Cardiopulmonary resuscitation

Cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Intervention

CPR being performed on a medical-training manikin

[1]

ICD-9:

99.60

MeSH

D016887

OPS-301code:

8-771

MedlinePlus

000010

[2]

[3]
[4]

Cardiopulmonary resuscitation (CPR) is an emergency procedure, performed in an effort to manually preserve

intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a
person in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for
example, agonal respirations.
CPR involves chest compressions at least 5cm (2in) deep and at a rate of at least 100 per minute in an effort to
create artificial circulation by manually pumping blood through the heart. In addition, the rescuer may provide
breaths by either exhaling into the subject's mouth or nose or utilizing a device that pushes air into the subject's
lungs. This process of externally providing ventilation is termed artificial respiration. Current recommendations
place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving
chest compressions only is recommended for untrained rescuers.
CPR alone is unlikely to restart the heart; its main purpose is to restore partial flow of oxygenated blood to the brain
and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful
resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed
defibrillation, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is only
effective for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than
asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm which may be shockable. CPR
is generally continued until the patient has a return of spontaneous circulation (ROSC) or is declared dead.

Cardiopulmonary resuscitation

Medical uses
CPR is indicated for any person who is unresponsive with no breathing, or who is only breathing in occasional
agonal gasps, as it is most likely that they are in cardiac arrest.:S643 If a person still has a pulse, but is not breathing
(respiratory arrest), artificial respirations may be more appropriate, but due to the difficulty people have in accurately
assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to
check the pulse, while giving health care professionals the option to check a pulse.[5] In those with cardiac arrest due
to trauma CPR is considered futile in the pulseless case, but still recommended for correctible causes of arrest.

Methods
In 2010, the American Heart Association and International Liaison
Committee on Resuscitation updated their CPR guidelines.:S640 The
importance of high quality CPR (sufficient rate and depth without
excessively ventilating) was emphasized.:S640 The order of
interventions was changed for all age groups except newborns from
airway, breathing, chest compressions (ABC) to chest compressions,
airway, breathing (CAB).:S642 An exception to this recommendation is
for those who are believed to be in a respiratory arrest (drowning,
etc.).:S642 The most important aspect of CPR are: few interruptions of
chest compressions, a sufficient speed and depth of compressions,
completely relaxing pressure between compressions, and not
ventilating too much.

CPR training: CPR is being administered while a

second rescuer prepares for defibrillation.

Standard
A universal compression to ventilation ratio of 30:2 is recommended.:8 With children, if at least 2 trained rescuers
are present a ratio of 15:2 is preferred.:8 In newborns a rate of 3:1 is recommended unless a cardiac cause is known in
which case a 15:2 ratio is reasonable.:S647 If an advanced airway such as an endotracheal tube or laryngeal mask
airway is in place delivery of ventilations should occur without pauses in compressions at a rate of 810 per minute.
The recommended order of interventions is chest compressions, airway, breathing or CAB in most situations,:S642
with a compression rate of at least 100 per minute in all groups.:8 Recommended compression depth in adults and
children is at least 5cm (2inches) and in infants it is 4cm (1.5inches.:8 As of 2010 the Resuscitation Council (UK)
still recommends ABC for children. As it can be difficult to determine the presence or absence of a pulse the pulse
check has been removed for lay providers and should not be performed for more than 10 seconds by health care
providers.:8 In adults rescuers should use two hands for the chest compressions, while in children they should use
one, and with infants two fingers (index and middle fingers).

Compression only
Compression-only (hands-only or cardiocerebral resuscitation) CPR is a technique that involves chest compressions
without artificial respiration.:S643 It is recommended as the method of choice for the untrained rescuer or those who
are not proficient as it is easier to perform and instructions are easier to give over the phone.:S643:8 In adults with
out-of-hospital cardiac arrest, compression-only CPR by the lay public has a higher success rate than standard CPR.
The exceptions are cases of drownings, drug overdose, and arrest in children. Children who receive
compression-only CPR have the same outcomes as those who received no CPR.:S646 The method of delivering chest
compressions remains the same, as does the rate (at least 100 per minute). It is hoped that the use of
compression-only delivery will increase the chances of the lay public delivering CPR. As per the American Heart
Association, the beat of the Bee Gees song "Stayin' Alive" provides an ideal rhythm in terms of beats per minute to

Cardiopulmonary resuscitation

use for hands-only CPR. One can also hum Queen's "Another One Bites The Dust", which is exactly 100
beats-per-minute and contains a memorable repeating drum pattern. For those with non cardiac arrest and people less
than 20 years of age, standard CPR is superior to compression-only CPR.

