Cardiopulmonary Resuscitation

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Contents 1 More Specific Terms 2 Introduction 3 Epidemiology 4 Management 5 Notes 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• advanced cardiac life support (ACLS)
• basic life support (BLS)
• CPR class 1 intervention
• CPR class 2 intervention
• CPR class 3 intervention
• in-hospital cardiopulmonary resuscitation (CPR)
• pediatric basic & advanced cardiopulmonary life support
• termination of cardiopulmonary resuscitation (CPR)

Introduction

• An emergency measure to maintain a person's breathing & heartbeat when they have stopped as a result of myocardial infarction, trauma, or other disorder. Ventricular arrhythmias are responsible for the majority of cardiopulmonary arrests in adults.

Epidemiology

• see in-hospital cardiopulmonary resuscitation

Management

• priorities:
• recognition of cardiopulmonary arrest
• activation of the emergency medical system (EMS)
• basic life support (see basic life support)
• defibrillation

• restoration normal effective rhythm as soon as possible the single most important goal of resuscitation [14]
• more basic life support prior to defibrillation does not improve outcomes [14]

• intubation
• administration of appropriate IV medications
• also see pediatric basic & advanced cardiopulmonary life support

Notes

• often performed poorly [2,15]
• when performed properly, delivers only a small fraction of normal cardiac output [14]
• chest-compression-only out-of- hospital bystander CPR at least as effective as standard CPR [4,7,8]
• uninterrupted chest compressions in out-of- hospital cardiac arrest improves outcomes [5,11]
• conventional cardiopulmonary resuscitation better than compression-only CPR for children with noncardiac causes of arrest [6,13]
• suction cup device used by emergency medical services personnel may improve survival [12]
• CPR is more efficient with use of two devices:

• a chest-wall suction device that allows active decompression as well as compression of the chest
• an airway impedance-threshold device that limits passive ventilation during chest decompression

• In 1998, paramedics implemented a new guideline that allows emergency personnel to withhold resuscitation if a patient has a terminal condition & the patient, a family member, or a caregiver has indicated (verbally or in writing) that the patient did not want resuscitation. [3,4]

More General Terms

• clinical procedure

Additional Terms

• cardiac arrest (sudden death)
• emergency medical system (EMS)
• outcomes of comatose patients after cardiopulmonary resuscitation (CPR)

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170
2. Journal Watch 25(4):33, 2005 Wik L, Kramer-Johansen J, Myklebust H, Sorebo H, Svensson L, Fellows B, Steen PA. Quality of cardiopulmonary resuscitation during out-of- hospital cardiac arrest. JAMA. 2005 Jan 19;293(3):299-304. PMID: [1]
   - Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O'Hearn N, Wigder HN, Hoffman P, Tynus K, Vanden Hoek TL, Becker LB. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005 Feb 1;111(4):428-34. PMID: [2]
3. Feder S, Matheny RL, Loveless RS Jr, Rea TD. Withholding resuscitation: a new approach to prehospital end-of-life decisions. Ann Intern Med. 2006 May 2;144(9):634-40. PMID: [3]
   - Kellermann A, Lynn J. Withholding resuscitation in prehospital care. Ann Intern Med. 2006 May 2;144(9):692-3. No abstract available. PMID: [4]
4. Iwami T et al, Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation 2007, 116:2900 PMID: [5]
   - Blohm K et al, Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation 2007, 116:2908 PMID: [6]
   - Ewy GA Continuous-chest-compression cardiopulmonary resuscitation for cardiac arrest. Circulation 2007, 116:2894 PMID: [7]
5. Sayre MR et al. Impact of the 2005 American Heart Association cardiopulmonary resuscitation and emergency cardiovascular care guidelines on out-of-hospital cardiac arrest survival. Prehosp Emerg Care 2009 Oct-Dec; 13:469. PMID: [8]
6. Lopez-Herce J and Alvarez AC. Bystander CPR for paediatric out-of-hospital cardiac arrest. Lancet 2010 Mar 3; [e-pub ahead of print] <PubMed> PMID: [9] <Internet> [10]
7. Rea TD et al CPR with Chest Compression Alone or with Rescue Breathing N Engl J Med 2010; 363:423-433July 29, 2010 <PubMed> PMID: [11] <Internet> [12]
   - Svensson L et al Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest N Engl J Med 2010; 363:434-442July 29, 2010 <PubMed> PMID: [13] <Internet> [14]
   - Weisfeldt ML In CPR, Less May Be Better N Engl J Med 2010; 363:481-483July 29, 2010 <PubMed> PMID: [15] <Internet> [16]
8. Hupfl M et al Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis The Lancet, Early Online Publication, 15 October 2010 <PubMed> PMID: &dopt=Abstract <Internet> [17]
9. American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes [18]
10. Bobrow BJ et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 2010 Oct 6; 304:1447. PMID: [19]
11. Hupfl M et al. Chest-compression-only versus standard cardiopulmonary resuscitation: A meta-analysis. Lancet 2010 Nov 6; 376:1552 PMID: [20]
    - Nolan JP and Soar J. Dispatcher-assisted bystander CPR: A KISS for a kiss. Lancet 2010 Nov 6; 376:1522. PMID: [21]
12. Aufderheide TP et al Standard cardiopulmonary resuscitation versus active compression- decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial The Lancet, Volume 377, Issue 9762, Pages 301 - 311, 22 January 2011 <PubMed> PMID: [22] <Internet> [23]
13. Ogawa T et al. Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: Nationwide population based observational study. BMJ 2011 Jan 27; 342:c7106. <PubMed> PMID: [24] <Internet> [25]
14. Stiell IG et al. Early versus later rhythm analysis in patients with out-of- hospital cardiac arrest. N Engl J Med 2011 Sep 1; 365:787. PMID: [26]
15. Stiell IG et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012 Jan 5 PMID: [27]
16. International Consensus on CPR and ECC Science with Treatment Recommendations (American Heart Association) [28]
17. National Guideline Clearinghouse
    - First aid: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. American Heart Association ngc-guideline: [29]
    - Neonatal resuscitation: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. American Heart Association ngc-guideline: [30]
    - Pediatric basic and advanced life support: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. American Heart Association ngc-guideline: [31]
    - Stroke: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. American Heart Association ngc-guideline: [32]

cardiopulmonary resuscitation (CPR)