Cardiopulmonary resuscitation
Overview
Cardiopulmonary resuscitation (CPR) is an emergency procedure which is 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
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example agonal respirations. It may be performed both in and outside of a hospital.

CPR involves chest compressions at least 5 cm 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.
Encyclopedia
Cardiopulmonary resuscitation (CPR) is an emergency procedure which is 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
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example agonal respirations. It may be performed both in and outside of a hospital.

CPR involves chest compressions at least 5 cm 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 utilizing a device that pushes air into the subject's lungs. This process of externally providing ventilation is termed artificial respiration
Artificial respiration
Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal 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
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...

 and heart
Human heart
The human heart is a muscular organ that provides a continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body...

. The objective is to delay tissue death
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

 and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...

. Administration of an electric shock to the subject's heart, termed defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...

, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is only effective for certain heart rhythms, namely ventricular fibrillation
Ventricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...

 or pulseless ventricular tachycardia, rather than asystole
Asystole
In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow...

 or pulseless electrical activity
Pulseless electrical activity
Pulseless electrical activity or PEA refers a cardiac arrest situation in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse, but is not...

. CPR may succeed in inducing a heart rhythm which may be shockable. CPR is generally continued until the subject regains return of spontaneous circulation
Return of spontaneous circulation
Return of spontaneous circulation is resumption of sustained perfusing cardiac activity associated with significant respiratory effort after cardiac arrest. Signs of ROSC include breathing, coughing, or movement and a palpable pulse or a measurable blood pressure...

 (ROSC) or is declared dead
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

.

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
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

. If a person still has a pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...

, but is not breathing (respiratory arrest
Respiratory arrest
Respiratory arrest is the cessation of breathing. It is a medical emergency and it usually is related to or coincides with a cardiac arrest. Causes include opiate overdose, head injury, anaesthesia, tetanus, or drowning...

), artificial respiration
Artificial respiration
Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration...

s 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. In those with cardiac arrest due to trauma
Trauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 CPR is considered futile but still recommended.

Methods

In 2010, the American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...

 and International Liaison Committee on Resuscitation
International Liaison Committee on Resuscitation
The International Liaison Committee on Resuscitation was formed in 1992 to provide an opportunity for the major organizations in resuscitation to work together on CPR and ECC protocols...

 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). An exception to this recommendation is for those who are believed to be in a respiratory arrest
Respiratory arrest
Respiratory arrest is the cessation of breathing. It is a medical emergency and it usually is related to or coincides with a cardiac arrest. Causes include opiate overdose, head injury, anaesthesia, tetanus, or drowning...

 (drowning
Drowning
Drowning is death from asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia....

, etc.).

Standard

A universal compression to ventilation ratio of 30:2 is recommended. With children, if at least 2 rescuers are present a ratio of 15:2 is preferred. In newborns a rate of 3:1 is recommended unless a cardiac cause is known in which case a 15:2 ratio is reasonable. If an advanced airway such as an endotracheal tube or laryngeal mask airway
Laryngeal mask airway
The laryngeal mask airway is a supraglottic airway device invented by Archie Brain, a British anaesthetist.-Description:Laryngeal masks consist of a tube with an inflatable cuff that is inserted into the pharynx. Laryngeal mask airways come in a variety of sizes ranging from large adult to infant...

 is in place delivery of respirations should occur without pauses in compressions at a rate of 8–10 per minute. The recommended order of interventions is chest compressions, airway, breathing or CAB in most situations. With a compression rate of at least 100 per minute in all groups. Recommended compression depth in adults and children is about 5 cm (2 inches) and in infants it is 4 cm (1.5 inches. As of 2010 the Resuscitation Council (UK)
Resuscitation Council (UK)
The Resuscitation Council is the United Kingdom body responsible for setting central standards for cardiopulmonary resuscitation and related disciplines, and is a member of the European Resuscitation Council, which in turn is part of the international standards body, the International Liaison...

 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. 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
Artificial respiration
Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration...

. 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. In adults with out-of-hospital cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

, compression-only CPR by the lay public has a higher success rate than standard CPR. The exceptions are cases of drowning
Drowning
Drowning is death from asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia....

s, drug overdose
Drug overdose
The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced...

, and arrest in children. Children who receive compression only CPR have the same outcomes as those who received no CPR. 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
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...

, the beat of the Bee Gees
Bee Gees
The Bee Gees are a musical group that originally comprised three brothers: Barry, Robin, and Maurice Gibb. The trio was successful for most of their 40-plus years of recording music, but they had two distinct periods of exceptional success: as a pop act in the late 1960s and early 1970s, and as a...

