Cardiopulmonary Resuscitation (CPR)

Definition

Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest).

Purpose

CPR is performed to restore and maintain breathing and circulation and to provide oxygen and blood flow to the heart, brain, and other vital organs. CPR should be performed if a person is unconscious and not breathing. Respiratory and cardiac arrest can be caused by allergic reactions, an ineffective heartbeat, asphyxiation, breathing passages that are blocked, choking, drowning, drug reactions or overdoses, electric shock, exposure to cold, severe shock, or trauma. CPR can be performed by trained bystanders or healthcare professionals on infants, children, and adults. It should always be performed by the person on the scene who is most experienced in CPR.

Precautions

CPR should never be performed on a healthy person because it can cause serious injury to a beating heart by interfering with normal heartbeats.

Description

CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of the problem and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advanced cardiac life support measures.

CPR must be performed within four to six minutes after cessation of breathing so as to prevent brain damage or death. It is a two-part procedure that involves rescue breathing and external chest compressions. To provide oxygen to a person's lungs, the rescuer administers mouth-to-mouth breaths, then helps circulate blood through the heart to vital organs by external chest compressions. Mouth-to-mouth breathing and external chest compression should be performed together, but if the rescuer is not strong enough to do both, the external chest compressions should be done. This is more effective than no resuscitation attempt, as is CPR that is performed "poorly."

When performed by a bystander, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.

According to the American Heart Association, early CPR and defibrillation combined with early advanced emergency care can increase survival rates for people with a type of abnormal heart beat called ventricular fibrillation by as much as 40%. CPR by bystanders may prolong life during deadly ventricular fibrillation, giving emergency medical service personnel time to arrive.

However, many CPR attempts are not ultimately successful in restoring a person to a good quality of life. Often, there is brain damage even if the heart starts beating again. CPR is therefore not generally recommended for the chronically or terminally ill or frail elderly. For these people, it represents a traumatic and not a peaceful end of life.

Each year, CPR helps save thousands of lives in the United States. More than five million Americans annually receive training in CPR through American Heart Association and American Red Cross courses. In addition to courses taught by instructors, the American Heart Association also has an interactive video called Learning System, which is available at more than 500 healthcare institutions. Both organizations teach CPR the same way, but use different terms. These organizations recommend that family members or other people who live with people who are at risk for respiratory or cardiac arrest be trained in CPR. A hand-held device called a CPR Prompt is available to walk people trained in CPR through the procedure, using American Heart Association guidelines. CPR has been practiced for more than 40 years.

Performing CPR

The basic procedure for CPR is the same for all people, with a few modifications for infants and children to account for their smaller size.

PERFORMING CPR ON AN ADULT. The first step is to call the emergency medical system for help by telephoning 911; then to begin CPR, following these steps:

• The rescuer opens a person's airway by placing the head face up, with the forehead tilted back and the chin lifted. The rescuer checks again for breathing (three to five seconds), then begins rescue breathing (mouth-to-mouth artificial respiration), pinching the nostrils shut while holding the chin in the other hand. The rescuer's mouth is placed against the unconscious person's mouth with the lips making a tight seal, then gently exhales for about one to one and a half seconds. The rescuer breaks away for a moment and then repeats. The person's head is repositioned after each mouth-to-mouth breath.
• After two breaths, the rescuer checks the unconscious person's pulse by moving the hand that was under the person's chin to the artery in the neck (carotid artery). If the unconscious person has a heartbeat, the rescuer continues rescue breathing until help arrives or the person begins breathing without assistance. If the unconscious person is breathing, the rescuer turns the person onto his or her side.
• If there is no heartbeat, the rescuer performs chest compressions. The rescuer kneels next to the unconscious person, placing the heel of one hand in the spot on the lower chest where the two halves of the rib cage come together. The rescuer puts one hand on top of the other on the person's chest and interlocks the fingers. The arms are straightened, the rescuer's shoulders are positioned directly above the hands on the unconscious person's chest. The hands are pressed down, using only the palms, so that the person's breastbone sinks in about 1 1/2-2 inches. The rescuer releases pressure without removing the hands, then repeats about 15 times per 10-15 second intervals.
• The rescuer tilts the unconscious person's head and returns to rescue breathing for one or two quick breaths. Then breathing and chest compressions are alternated for one minute before checking for a pulse. If the rescuer finds signs of a heartbeat and breathing, CPR is stopped. If the unconscious person is breathing but has no pulse, the chest compressions are continued. If the unconscious person has a pulse but is not breathing, rescue breathing is continued.
• For children over the age of eight, the rescuer performs CPR exactly as for an adult.

