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James CVAH-NET

Jude Guy Knickerbocker Peter Safar

 1962 training video

 promoted artificial respiration combined with
chest compressions as a key part of
resuscitation following cardiac arrest
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 Technique of CPR was originally developed

 First effort at testing the technique was
performed on a dog by Redding, Safar and
JW Perason

 ABC of resuscitation in 1957

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 One is cautioned to only

perform CPR on
unconscious animals to
avoid the risk of being bitten
and that animals, depending
on species, have a lower
bone density than humans,
causing bones to become
weakened after CPR is
performed.
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 CPR involves chest compressions at a rate of

at least 100 per minute in an effort to create
artificial circulation by manually pumping
blood through the heart
 Rescuer may provide breaths by either
exhaling into their mouth or utilizing a device
that pushes air into the lungs. The process
of externally providing ventilation is
termed artificial respiration.
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 CPR alone is unlikely to restart the heart; its

main purpose is to restore partial flow of
oxygenated blood to the brain and heart
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 CPR may however induce a shockable

rhythm. CPR is generally continued until the
person regains return of spontaneous
circulation (ROSC) or is declared dead.
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 CPR is indicated for any person who

is unresponsive with no breathing or only
gasps as breathing as it is most likely that
they are in cardiac arrest. If a person still has
a pulse, but is not breathing (respiratory
arrest), artificial respirations are more
appropriate.
 In 2010, the American Heart CVAH-NET

Association and International Liaison

Committee on Resuscitation updated their
CPR guidelines. The importance of high
quality CPR (sufficient rate and depth
without excessively ventilating) was
emphasized. The order of interventions was
changed for all age groups
except newborns from airway, breathing,
chest compressions (ABC) to chest
compressions, airway, breathing (CAB).
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One rescuer
 Adult, child, infant- 30:2

At least 2 rescuers
 Child & infant 15:2 preferred

 Newborn 3:1 recommended (unless a

cardiac cause is known in which case a 15:2

ratio is reasonable.
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 As of 2010 the Resuscitation Council

(UK) still recommends ABC for children.

 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)
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 There is no substitute for learning cardiopulmonary

resuscitation (CPR), but emergencies don't wait for
training. These instructions are for conventional adult
CPR. If you've never been trained in CPR and the
victim collapsed in front of you, use hands-only CPR.

 Difficulty: Easy
 Time Required: CPR should start as soon as possible
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1. Attempt to wake victim

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2. Begin chest compressions

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3. Begin rescue breathing

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4. Repeat chest compressions

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5. Repeat rescue breaths.

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6. Keep going.
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7. After 2 minutes of chest compressions and

rescue breaths, stop compressions and
recheck victim for breathing.
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 8. Repeat the process, checking for breathing

every 2 minutes (5 cycles or so), until help
arrives. If the victim wakes up, you can stop
CPR.
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 9. Place victim on recovery position

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 Chest compressions are extremely

important. If you are not
comfortable giving rescue breaths,
still perform chest compressions!
It's called Hands Only CPR.

 If the victim is breathing, briskly rub

your knuckles against the victim's
sternum. If the victim does not
wake, call 911.
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 If the victim wakes up, but is confused or not

able to speak, call 911.
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 Nothing. You can do CPR without any

special tools.
 A mouth-to-mouth CPR barrier is optional.
 An automated external defibrillator (AED)
may be available.
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 There is no substitute for proper training.

However, emergencies wait for no one.
Use these steps to provide CPR to babies
under 1 year old.
 Time Required: As long as it takes
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1. Stay Safe
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2. Try to wake the infant

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 If the infant does not wake up, have

someone call 911 immediately. If no one
else is available to call 911 and the baby is
not breathing, continue to step 3 and do CPR
for about 2 minutes before calling 911.
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3. Begin chest compressions

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4. Give the baby two breaths

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5. Keep doing CPR and call 911 after 2 minutes

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 Once 911 has been called or you have

someone else calling, keep doing CPR. Don't
stop until help arrives or the baby wakes up.
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 6. Place in recovery position