Pregnancy
During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus
decrease venous return. It is recommended for this reason that the uterus be pushed to the woman's left and if this is
not effective either roll the person 30 or for healthcare professionals to consider emergency Caesarean section.

Other
Interposed abdominal compressions may be beneficial in the hospital environment. There is however no evidence of
benefit pre hospital or in children. Internal cardiac massage is manual squeezing of the heart carried out through a
surgical incision into the chest cavity. This may be carried out if the chest is already open for cardiac surgery.

Effectiveness
Type of Arrest

ROSC Survival Source

Witnessed In-Hospital Cardiac Arrest

52%

19%

Unwitnessed In-Hospital Cardiac Arrest

33%

8%

Out-of-Hospital Cardiac Arrest Overall

59%

10%

Unwitnessed Out-of-Hospital Cardiac Arrest

21%

4%

Witnessed Out-of-Hospital Cardiac Arrest

41%

15%

Witnessed and "Shockable" with Bystander CPR

53%

37%

Bystander Compression-only Resuscitation

13%

Bystander Conventional CPR

8%

CPR serves as the foundation of successful cardiopulmonary resuscitation, preserving the body for defibrillation and
advanced life support. Even in the case of a "non-shockable" rhythm, such as Pulseless Electrical Activity (PEA)
where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete
recoveries, though survival without is almost uniformly fatal.
Studies have shown that immediate CPR followed by defibrillation within 35 minutes of sudden VF cardiac arrest
dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS
personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed
"shockable" arrest. In cities such as New York, without those advantages, the survival rate is only 5 percent for
witnessed shockable arrest.
Compression-only CPR may be less effective in children than in adults, as cardiac arrest in children is more likely to
have a non-cardiac cause. In a 2010 prospective study of cardiac arrest in children (age 117), for arrests with a
non-cardiac cause, provision by bystanders of conventional CPR with rescue breathing yielded a favorable
neurological outcome at one month more often than did compression-only CPR (OR 5.54; 95% confidence interval
2.5216.99). For arrests with a cardiac cause in this cohort, there was no difference between the two techniques (OR
1.20; 95% confidence interval 0.552.66). This is consistent with American Heart Association guidelines for parents.
In most cases, there is a higher proportion of patients who achieve a Return of Spontaneous Circulation (ROSC),
where their heart starts to beat on its own again, than ultimately survive to be discharged from hospital (see table
above). This is due to medical staff either being ultimately unable to address the cause of the cardiac arrest, or in
some instances due to other co-morbidities, due to the patient being gravely ill in more than one way. Ultimately,

Cardiopulmonary resuscitation
only 510% of patients in cardiac arrest will go on to survive after an attempted resuscitation.

Pathophysiology
CPR is used on people in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital
organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The brain may
sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven
minutes. Typically if blood flow ceases for one to two hours, the cells of the body die. Because of that CPR is
generally only effective if performed within seven minutes of the stoppage of blood flow.[6] The heart also rapidly
loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings,
prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the
brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts.

Complications
Whilst CPR is a last resort intervention, without which a patient without a pulse will certainly die, the physical
nature of how CPR is performed does lead to complications that may need to be rectified. Common complications
due to CPR include rib fractures, sternal fractures, bleeding in the anterior mediastinum, heart contusion,[7]
hemopericardium,[8][9][10] upper airway complications, damage to the abdominal viscus - lacerations of the liver and
spleen, fat emboli, pulmonary complications - pneumothorax, hemothorax, lung contusions.[11]
The most common injuries sustained from CPR are rib fractures, with literature suggesting an incidence between
13% and 97%, and sternal fractures, with an incidence between 1% to 43%. Whilst these iatrogenic injuries can
require further intervention (assuming the patient survives the cardiac arrest), only 0.5% of them are life threatening
in their own right.
The type and frequency of injury can be affected by factors such as gender and age. For instance, women have a
higher risk of sternal fractures than men, and risk for rib fractures increases significantly with age. Children and
infants have a low risk of rib fractures during CPR, with an incidence less than 2%, although when they do occur,
they are usually anterior and multiple.
Where CPR is performed in error by a bystander, on a patient who is not in cardiac arrest, only around 2% suffer
injury as a result (although 12% experienced discomfort).