' song Stayin' Alive
Stayin' Alive
"Stayin' Alive" is a song by the pop group Bee Gees from the Saturday Night Fever motion picture soundtrack. The song was written by the Bee Gees and produced by the Bee Gees, Albhy Galuten and Karl Richardson. It was released on 13 December 1977, as the second single from the Saturday Night Fever...

 provides an ideal amount of beats-per-minute to use for hands-only CPR. For those with non cardiac arrest and people less than 20 years of age standard CPR is superior to compression only CPR.

In pregnancy

During pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...

 when a woman is lying on her back the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

 may compress the inferior vena cava
Inferior vena cava
The inferior vena cava , also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart....

 and thus decrease venous return. It is recommended for this reason that the uterus be pushed to the persons left and if this is not effective either roll the person 30°s or consider emergency cesarean section.

Other

Interposed abdominal compressions may be beneficial in the in 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 48% 22%
Unwitnessed In-Hospital Cardiac Arrest 21% 1%
Bystander Cardiocerebral Resuscitation 40% 6%
Bystander Cardiopulmonary Resuscitation 40% 4%
No Bystander CPR (Ambulance CPR) 15% 2%
Defibrillation within 3–5 minutes 74% 30%


Used alone, CPR will result in few complete recoveries, and those who do survive often develop serious complications. Estimates vary, but many organizations stress that CPR does not "bring anyone back," it simply preserves the body for defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...

 and advanced life support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...

. However, in the case of "non-shockable" rhythms such as Pulseless Electrical Activity
Pulseless electrical activity
Pulseless electrical activity or PEA refers a cardiac arrest situation in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse, but is not...

 (PEA), defibrillation is not indicated, and the importance of CPR rises. On average, only 5–10% of people who receive CPR survive. The purpose of CPR is not to "start" the heart, but rather to circulate oxygenated blood, and keep the brain alive until advanced care (especially defibrillation) can be initiated. As many of these patients may have a pulse that is impalpable by the layperson rescuer, the current consensus is to perform CPR on a patient who is not breathing.

Studies have shown the importance of immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest improve survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York, without those advantages, the survival rate is only 1–2 percent.

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 below). This is due to medical staff either being ultimately unable to address the cause of the arrhythmia or cardiac arrest, or in some instances due to other co-morbidities, due to the patient being gravely ill in more than one way.

Compression-only CPR is 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 1–17), 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 that did compression-only CPR (OR
Odds ratio
The odds ratio is a measure of effect size, describing the strength of association or non-independence between two binary data values. It is used as a descriptive statistic, and plays an important role in logistic regression...

 5.54; 95% confidence interval
Confidence interval
In statistics, a confidence interval is a particular kind of interval estimate of a population parameter and is used to indicate the reliability of an estimate. It is an observed interval , in principle different from sample to sample, that frequently includes the parameter of interest, if the...

 2.52–16.99). For arrests with a cardiac cause in this cohort, there was no difference between the two techniques (OR 1.20; 95% confidence interval 0.55–2.66). This is consistent with American Heart Association guidelines for parents.

Pathophysiology

CPR is used on people in cardiac arrest in order to oxygenate
Oxygenation (medical)
Oxygenation occurs when oxygen molecules enter the tissues of the body. For example, blood is oxygenated in the lungs, where oxygen molecules travel from the air and into the blood...

 the blood and maintain a cardiac output
Cardiac output
Cardiac output is the volume of blood being pumped by the heart, in particular by a left or right ventricle in the time interval of one minute. CO may be measured in many ways, for example dm3/min...

 to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...

 to the tissues. The brain
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...

 may sustain damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...

 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
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

. Because of that CPR is generally only effective if performed within seven minutes of the stoppage of blood flow. 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
Brain death
Brain death is the irreversible end of all brain activity due to total necrosis of the cerebral neurons following loss of brain oxygenation. It should not be confused with a persistent vegetative state...

, and allows the heart to remain responsive to defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...

 attempts.

Adjunct devices

While several adjunctive devices are available none other than defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...

 as of 2010 have consistently been found to be better than standard CPR for out of hospital cardiac arrest. These devices can be split in to 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
Metronome
A metronome is any device that produces regular, metrical ticks — settable in beats per minute. These ticks represent a fixed, regular aural pulse; some metronomes also include synchronized visual motion...

 (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.

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.

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 ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....

s, 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.

Another system called the AutoPulse
AutoPulse
The AutoPulse is an automated, portable, battery-powered cardiopulmonary resuscitation device created by Revivant and subsequently purchased and currently manufactured by ZOLL Medical Corporation...

 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.

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.