PERFORMING CPR ON AN INFANT OR CHILD UNDER THE AGE OF EIGHT. The procedures outlined above are followed with these differences:

• The rescuer administers CPR for one minute, then calls for help.
• The rescuer makes a seal around the child's mouth or infant's nose and mouth to give gentle breaths. The rescuer delivers 20 rescue breaths per minute, taking 1 1/2-2 seconds for each breath.
• Chest compressions are given with only one hand for a child and with two or three fingers for an infant. The breastbone is depressed only 1-1 1/2 inch for a child and 1/2-1 inch for an infant, the rescuer gives at least 100 chest compressions per minute.

New developments in CPR

Some new ways of performing CPR have been tried. Active compression-decompression resuscitation, abdominal compression done in between chest compressions, and chest compression using a pneumatic vest have all been tested but none are currently recommended for routine use.

The active compression-decompression device was developed to improve blood flow from the heart, but clinical studies have found no significant difference in survival between standard and active compression-decompression CPR. Interposed abdominal counterpulsation, which requires two or more rescuers, one compressing the chest and the other compressing the abdomen, was developed to improve pressure and therefore blood flow. It has been shown in a small study to improve survival but more data is needed. A pneumatic vest, which circles the chest of an unconscious person and compresses it, increases pressure within the chest during external chest compression. The vest has been shown to improve survival in a preliminary study but more data is necessary for a full assessment.

Preparation

If a person suddenly becomes unconscious, a rescuer should call out for help from other bystanders, and then determine if the unconscious person is responsive by gently shaking the shoulder and shouting a question. Upon receiving no answer, the rescuer should call the emergency medical system. The rescuer should check to see whether the unconscious person is breathing by kneeling near the person's shoulders, looking at the person's chest, and placing a cheek next to the unconscious person's mouth. The rescuer should look for signs of breathing in the chest and abdomen, and listen and feel for signs of breathing through the person's lips. If no signs of breathing are present after three to five seconds, CPR should be started.

Aftercare

Emergency medical care is always necessary after successful CPR. Once a person's breathing and heartbeat have been restored, the rescuer should make the person comfortable and stay there until emergency medical personnel arrive. The rescuer can continue to reassure the person that help is coming and talk positively until professionals arrive and take over.

Risks

CPR can cause injury to a person's ribs, liver, lungs, and heart. However, these risks must be accepted if CPR is necessary to save the person's life.

Normal results

In many cases, successful CPR results in restoration of consciousness and life. Barring other injuries, a revived person usually returns to normal functions within a few hours of being revived.

Abnormal results

These include injuries incurred during CPR and lack of success with CPR. Possible sites for injuries include a person's ribs, liver, lungs, and heart. Partially successful CPR may result in brain damage. Unsuccessful CPR results in death.

KEY TERMS

Cardiac arrest— Temporary or permanent cessation of the heartbeat.

Cardiopulmonary— Relating to the heart and the lungs.

Defibrillation— A procedure to stop the type of irregular heart beat called ventricular fibrillation, usually by using electric shock.

Resuscitation— Bringing a person back to life after an apparent death or in cases of impending death.

Ventricular fibrillation— An irregular heartbeat where the heart beats very fast but ineffectively. Ventricular fibrillation is fatal if not quickly corrected.

Resources

BOOKS

Alton, Thygerson. First Aid and CPR. 4th ed. Sudbury, Massachusetts: Jones & Bartlett Pub, 2001.

Knoop, Kevin J., and Lawrence B. Stack. Atlas of Emergency Medicine. 2nd ed. New York: McGraw Hill, 2001.

National Safety Council. First Aid and CPR for Infants and Children. 4th ed. Sudbury, Massachusetts: Jones & Bartlett Pub, 2001.