Adjunct devices
While several adjunctive devices are available none other than defibrillation as of 2010 have consistently been found
to be better than standard CPR for out of hospital cardiac arrest.:S644 These devices can be split into three broad
groups - timing devices, those that assist the rescuer to achieve the correct technique, especially depth and speed of
compressions, and those which take over the process completely.

Timing devices
They can feature a metronome (an item carried by many ambulance crews) in order to assist the rescuer in getting the
correct rate. Some units can also give timing reminders for performing compressions, breathing and changing
operators.

Cardiopulmonary resuscitation

Manual assist devices

Mechanical devices have not been found to have greater benefit than harm and thus are not currently recommended
for widespread use.
Audible and visual prompting may improve the quality of CPR and prevent the decrease of compression rate and
depth that naturally occurs with fatigue, and to address this potential improvement, a number of devices have been
developed to help improve CPR technique.
These items can be devices to placed on top of the chest, with the rescuers hands going over the device, and a display
or audio feedback giving information on depth, force or rate, or in a wearable format such as a glove. Several
published evaluations show that these devices can improve the performance of chest compressions.
As well as use during actual CPR on a cardiac arrest victim, which relies on the rescuer carrying the device with
them, these devices can also be used as part of training programs to improve basic skills in performing correct chest
compressions.[12]

Automatic devices
There are also some automated devices available which take over the chest compressions for the rescuer. These have
several advantages: they allow rescuers to focus on performing other interventions; they do not fatigue and begin to
perform less effective compressions, as humans do; and they are able to perform effective compressions in
limited-space environments such as air ambulances, where manual compressions are difficult. These devices use
either pneumatic (high-pressure gas) or electrical power sources to drive a compressing pad on to the chest of the
patient. One such device, known as the LUCAS, was developed at the University Hospital of Lund, is powered by
the compressed oxygen supplies already standard in ambulances and hospitals, and has undergone numerous clinical
trials, showing a marked improvement in coronary perfusion pressure and return of spontaneous circulation.
In August 2013, a 41 year old woman living in a town near Melbourne in Australia was treated with the LUCAS
device for 53 minutes while a stent was placed in an artery near her heart, clearing a 100% blockage. She was
considered to be clinically dead for 40 minutes. She left hospital a week later.[13]
Artificial ventilation can be done with multiple devices: bag mask gives way valve ball with oxygen-enriched air
(which is in the bag) through a facial mask filing (but not external tubes, does not open the airway ). This uses an
oropharyngeal airway, called Bergman, tube May or Guedel airway (these do not prevent mouth to mouth contact if
there were no masks or masks with air balloons) or Maselli: oropharyngeal Maselli respirator (avoiding contagion in
both directions) and is necessary to facilitate air pass to place the tongue in place and prevent it from falling back and
relax in by the unconscious, as well as whether the person has a voluminous tongue, such as in cases of Angioedema.
It also has a nozzle for the rescuer with a protective mask mode, which prevents any mouth to mouth contact.
Another system called the AutoPulse is electrically powered and uses a large band around the patients chest which
contracts in rhythm in order to deliver chest compressions. This is also backed by clinical studies showing increased
successful return of spontaneous circulation.

Prevalence
Chance of receiving CPR
Various studies suggest that in out-of-home cardiac arrest, bystanders, lay persons or family members attempt CPR
in between 14% and 45% of the time, with a median of 32%. This indicates that around a third of out-of-home
arrests have a CPR attempt made on them. However, the effectiveness of this CPR is variable, and the studies
suggest only around half of bystander CPR is performed correctly. A recent study has shown that members of the
public who have received CPR training in the past lack the skills and confidence needed to save lives. These experts
believe that better training is needed to improve the willingness to respond to cardiac arrest.

Cardiopulmonary resuscitation
There is a clear correlation between age and the chance of CPR being commenced, with younger people being far
more likely to have CPR attempted on them prior to the arrival of emergency medical services. It was also found that
CPR was more commonly given by a bystander in public than when an arrest occurred in the patient's home,
although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts. This is
supported by further research, which suggests that people with no connection to the victim are more likely to
perform CPR than a member of their family.
There is also a correlation between the cause of arrest and the likelihood of bystander CPR being initiated. Lay
persons are most likely to give CPR to younger cardiac arrest victims in a public place when it has a medical cause;
victims in arrest from trauma, exsanguination or intoxication are less likely to receive CPR.
Finally, it has been claimed that there is a higher chance of CPR being performed if the bystander is told to only
perform the chest compression element of the resuscitation.

