What is the procedure for cardiopulmonary resuscitation (CPR)?

From the Guidelines

Cardiopulmonary resuscitation (CPR) should be performed with high-quality chest compressions at a rate of 100-120 compressions per minute and a depth of at least 2 inches, allowing for full chest recoil and minimizing interruptions, as recommended by the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1. To perform CPR effectively, follow these steps:

• Check for responsiveness by tapping the person and shouting
• If unresponsive, call emergency services immediately or have someone else call while you begin CPR
• Position the person on their back on a firm surface
• Place the heel of one hand on the center of the chest, put your other hand on top, and compress the chest at least 2 inches deep at a rate of 100-120 compressions per minute
• After 30 compressions, give 2 rescue breaths by tilting the head back, lifting the chin, pinching the nose, and blowing into the mouth for about 1 second each
• Continue this 30:2 ratio until help arrives
• If untrained or uncomfortable with rescue breaths, perform hands-only CPR with continuous chest compressions The importance of high-quality CPR is re-emphasized in the 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations, which highlights the need for adequate compression rate and depth, allowing full chest recoil after each compression, minimizing interruptions in chest compressions, and avoiding excessive ventilation 1. Additionally, the 2013 consensus statement from the American Heart Association on cardiopulmonary resuscitation quality emphasizes the critical components of high-quality CPR, including minimizing interruptions in chest compressions, providing compressions of adequate rate and depth, avoiding leaning between compressions, and avoiding excessive ventilation 1. Overall, the key to effective CPR is to provide high-quality chest compressions with minimal interruptions, allowing for the best possible chance of survival and recovery from cardiac arrest.

From the FDA Drug Label

If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias and cardiac arrest. If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted

• Cardio pulmonary resuscitation is mentioned in the context of management of local anesthetic emergencies, specifically in the event of cardiac arrest.
• The drug label states that if cardiac arrest occurs, standard cardiopulmonary resuscitative measures should be instituted 2.

From the Research

Overview of Cardio Pulmonary Resuscitation (CPR)

• CPR is a critical component of cardiopulmonary resuscitation, and its effectiveness can be improved with the use of automated external defibrillators (AEDs) 3, 4.
• The American Heart Association recommends that CPR be started as soon as possible after cardiac arrest, with a goal of initiating CPR within 4-6 minutes of collapse 4.

Use of Automated External Defibrillators (AEDs)

• AEDs can analyze a heart rhythm and deliver a shock if needed, making them a valuable tool for first responders and laypersons 4.
• The use of AEDs has been shown to improve survival rates in out-of-hospital cardiac arrests, particularly when used in conjunction with CPR 4, 5.
• However, the effectiveness of AEDs can be limited by factors such as response time, bystander-initiated CPR, and the availability of trained personnel 4, 6.

Interruption of CPR with AED Use

• The use of AEDs can result in interruptions to CPR, which can negatively impact patient outcomes 5.
• Studies have shown that first responders using AEDs may provide CPR for less than half of the time that the AED is connected to the patient 5.

Retention of CPR and AED Skills

• The retention of CPR and AED skills by laypersons can decline over time, particularly if refresher training is not provided 7.
• However, studies have shown that the majority of volunteers remain competent in CPR and AED skills up to 1 year after initial training, with minimal deterioration in skills 7.

Cost-Effectiveness of AED Programs

• The cost-effectiveness of AED programs can vary depending on the setting and the specific program components 4.
• Studies have shown that AED programs can be cost-effective in certain settings, such as hospitals and public access areas with high cardiac arrest rates 4.