GK: Give us a brief about CPR.
Dr Shah: CPR is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood Circulation & breathing in a person who is in cardiac arrest.
Cardiopulmonary Resuscitation (CPR) delivers oxygen to the brain and other major organs until medical professionals arrive and can better administer care.
It can save the life of a person whose heart or breathing has stopped by heart attack. If you know CPR, you can save a life and keep a person from brain damage. It is an important skill to learn.
Nowadays we hear cardiac arrests occurring in young people doing gyms and while playing sports. Importantly, every gym, park, field pitch, playground and court should have an AED (Defibrillators) close at hand.
Ideally every high school student should be taught this CPR before graduating and you know if someone is going to be successfully brought back to life, it has to happen in the first few minutes that is why bystander CPR is so critical to know. Waiting for the ambulance might be too late.
Most of the time doctors declare a patient as brought dead in the hospital, most of the reason is time lost because of no bystander CPR.
GK: How CPR helps in a cardiac arrest person?
Dr Shah: CPR is used in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. The brain sustains damage after blood flow has been stopped for about four minutes and irreversible damage after seven minutes. So CPR is effective only if performed within seven minutes of the stoppage of blood flow. Effective CPR enables enough oxygen to reach the brain to delay brain stem death and allows the heart to remain responsive to defibrillation attempts. CPR involves chest compression for adults between 5cm (2.0 inch) & 6 cm (2.4 inch) deep and @ 100-120/ minute. A simplified CPR method involving only chest compressions is recommended for untrained rescuers. CPR is continued until the person has a return of spontaneous blood circulation (ROSC) or is declared dead.
GK: WHAT IS ABC IN CPR?
Dr Shah: Previously it used to be ABC. Means Airway, Breathing and Chest compressions. But the new order is CAB which means Chest Compressions, Airway and Breathing. Except in newborn and respiratory arrest (Airway obstruction, drug overdose, drowning). The compressions push on the bone that is in the middle of the chest (Sternum). The compression depth in adults and children is 5cm (2’’) and in infants it is 4cm (1.6’’). The current focus is on Hands on CPR outside the hospital cardiac arrest. In Adults, rescuers should use two hands for the chest compressions (one on the top of the other) while in children one hand can be enough and with babies the rescuers must use only two fingers.
GK: What is Hands on CPR?
Dr Shah: This is compression only for adults with cardiac arrest. I mean this is compression only (hand-only or cardio cerebral resuscitation) CPR which involves chest compression without artificial ventilation. 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 a phone. The American Heart Association recommends bystanders and those formally trained alike administer CPR. When death is on the line, it is better to do something to try to help than nothing.
GK: How to perform the CPR?
Dr Shah: Place the victim on a flat surface with a slight head tilt. Put your other hand on top of the first, palm down. Interlock the fingers of your second hand with the fingers of your first hand. Position yourself directly over your hands. Keep your arms straight and rigid. Perform 100-120 High quality chest compressions per minute pushing the chest down. Clear the airway, gently pull back the head to look inside the mouth and see if there is any obstruction. If you see something obvious, remove it first.
GK: What are High quality chest compressions?
Dr Shah: You need to Push hard ( 2 to 2.4 inches), Push fast (100 – 120/min). Allow adequate chest recoil and minimize interruption of chest compressions. There are three causes of cardiac arrest: Asystole/PEA,VF,VT. Cardiac arrest victims who present with VF or pulse less VT have a substantially better outcome compared with those who present with Asystole or pulse less electrical activity with the use of Defibrillators.
GK: What are DEFIBRILLATORS?
Dr Shah: Defibrillators produce a defibrillation (electric shocks) that can restore the normal heart beat of the victim. The standard defibrillator device is AED, a portable machine of small size that can be used by any user with no previous training. That machine produces recorded voice instructions that guide the user along the defibrillation process.
GK: What is AED? How and when to use AED?
Dr Shah: AED is an Automated External Defibrillator. It should be used in cardiac arrest victims as soon as possible. Make sure the chest is dry, analyze the rhythm and apply shock. Be sure ,no one is touching the body press. Press analyze on the AED and it will tell you if shock needs to be administered. Leave sticky pads on the victim & resume CPR again for another two minutes. Apply Pads to the patient bare chest. If shock is needed, it will deliver shock. Two more rescuers should change the compressor role every two minutes to prevent compressor fatigue.
GK: Are Rescue breaths (mouth to mouth) important?
Dr Shah: Recently CPR guidelines changed to include something called “Hands only CPR”. It is CPR with chest compressions only and without rescue breaths. This tactic was created because some rescuers might not want to put their mouth on another person’s mouth. Therefore it is better to do chest compressions only,instead of doing at all. Managing the Airway head tilt-chin lift maneuver to open the airway of a victim. Check the victims mouth & remove any visible obstructions. Remember to always only perform CPR on a victim that is unresponsive.
GK: How long should I perform CPR for?
Dr. Shah: You should perform CPR for as long as you are physically able to or until emergency help arrives. Unless you are a doctor, you will not be able to declare a person dead so you should keep performing CPR until help arrives.
GK: What is BLS and ACLS?
Dr Shah: Basic Life Support (BLS) is a reference to the emergency medical care given to a victim whose vital signs need to be sustained until they can get further care at a hospital. BLS is a non –invasive technique and does not include medicine but instead focuses on using life preserving techniques like CPR to maintain the victims vital signs to avoid brain damage or death.
Advanced cardiac life support (ACLS) is an advanced CPR usually provided by experienced doctors and paramedics in hospital involving iv medications, iv fluids, intubation, manual defibrillator, temporary pacing and invasive ventilator support.
BLS is more suitable for outside hospital cardiac arrest provided by lay rescuers and paramedics or as an immediate step to start CPR in hospital cardiac arrest till ACLS is being provided. Purpose of BLS is to maintain circulation and respiration till expert help arrives. In 1966 the American Heart Association (AHA) developed the first cardiopulmonary resuscitation (CPR) guidelines which have been followed by periodic updates.
During the past 50 years the fundamentals of early recognition and activation, early CPR, early defibrillation and early access to emergency medical care have saved hundreds of thousands of lives around the world.
The key principles in resuscitation are strengthening the links in the chain of survival, immediate recognition of cardiac arrest and activation of the emergency response system, early CPR with an emphasis on chest compressions, rapid defibrillation and effective advanced life support, integrated post cardiac arrest care.
It is important to do CPR immediately as every minute delay decreases prognosis by seven to 10 percent and gives early shock within five minutes. There is 25 percent survival in hospital cardiac arrests and 15 percent out of hospital cardiac arrests. At least target CPR training to family members of potential cardiac arrest.