PERIODICALS

Davies, N., and D. Gould. "Updating cardiopulmonary resuscitation skills: a study to examine the efficacy of self-instruction on nurses' competence." Journal of Clinical Nursing 9 (2000): 400-410.

Eftestol T., K. Sunde, S. O. Aase, J. H. Husoy, and P. A. Steen. "'Probability of successful defibrillation' as a monitor during CPR in out-of-hospital cardiac arrested patients." Resuscitation 48 (2001): 245-254.

Kern, K. B., H. R. Halperin, and J. Field. "New guidelines for cardiopulmonary resuscitation and emergency cardiac care: changes in the management of cardiac arrest." Journal of the American Medical Association 285 (2001): 1267-1269.

Meyer W., and F. Balck. "Resuscitation decision index: a new approach to decision-making in prehospital CPR." Resuscitation 48 (2001): 255-263.

ORGANIZATIONS

American College of Emergency Physicians. P.O. Box 619911, Dallas, TX 75261-9911. (800) 798-1822 or (972) 550-0911. Fax: (972) 580-2816. 〈http://www.acep.org/〉. info@acep.org.

American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago, IL 60611. (312) 587-3709 or (800) 521-3709. Fax: (312) 587-9951. 〈http://www.acoep.org〉.

American Heart Association, National Center. 7272 Greenville Avenue, Dallas, TX 75231. (877) 242-4277. 〈http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/heim.html〉.

Heimlich Institute. PO Box 8858, Cincinnati, OH 45208. 〈http://www.heimlichinstitute.org/index.htm〉. heimlich@iglou.com.

National Safe Kids Campaign. 1301 Pennsylvania Avenue, Suite 1000, Washington, DC 20004-1707. 〈http://pedsccm.wustl.edu/All-Net/english/neurpage/protect/drown.htm〉.

OTHER

American Heart Association. 〈http://www.cpr-ecc.org/〉 and 〈http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cprs.html〉.

Columbia Presbyterian Medical Center. 〈http://cpmcnet.columbia.edu/texts/guide/hmg13_0001.html〉.

Learn CPR. 〈http://www.learn-cpr.com〉.

National Registry of Cardiopulmonary Resuscitation. 〈http://www.nrcpr.org/〉.

University of Washington School of Medicine. 〈http://depts.washington.edu/learncpr/〉.

Cardiopulmonary resuscitation

Definition

Cardiopulmonary resuscitation, commonly called CPR, combines rescue breathing (one person breathing into another person) and chest compression in a lifesaving procedure performed when a person has stopped breathing or a person's heart has stopped beating.

Purpose

When performed quickly enough, CPR can save lives in such emergencies as loss of consciousness, heart attacks or heart "arrests," electric shock, drowning, excessive bleeding, drug overdose, and other conditions in which there is no breathing or no pulse. The purpose of CPR is to bring oxygen to the victim's lungs and to keep blood circulating so oxygen gets to every part of the body. When a person is deprived of oxygen, permanent brain damage can begin in as little as four minutes and death can follow only minutes later.

Description

There are three physical symptoms that indicate a need for CPR to be performed immediately and for emergency medical support to be called: unconsciousness, not breathing, and no pulse detected.

Unconsciousness

Unconsciousness is when the victim seems to be asleep but has lost all awareness and is not able to respond to questions or to touch or gentle shaking. A sleeping person will usually respond to a loud noise, shouting, or gentle shaking. An unconscious person will not respond to noise or shaking. When unconscious, a person can not cough or clear the throat, which can block the windpipe and cause suffocation and death. People with a major illness or injury or who have had recent surgery are at risk for losing consciousness. If the person has fainted, which is brief unconsciousness, the cause may be dehydration (lack of body fluids), low blood pressure, or low blood sugar. This is a temporary condition. If the victim is known to have diabetes, a bit of fruit juice may revive the person once they have regained consciousness.

