WHAT DO WE KNOW ABOUT CPR?
BY DR. LAHIRU PERERA, PRE-INTERN MEDICAL DOCTOR AT DURDANS HOSPITAL
Ever since I started to watch Hollywood movies and television series, I have seen how people are saved by receiving immediate cardiopulmonary resuscitation, or CPR. From an early age, I wondered what this miracle technique that saves people is. Then, when I got into medical school, I learned not only about the importance, but also the different techniques of CPR.
To elaborate on CPR, it is a lifesaving procedure that originated more than 300 years ago, which was used for people who were drowning by giving mouth-to-mouth and it was founded by the Paris Academy of Sciences and the Society for Recovery of Drowned Persons. Along with other head positioning methods, these techniques have been adopted by most of the swimming clubs in the world. People still stick to these traditional methods.
Dr. Frederick Maas was the first person in history to document an external chest compression in 1903. In 1960, Peter Safar came up with the manual for public CPR training. Nowadays, everyone, from medical students to the general population, is getting trained to give CPR but unfortunately, I don’t see many public awareness programmes in Sri Lanka about CPR.
According to recent statistics, 470,000 Americans die from cardiac arrest per year. From those people, 350,000 cardiac arrests occur outside the hospital premises. Only 32% of cardiac arrest victims receive CPR and it has been found that giving CPR immediately can double or triple the chances of survival.
During some emergency conditions when the heart stops beating (cardiac arrest), the amount of blood pumped into the brain will be reduced and if the brain doesn’t get the proper amount of blood, it will die. Eventually, the other organs will die without any oxygenated blood within a few minutes due to less oxygen. To maintain the flow of oxygenated blood to the brain, we have to continue CPR until an emergency team arrives.
The first step to give CPR is to identify a cardiac arrest. For that, we have to check whether the victim is in a safe area or not, such as an area covered with electric wires or anything that can put us in danger. After clearing those things, we have to go near the victim and tap on his or her shoulders and ask whether that person is okay or not. With the look, listen, and feel method (especially by checking the breathing for five to 10 seconds or chest movements) you can identify whether that person is unresponsive or not within a few seconds. If the person is unresponsive, immediately call someone around you but never leave the victim alone. You can call 119 and inform them about the victim as well as the location. If you don’t have any clue about lifesaving or CPR techniques, just put the responder of 119 on speaker and follow their instructions. After informing the 119 emergency line or while informing them, you can start CPR.
The American Heart Association came up with a mnemonic CAB to help with the CPR process so that it will be easy for everyone, and not only for the people who are involved professionally.
CAB stands for:
• Better if the person is on a firm surface
• Kneel down next to the person’s neck and shoulder area
• Place the palm (mainly lower part) of one hand over the centre of the chest or between the two nipples where you can feel the bony structure, which is the sternum, then cover the hand with your other hand and lock them strongly
• Keep your elbows straight and use your upper body weight rather than only using your hands
• Start pushing or compressions of at least two inches or 5 cm and the compression rate should be 100 per minute
• If you never had CPR training, it is better to continue compressions until the emergency responders arrive
After performing 30 compressions you can move onto airway techniques, but only if you’ve had CPR training before. The airway techniques include tilting the head back gently with your palms over the victim’s forehead. Then with the other hand lift the chin towards you and open the airway.
After opening the airway, pinch the victim’s nostrils close and start mouth-to-mouth breathing. Start with one rescue breath, then check for the rise of the chest. If no movement of the chest, then try the second rescue breath. Continue with the compressions. That will complete one cycle. Thirty chest compressions followed with two rescue breaths are considered as one CPR cycle.
With regard to children
1. For ages one to 12: One or two hand compressions over the middle of the chest with a depth of two inches which is more similar to adults
2. For ages one or below: Better to use two fingers on the centre of the chest or just below the nipple line with a depth of one-and-a-half inches.
CPR is a lifesaving technique that can be extremely useful to save someone you love or a stranger in the street. Therefore, it is better to learn about the techniques and the procedure of it. Nowadays, with the help of YouTube and other articles on the web, you can easily find out more about CPR.