breathing or only gasping and check pulse simultaneously (within 10 seconds) 1
• If no pulse is detected, immediately begin CPR 1

Chest Compression Technique

• Position hands on the lower half of the sternum for chest compressions 1
• Push hard at a rate of 100-120 compressions per minute 1, 2
• Compress to a depth of at least 2 inches (5 cm) but avoid exceeding 2.4 inches (6 cm) 1
• Allow complete chest wall recoil between compressions to enable adequate cardiac filling 1
• Minimize interruptions in chest compressions to maintain perfusion 1
• Change compressors every 2 minutes or sooner if fatigued to maintain quality 1, 3

Ventilation

• For lay rescuers without training: provide compression-only CPR 1, 4
• For trained rescuers: use a 30:2 compression-to-ventilation ratio 1
• Deliver each breath over approximately 1 second 1
• Pause compressions for less than 10 seconds to deliver 2 breaths 1
• With advanced airway in place, provide 1 breath every 6 seconds (10 breaths/minute) while continuing uninterrupted chest compressions 1

AED Use

• Apply AED as soon as it becomes available 1, 3
• If shockable rhythm is detected, deliver one shock 1
• Resume CPR immediately after shock for 2 minutes before reassessing rhythm 1
• If no shock is advised, immediately resume CPR for 2 minutes before rechecking rhythm 1

Special Considerations

• For suspected opioid overdose, administer naloxone after initiating CPR if available 1
• For victims with suspected spinal injury, use manual spinal motion restriction rather than immobilization devices 1
• Target a chest compression fraction (proportion of time spent performing compressions) of at least 60% 1

Advanced Life Support (for Healthcare Providers)

• Establish IV/IO access for medication administration 1, 3
• Administer epinephrine 1 mg IV/IO every 3-5 minutes 1, 3
• For refractory VF/pVT, administer amiodarone or lidocaine 1, 3
• Consider advanced airway placement with confirmation using waveform capnography 1, 3
• Identify and treat reversible causes (Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis-pulmonary, Thrombosis-coronary) 1

Common Pitfalls to Avoid

• Taking too long to check for a pulse (should be less than 10 seconds) 1
• Interrupting compressions for extended periods, which significantly reduces perfusion 2, 5
• Inadequate compression depth or rate, which reduces effectiveness 2, 6
• Leaning on the chest between compressions, which prevents full chest recoil 1
• Excessive ventilation, which can increase intrathoracic pressure and decrease venous return 1, 5
• Delaying defibrillation when an AED is available 1, 3

High-quality CPR is the cornerstone of cardiac arrest management and directly impacts survival outcomes. The emphasis should always be on minimizing interruptions to chest compressions while maintaining adequate depth and rate 3, 5.