Chance of receiving CPR in time

CPR is only likely to be effective if commenced within 6 minutes after the blood flow stops, because permanent
brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become
dormant in as little as 46 minutes in an oxygen deprived environment and the cells are unable to survive the
reintroduction of oxygen in a traditional resuscitation. Research using cardioplegic blood infusion resulted in a
79.4% survival rate with cardiac arrest intervals of 7243 minutes, traditional methods achieve a 15% survival rate
in this scenario, by comparison. New research is currently needed to determine what role CPR, electroshock, and
new advanced gradual resuscitation techniques will have with this new knowledge. A notable exception is cardiac
arrest occurring in conjunction with exposure to very cold temperatures. Hypothermia seems to protect by slowing
down metabolic and physiologic processes, greatly decreasing the tissues' need for oxygen. There are cases where
CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia.

Society and culture

Portrayed effectiveness
CPR is often severely misrepresented in movies and television as being highly effective in resuscitating a person
who is not breathing and has no circulation. A 1996 study published in the New England Journal of Medicine
showed that CPR success rates in television shows was 75% for immediate circulation, and 67% survival to
discharge. This gives members of the public an unrealistic expectation of a successful outcome. When educated on
the actual survival rates, the proportion of patients over 60 years of age desiring CPR should they suffer a cardiac
arrest drops from 41% to 22%.

Stage CPR
Chest compressions are capable of causing significant local blunt trauma, including bruising or fracture of the
sternum or ribs. Performing CPR on a healthy person may or may not disrupt normal heart rhythm, but regardless the
technique should not be performed on a healthy person because of the risk of trauma.
The portrayal of CPR technique on television and film often is purposely incorrect. Actors simulating the
performance of CPR may bend their elbows while appearing to compress, to prevent force from reaching the chest of
the actor portraying the victim. Other techniques, such as substituting a mannequin torso for the "victim" in some
shots, may also be used to avoid harming actors.

Cardiopulmonary resuscitation

Self-CPR hoax
A form of "self-CPR" termed "Cough CPR" was the subject of a hoax chain e-mail entitled "How to Survive a Heart
Attack When Alone" which wrongly cited "ViaHealth Rochester General Hospital" as the source of the technique.
Rochester General Hospital has denied any connection with the technique.
"Cough CPR" cannot be used outside the hospital because the first symptom of cardiac arrest is unconsciousness in
which case coughing is impossible, although myocardial infarction (heart attack) may occur to give rise to the
cardiac arrest, so a patient may not be immediately unconscious. Further, the vast majority of people suffering chest
pain from a heart attack will not be in cardiac arrest and CPR is not needed. In these cases attempting "cough CPR"
will increase the workload on the heart and may be harmful. When coughing is used on trained and monitored
patients in hospitals, it has only been shown to be effective for 90 seconds.
The American Heart Association (AHA) and other resuscitation bodies do not endorse "Cough CPR", which it terms
a misnomer as it is not a form of resuscitation. The AHA does recognize a limited legitimate use of the coughing
technique: "This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital,
particularly during cardiac catheterization. In such cases the patients ECG is monitored continuously, and a
physician is present."

CPR learned from movies and television

In at least one case, it has been claimed that CPR allegedly learned from a movie was used to save a person's life. In
April 2011, it was claimed that nine-year-old Tristin Saghin saved his sister's life by administering CPR on her after
she fell into a swimming pool, using only the knowledge of CPR that he had gleaned from a motion picture, Black
Hawk Down.