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 When checking for breathing, if you're not

sure then assume the baby isn't breathing.
It's much worse to assume a baby is
breathing and not do anything than to
assume he or she isn't and start CPR.
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 Put a book under the baby's shoulders -- if

you have time -- to help keep his head tilted
back.
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 When asking someone else to call 911,

make sure you tell them why they are calling.
If not, they may not tell the 911 dispatcher
exactly what's going on. If the dispatcher
knows the baby isn't breathing or
responding, the dispatcher may be able to
give you instructions to help.
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 There is no substitute for proper

training. However, emergencies wait for
no one. Use these steps to provide CPR
to children 1 to 8 years old.
 Time Required: As long as it takes
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1. Stay Safe
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2. Try to Wake the Child

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 If the child does not wake up, have someone

call 911 immediately. If no one else is
available to call 911 and the child is not
breathing, continue to step 3 and do CPR for
about 2 minutes before calling 911.
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3. Begin chest compressions

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4. Give the child two breaths

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5. Keep doing CPR and call 911 after 2 minutes

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 Once 911 has been called or you have

someone else calling, keep doing CPR. Don't
stop until help arrives or the child wakes up.
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 6. Place in recovery position

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 When checking for breathing, if you're not

sure then assume the child isn't breathing.
It's much worse to assume a kid is breathing
and not do anything than to assume he or
she isn't and start rescue breaths.
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 When giving rescue breaths, using a CPR

mask helps with making a proper seal and
keeps vomit out of the rescuer's mouth.

 Put a book under the child's shoulders -- if

you have time -- to help keep his or her head
tilted back.
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 When asking someone else to call 911,

make sure you tell them why they are calling.
If not, they may not tell the 911 dispatcher
exactly what's going on. If the dispatcher
knows a child isn't breathing or responding,
the dispatcher may be able to give you
instructions to help. If you call 911, be calm
and listen carefully.
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 Choking requires a quick response to

remove the airway obstruction before it
leads to unconsciousness. These steps
are for conscious adults and children
aged 1 to 8.

 Difficulty: Easy
 Time Required: N/A
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1.Stay Safe!
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2.Establish that the victim is actually choking.

Choking victims cannot speak, cough, or
breath.
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3.Stand behind the victim.

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4.Wrap your hands around the victim as

if to give a hug.
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5.Make a fist with your right hand and place

it just above the victim's belly button
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6.Grab your fist with your left and thrust

inwards and upwards forcefully.
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7.Repeat thrusts until the victim is able to breath

again - or until the victim becomes unconscious
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8.If the victim becomes unconscious, begin adult

CPR if the victim is over 8 years old and child
CPR if the victim is between 1 and 8 years old.
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 Do not slap the victim on the back.

Dislodging the airway obstruction while
the victim is upright will result in a deeper
obstruction (gravity will pull it down).
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 There's no substitute for proper training when it

comes to saving an infant from choking.
However, emergencies don't wait for training.
Follow these steps for a choking infant under 1
year old.
 Time Required: As long as it takes
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1.Stay Safe
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2.Quickly Assess the Infant

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3.Give 5 Blows to the Back

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4.Give 5 Chest Thrusts

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5.Look in the Baby's Mouth

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 When asking someone else to call 911,

make sure you tell them why they are
calling. If not, they may not tell the 911
dispatcher exactly what's going on. If the
dispatcher knows the baby isn't breathing
or responding, the dispatcher may be
able to give you instructions to help.
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 No more looking, listening and feeling.

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 Push a little harder

 Push a little faster

2010 American Heart Association Guidelines for
CPR and Emergency Cardiovascular Care
Comparison Chart of Key Changes
EMBARGOED FOR RELEASE
Oct. 18, 12:30 a.m. EST
 2010 2005 Explanation
Recommendation Recommendation

Basic Life Support

A change in the basic life Use of the “A-B-C” In the majority of cardiac arrests, the
support (BLS) sequence basic life support critical initial elements of CPR are chest
of steps for trained sequence. compressions and early
rescuers from “A-B-C” defibrillation.
(Airway, Breathing, Chest • In the C-A-B sequence, chest
compressions) to “C-A-B” compressions will be initiated
(Chest compressions, sooner and ventilation only minimally
Airway, Breathing) for delayed until completion of the first cycle
adults and pediatric of chest compressions.
patients • The A-B-C sequence could be a reason
why fewer than a third of people in
cardiac arrest receive bystander CPR.
ABC starts with the most difficult
procedures: opening the airway and
delivering rescue breaths.
 2010 2005 Recommendation Explanation
Recommendation

“Look, Listen and Feel” “Look, Listen and Feel” Performance of “Look, Listen and
has been removed from Included in BLS algorithm Feel,” is inconsistent and
the BLS algorithm. time consuming.
Also applies to BLS for
healthcare providers.