Just before a person loses consciousness, symptoms may include:

• lack of response to voice or touch
• disorientation or stupor
• light-headedness
• headache
• sleepiness

Not breathing

Not breathing, which is also called apnea, is the lack of spontaneous breathing. It requires immediate medical attention. The victim may become limp and lifeless, have a seizure, or turn blue. Prolonged apnea is called respiratory arrest. In children, this can lead quickly to cardiac arrest in which the heart stops beating. In adults, cardiac arrest usually happens first and then respiratory arrest. The common causes of apnea in adults are obstructive sleep apnea (something blocks the airway during sleep), choking, drug overdose, near-drowning, head injury, heart irregularities (arrhythmia, fibrillation) or cardiac arrest, nervous system disorders, or metabolic disorders. In children the causes may be different, such as prematurity, bronchial disturbances or pneumonia, airway blockage or choking on a foreign object, holding the breath, seizures, meningitis, regurgitating food, or asthma attacks.

No pulse detected

If the rescuer is unable to detect a pulse or has difficulty in feeling a pulse it can be an indication of the use of improper technique by the rescuer, or shock or cardiac arrest in the victim. If a sudden, severe decrease occurs in pulse quality (such as pulse weakness) or pulse rate (how many beats in a minute) when other symptoms are also present, life-threatening shock is suspected. The rescuer may need to explain to a doctor or medical professional where on the victim's body the pulse was measured, if the pulse is weak or absent altogether, and what other symptoms are present.

Medical help and CPR are needed immediately if any of these symptoms is found. Time is critical. A local emergency number should be called immediately. If more than one person is available to help, one can call 911 or a local emergency medical service, while the other person begins CPR. Ideally, someone CPR certified performs the procedure. Local medical personnel, a hospital, or the American Heart Association teaches special accredited CPR courses. If a critically ill patient or post-operative patient is being cared for at home, it is a good idea for a family member to take a CPR course to be better prepared to help in case of an emergency.

The steps usually followed in CPR are as follows:

• If the victim appears to be unconscious with either no breathing or no pulse, the person should be shaken or tapped gently to check for any movement. The victim is spoken to loudly, asking if he or she is OK. If there is no response, emergency help must be called and CPR begun immediately.
• The victim is placed on his or her back on a level surface such as the ground or the floor. The victim's back should be in a straight line with the head and neck supported slightly by a rolled up cloth, small towel, or piece of clothing under the neck. A pillow should not be used to support the head. The victim's clothing should be loosened to expose the chest.
• The rescuer kneels next to the victim, tilts the victim's head back, lifts the jaw forward, and moves the tongue forward or to the side, making sure it does not block the opening to the windpipe. The victim's mouth must be kept open at all times, reopening as necessary.
• The rescuer listens close to the victim's mouth for any sign of breathing, and watches the chest for movement. If the victim is found to be breathing, and has perhaps fainted, he or she can be placed in the recovery position until medical assistance arrives. This is done by straightening the victim's legs and pulling the closest arm out away from the body with the elbow at a right angle or 3 o'clock position, and the other arm across the chest. The far leg should be pulled up over the victim's body with the hip and knee bent. This allows the victim's body to be rolled onto its side. The head should be tilted back slightly to keep the windpipe open. The head should not be propped up.
• If the victim is not breathing, rescue breathing begins, closing the victim's nostrils between a thumb and index finger, and covering the victim's mouth with the rescuer's mouth. Two slow breaths, about two seconds each, are breathed into the victim's mouth with a pause in between. This is repeated until the chest begins to rise. The victim's head should be repositioned as often as necessary during the procedure. The mouth must remain open and the tongue kept away from the windpipe.
• When the chest begins to rise, or the victim begins to breathe on his or her own, the rescuer looks for signs of circulation, such as coughing or movement. If a healthcare professional has arrived by this time, the pulse will be checked before resuming resuscitation.
• If chest compressions are needed to restart breathing, the rescuer will place the heel of a hand above the lowest part of the victim's ribcage where it meets the middle-abdomen. The other hand will be placed over the heel of the first hand, with fingers interlocked. Keeping the elbows straight, the rescuer will lean his or her shoulders over the hands and press down firmly about 15 times. It is best to develop an up-and-down rhythm, keeping the hands firmly on the victim's chest.
• After the compressions, the rescuer will give the victim two long breaths. The sequence of 15 compressions and two breaths will be repeated until there are signs of spontaneous breathing and circulation or until professional medical help arrives.