Hands-Only CPR portrayed as more palatable version

Less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location have CPR
performed on them. Most bystanders are worried that they might do something wrong.[14] On October 28, 2009 The
American Heart Association and the Ad Council launched a Hands Only CPR public service announcement and
website as a means to address this issue.[15] In July 2011, new content was added to the website including a digital
app that helps a user learn how to perform Hands-Only CPR.[16]

History

Cardiopulmonary resuscitation

In the 19th century, Doctor H. R. Silvester

described a method (The Silvester Method)
of artificial respiration in which the patient
is laid on their back, and their arms are
raised above their head to aid inhalation and
then pressed against their chest to aid
exhalation. The procedure is repeated
sixteen times per minute. This type of
artificial respiration is occasionally seen in
films made in the early part of the 20th
century.
A second technique, called the Holger
Nielsen technique, described in the first
edition of the Boy Scout Handbook in the
Mouth-to-mouth resuscitation
United States in 1911, described a form of
artificial respiration where the person was laid face down, with their head to the side, resting on the palms of both
hands. Upward pressure applied at the patients elbows raised the upper body while pressure on their back forced air
into the lungs, essentially the Silvester Method with the patient flipped over. This form is seen well into the 1950s (it
is used in an episode of Lassie during the mid-1950s), and was often used, sometimes for comedic effect, in
theatrical cartoons of the time (see Tom and Jerry's "The Cat and the Mermouse"). This method would continue to
be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in
1979. The technique was later banned from first-aid manuals in the U.K.
Similar techniques were described in early 20th century ju-jutsu and judo books, as being used as far back as early
17th century. A New York Times correspondent reported those techniques being used successfully in Japan in 1910.
In ju-jutsu (and later on, judo), those techniques were called Kappo or Kutasu.
However, it was not until the middle of the 20th century that the wider medical community started to recognize and
promote artificial respiration combined with chest compressions as a key part of resuscitation following cardiac
arrest. The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude,
Guy Knickerbocker and Peter Safar. Jude and Knickerbocker, along with William Kouwenhoven and Joseph S.
Redding had recently discovered the method of external chest compressions, whereas Safar had worked with
Redding and James Elam to prove the effectiveness of artificial respiration. It was at Johns Hopkins University
where the technique of CPR was originally developed. The first effort at testing the technique was performed on a
dog by Redding, Safar and JW Perason. Soon afterward, the technique was used to save the life of a child. Their
combined findings were presented at the annual Maryland Medical Society meeting on September 16, 1960 in Ocean
City, and gained rapid and widespread acceptance over the following decade, helped by the video and speaking tour
they undertook. Peter Safar wrote the book ABC of Resuscitation in 1957. In the U.S., it was first promoted as a
technique for the public to learn in the 1970s.[17]
Artificial respiration was combined with chest compressions based on the assumption that active ventilation is
necessary to keep circulating blood oxygenated, and the combination was accepted without comparing its
effectiveness with chest compressions alone. However, research over the past decade has shown that assumption to
be in error, resulting in the AHA's acknowledgment of the effectiveness of chest compressions alone (see
Compression only in this article).[18]

Cardiopulmonary resuscitation

Administering CPR to animals

It is feasible to perform CPR on animals, including cats and dogs. The principles and practices are virtually identical
to CPR for humans. One difference is that resuscitation is usually done through the animal's nose, not the mouth.
One is cautioned to only perform CPR on unconscious animals to avoid the risk of being bitten. Persons should first
and foremost understand that a conscious animal would not require chest compressions. Animals, depending on
species, have a lower bone density than humans, thus CPR can cause bones to become weakened after it is
performed.
[19]

References
[1]
[2]
[3]
[4]
[5]
[6]
[7]

http:/ / icd9cm. chrisendres. com/ index. php?srchtype=procs& srchtext=99. 60& Submit=Search& action=search
http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D016887
http:/ / ops. icd-code. de/ ops/ code/ 8-771. html
http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 000010. htm
(), "
Newsweek 2007-05-07
Myocardial contusion injury: redefining the diagnostic algorithm, M K Bansal, S Maraj, D Chewaproug, A Amanullah. Emerg Med J
2005;22:465-469 doi:10.1136/emj.2004.015339 ; http:/ / emj. bmj. com/ content/ 22/ 7/ 465. full