A compression rate of at A compression rate of The number of chest compressions

least 100/min. “approximately” delivered per minute
100/min. during CPR is an important
determinant of return of
spontaneous circulation (ROSC) and
survival with good
neurologic function. In most studies,
delivery of more compressions
during resuscitation is associated
with better
survival, and delivery of fewer
compressions is associated with
lower survival.
 2010
Recommendation
If a bystander is not
trained in CPR, the
bystander should provide
Hands-Only™
(compression-only)
CPR for the adult victim
who suddenly collapses,
with an emphasis to
“push hard and fast” on
the center of the chest,
or follow the directions of
the EMS dispatcher. All
trained lay rescuers
should, at a minimum,
provide chest
compressions for victims
of cardiac arrest. In
addition, if the trained lay
rescuer is able to perform
rescue breaths,
compressions and
breaths should be
2005 Recommendation Explanation
The 2005 AHA Guidelines Hands-Only (compression-only) CPR
for is easier for an untrained rescuer to
CPR and ECC did not perform and can be more readily
provide different guided
recommendations for by dispatchers over the telephone.
trained versus untrained In addition, survival rates from
rescuers cardiac arrests of cardiac etiology
but did recommend that are similar with either Hands-Only
dispatchers provide CPR or CPR with both compressions
compression-only CPR and rescue breaths. However, for the
instructions to untrained trained lay rescuer who is able, the
bystanders. The 2005 recommendation remains for the
AHA rescuer to perform both
Guidelines for CPR and compressions and ventilations
ECC did note that if the
rescuer was unwilling or
unable to provide
ventilations, the rescuer
should provide chest
compressions only.
2010 Recommendation 2005 Explanation
Recommendation
The new Depress adult breastbone Compressions generate critical blood
recommendation for approximately 1 1/2 to 2 flow and oxygen and energy delivery
chest compression inches to the heart and brain. Rescuers
depth: push down on the (approximately 4 to 5 cm). often do not push the chest hard
adult breastbone at enough.
least 2 inches (5 cm).
Also applies to BLS for
healthcare providers.
 2010 2005 Explanation
Recommendation Recommendation

Pediatric Basic Life

Support
Initiate CPR for infants Cardiopulmonary This proposed major change in CPR
and children with chest resuscitation was sequencing to compressions before
compressions rather than initiated with opening of ventilations (C-A-B) led to vigorous
rescue breaths (C-A-B the airway and the debate among experts in pediatric
rather than A-B-C). CPR provision of 2 breaths resuscitation. Because most pediatric
should begin with 30 before chest cardiac arrests are asphyxial, rather
compressions (any lone compressions. than sudden primary cardiac arrests,
rescuer) or 15 both intuition and clinical data
compressions (for support the need for ventilations and
resuscitation of infants compressions for pediatric CPR.
and children by two
healthcare providers)
rather than with two
ventilations.
 2010 2005 Explanation
Recommendation Recommendation

To achieve effective chest Push with sufficient Evidence from radiologic studies of
compressions, rescuers force to depress the the chest in children
should compress at least chest approximately one suggests that compression to one half
one third of the anterior third to one half the the anterior-posterior
posterior diameter of the anterior posterior diameter may not be achievable.
chest. This corresponds diameter of the chest. However, effective chest
to approximately 1-1.5 compressions require pushing hard,
inches (about 4 cm) in and based on new data,
most infants and about 2 the depth of about 1 . inches (4 cm)
inches (5 cm) in most for most infants and
children. about 2 inches (5 cm) in most
children is recommended.
 2010
Recommendation
For infants, a manual
defibrillator is preferred
to an AED for
defibrillation. If a manual
defibrillator is
not available, an AED
equipped with a pediatric
dose attenuator is
preferred. If neither is
available,
an AED without a
pediatric dose attenuator
may be
used.
2005 Recommendation Explanation
Data have shown that Newer case reports suggest that an
AEDs can be used safely AED may be safe and
and effectively in effective in infants. Because survival
children 1 to 8 years of requires defibrillation
age. However, there are when a shockable rhythm is present
insufficient data to make during cardiac arrest,
a recommendation for or delivery of a high-dose shock is
against using an AED in preferable to no shock.
infants < 1 year of age.