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. This is likely because of the shock experienced by finding a family member in need of CPR; it is easier to remain calm - and think clearly - when the person in need of CPR is a complete stranger, as in this case one will not be as frightened.

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 4–6 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 72±43 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
Hypothermia
Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...

 seems to protect by slowing down metabolic
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...

 and physiologic
Human physiology
Human physiology is the science of the mechanical, physical, bioelectrical, and biochemical functions of humans in good health, their organs, and the cells of which they are composed. Physiology focuses principally at the level of organs and systems...

 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.

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
Blunt trauma
In medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma...

, including bruising or fracture
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...

 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.

Self-CPR hoax

A form of "self-CPR" termed "Cough CPR
Cough CPR
Cough CPR is a fake resuscitation technique described in an email that began circulating around 1999, in which by coughing and deep breathing every 2 seconds a person suffering a cardiac dysrhythmia immediately before cardiac arrest can supposedly keep conscious until help arrives...

" was the subject of a hoax
Hoax
A hoax is a deliberately fabricated falsehood made to masquerade as truth. It is distinguishable from errors in observation or judgment, or rumors, urban legends, pseudosciences or April Fools' Day events that are passed along in good faith by believers or as jokes.-Definition:The British...

 chain e-mail entitled "How to Survive a Heart Attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

 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
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

 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
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...

 (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
Cardiac catheterization
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes...

. In such cases the patients ECG
Electrocardiogram
Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...

 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
April 2011
April 2011 was the fourth month of the current year. It began on a Friday and ended after 30 days on a Saturday.- Portal:Current events :This is an archived version of Wikipedia's Current events Portal from 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
Black Hawk Down
Black Hawk Down is a 2001 American drama war film depicting the Battle of Mogadishu, a raid integral to the United States' effort to capture Somali warlord Mohamed Farrah Aidid. The film is based on the book of the same name by Mark Bowden, which chronicles the events of the battle. It was...

.

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. On October 28, 2009 The American Heart Association and the Ad Council
Ad Council
The Advertising Council, commonly known as the Ad Council, is an American non-profit organization that distributes public service announcements on behalf of various sponsors, including non-profit organizations and agencies of the United States government....

 launched a Hands Only CPR PSA and website as a means to address this issue. 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.

History

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 Neilson technique, described in the first edition of the Boy Scout Handbook
Boy Scout Handbook
The Boy Scout Handbook is the official handbook of the Boy Scouts of America. It is a descendant of Baden-Powell's original handbook, Scouting for Boys, which has been the basis for Scout handbooks in many countries, with some variations to the text of the book depending on each country's codes and...

 in the United States in 1911, described a form of artificial respiration where the person was laid on their front, with their head to the side, resting on the palms of both hands. Upward pressure applied at the patient’s 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
Lassie (1954 TV series)
Lassie is an American television series that follows the adventures of a female Rough Collie named Lassie and her companions, human and animal. The show was the creation of producer Robert Maxwell and animal trainer Rudd Weatherwax and was televised from September 12, 1954, to March 24, 1973...

during the Jeff Miller era), and was often used, sometimes for comedic effect, in theatrical cartoons of the time (see Tom and Jerry
Tom and Jerry
Tom and Jerry are the cat and mouse cartoon characters that were evolved starting in 1939.Tom and Jerry also may refer to:Cartoon works featuring the cat and mouse so named:* The Tom and Jerry Show...

's
"The Cat and the Mermouse
The Cat and the Mermouse
The Cat and the Mermouse is a 1949 American one-reel animated cartoon and is the 43rd Tom and Jerry short directed by William Hanna and Joseph Barbera and produced by Fred Quimby...

"). 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.

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
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

. The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude, Guy Knickerbocker and Peter Safar
Peter Safar
Peter Safar was an Austrian physician of Czech descent. He is credited with pioneering cardiopulmonary resuscitation.- Early life :...

. 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
James Elam
James Otis Elam, was a U.S. M.D. and respiratory researcher.Based on his research at the Buffalo's Roswell Park Memorial Institute for understanding carbon dioxide absorption, he developed a prototype ventilator device that efficiently could absorb carbon dioxide during surgery, dubbed the Roswell...

 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 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
Peter Safar
Peter Safar was an Austrian physician of Czech descent. He is credited with pioneering cardiopulmonary resuscitation.- Early life :...

 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.

Artificial respiration
Artificial respiration
Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal 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
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...

's acknowledgment of the effectiveness of chest compressions alone (see Cardiocerebral resuscitation in this article).

In other 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 and that animals, depending on species, have a lower bone density than humans, causing bones to become weakened after CPR is performed.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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