[8] Implicatii medico-legale in resuscitarea cardio-respiratorie, Aurel Mogoseanu. http:/ / www. atitimisoara. ro/ _files/ documents/ files/ 2007/
Conferinte%20ATI/ Implicatii%20medico-legale%20in%20resuscitarea%20cardio-respiratorie. pdf
[9] AHA, The Textbook of Emergency Cardiovascular Care and CPR, page 541
[10] Forensic Pathology: Principles And Practice, David Dolinak,Evan W. Matshes,Emma O. Lew, page 322
[11] AHA, Part 3: Adult Basic Life Support, http:/ / circ. ahajournals. org/ content/ 102/ suppl_1/ I-22. full ; Circulation. 2000; 102: I-22-I-59
[12] Public Health Initiative Uses PocketCPR to Help Improve Cardiac Arrest Survival Rates (http:/ / www. pocketcpr. com/ pdf/
prs_rls_10_20_08. pdf), October 20, 2008.
[13] Automatic CPR device saves life of woman who was clinically dead for over 40 minutes (http:/ / www. abc. net. au/ news/ 2013-08-19/
automatic-cpr-device-saves-life-of-woman-who-was-clinically-dea/ 4896722), ABC News Online, 19 August 2013
[14] American Heart Association (http:/ / www. handsonlycpr. org/ )
[15] American Heart Association, Ad Council launch Hands-Only CPR campaign (http:/ / www. newsroom. heart. org/ index. php?s=43&
item=852)
[16] Americans can learn Hands-Only CPR with a new digital application (http:/ / www. multivu. com/ mnr/ 50577-ad-council-hands-only-cpr)
[17] See, e.g., "Award of the Heart", TIME magazine, November 28, 1973, retrieved on 05-28-2008 from time.com
[18] On June 4th 2011 Jeremiah Kliesing "coded" at the Michael DeBakey VA hospital in Houston, Tx. Jeremiah underwent 5 1/2 hours of CPR
by 20 doctors and nurses before being stabilized and transferred to St. Luke's Episcopal Hospital, where he's the second patient to receive the
SYNCARDIA artificial heart. One of the Dr.s who preformed CPR was Dr. Donald Lazarus. Source= http:/ / www. syncardia. com/
2011-Press-Releases/ total-artificial-heart-recipient-heads-home-for-the-holidays-with-new-donor-heart-a-kidney. html
[19] heart.org/American Heart association; Aspirin and Heart Disease update 30 March 2012 Most heart attacks and strokes occur from clogged
venous and arterial flow. Emergency medical workers are known to give aspirin to patients that suffer chest pain or headaches prior to
transport.

External links
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care (http://circ.ahajournals.org/content/122/16_suppl_2/S250.full)
ERC European Resuscitation Council (http://www.erc.edu/)
CPR (http://www.nhs.uk/conditions/accidents-and-first-aid/pages/cpr.aspx): NHS Choices
How to resuscitate a child (http://www.nhs.uk/Planners/birthtofive/Pages/Howtorescusitate.aspx): NHS
Choices
Sarver Heart Center's Continuous Chest Compression CPR on YouTube (http://medicine.arizona.edu/spotlight/
learn-sarver-heart-centers-continuous-chest-compression-cpr)
A Video of Rescue Breathing for Laryngectomees and Neck Breathers (http://www.youtube.com/
watch?v=YE-n8cgl77Q)*

Cardiopulmonary resuscitation
Comparison of CPR Training offered by AHA and Red Cross America (http://www.cprcertificationonlinehq.
com/difference-aha-red-cross-cpr-training-programs/)*

10

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Waters, CapFan, Carabinieri, Carolinapercas, Caspian, Cburnett, Cdang, Chamal N, Charbon, Chaser, Chris 73, Chris the speller, Chungahb, Chzz, ClaretAsh, Cntras, Cobalt387, Coderedkyle,
Coemgenus, CompuRuss, Courage Dog, Craigheinke, Cramyourspam, Crohnie, Cyan, DMCer, DS1953, DXRAW, Dah31, Dammit, Dan100, Dan6hell66, Dana boomer, Daniel Quinlan,
Danieladelrio, Dantheman4297, DataMatrix, Davered, Daveswagon, David, David Edgar, Davipo, Davodavy, Dbusher, DeknMike, DennisTheTiger, Dep. Garcia, DerHexer, DevilDoc82,
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Image Sources, Licenses and Contributors

File:CPR training-04.jpg Source: http://en.wikipedia.org/w/index.php?title=File:CPR_training-04.jpg License: Creative Commons Attribution-Sharealike 2.0 Contributors: Rama
File:CPR training-03.jpg Source: http://en.wikipedia.org/w/index.php?title=File:CPR_training-03.jpg License: Creative Commons Attribution-Sharealike 2.0 Contributors: Rama
File:Insulfation2.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Insulfation2.jpg License: unknown Contributors: Image by Rama

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