Precautions

There are certain important precautions for rescuers to remember in order to protect the victim and get the best result from CPR. These include:

• Do not leave the victim alone.
• Do not give chest compressions if the victim has a pulse. Chest compression when there is normal circulation could cause the heart to stop beating.
• Do not give the victim anything to eat or drink.
• Avoid moving the victim's head or neck if spinal injury is a possibility. The person should be left as found if breathing freely. To check for breathing when spinal injury is suspected, the rescuer should only listen for breath by the victim's mouth and watch the chest for movement.
• Do not slap the victim's face, or throw water on the face, to try and revive the person.
• Do not place a pillow under the victim's head.

The description above is not a substitute for CPR training and is not intended to be followed as a procedure.

Normal results

Successful CPR will restore breathing and circulation in the victim. Medical attention is required immediately even if successful CPR has been performed and the victim is breathing freely.

Prevention

Loss of consciousness is an emergency that is potentially life threatening. To avoid loss of consciousness and protect themselves from emergency situations, people at risk can follow these general guidelines:

• People with known conditions or diseases, such as diabetes or epilepsy, should wear a medical alert tag or bracelet.
• People with diabetes should avoid situations that will lower their blood sugar level.
• People who feel weak, become dizzy or light-headed, or have ever fainted, should avoid standing in one place too long without moving.
• People who feel faint, can lie down or sit with their head lowered between their knees.
• Risk factors that contribute to heart disease should be reduced or eliminated. People can reduce risks if they stop smoking, lower blood pressure and cholesterol, lose weight, and reduce stress.
• Illegal recreational drugs should be avoided.
• Seeing a doctor regularly and being aware of any disease conditions or risk factors can help prevent or complicate illness, as can seeking and following the doctor's advice about diet and exercise.
• Using seat belts and driving carefully can help avoid accidental injury.
• People with poor eyesight or those who have difficulty walking because of disability, injury, or recovery from illness, can use a cane or other assistance device to help them avoid falls and injury.

Resources

organizations

American CPR Training. <http://www.cpr-training-classes.com>.

American Heart Association, National Center. 7272 Greenville Avenue, Dallas, TX 75231. <http://www.americanheart.org>.

other

Emergency Cardiovascular Care. [cited April 2003]. <http://www.cpr-ecc.org>.

Severson, Todd. "Cardiopulmonary Resuscitation." Medline Plus. April 2003 [cited April 2003]. <http://www.nlm.nih.gov/medlineplus>.

L. Lee Culvert

Cardiopulmonary resuscitation

Definition

Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for an infant, child, or adolescent who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest).

Purpose

CPR is performed to restore and maintain breathing and circulation and to provide oxygen and blood flow to the heart, brain, and other vital organs. CPR can be performed by trained laypeople or healthcare professionals on infants, children, adolescents, and adults. CPR should be performed if an infant, child, or adolescent is unconscious and not breathing. Respiratory and cardiac arrest can be caused by allergic reactions, an ineffective heartbeat, asphyxiation, breathing passages that are blocked, choking , drowning, drug reactions or overdoses, electric shock, exposure to cold, severe shock, or trauma. In newborns, the most common cause of cardiopulmonary arrest is respiratory failure caused by sudden infant death syndrome (SIDS), airway obstruction (usually from inhalation of a foreign body), sepsis, neurologic disease, or drowning. Cardiac arrest in children over one year of age is most commonly caused by shock and/or respiratory failure resulting from an accident or injury.

Description

CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of cardiopulmonary arrest and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advanced cardiac life support measures. When performed by a layperson, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.

CPR must be performed within four to six minutes after cessation of breathing to prevent brain damage or death. CPR consists of rescue breathing, which delivers oxygen to the victim's lungs, and external chest compressions, which help circulate blood through the heart to vital organs.

CPR technique differs for infants, children, and adolescents. The American Heart Association and the American Red Cross, the two organizations that provide CPR training and guidelines, distinguish infants, children, and adolescents for the purposes of CPR as follows:

• "Infant" includes neonates (those in the first 28 days of life) and extends to the age of one year.
• "Child" includes toddlers aged one year to children aged eight years.
• "Adult" includes children aged eight years and older.

Because infants and children under the age of eight have smaller upper and lower airways and faster heart rates than adults, CPR techniques are different for them than for older children and adults. Children and adolescents aged eight years and older have reached a body size that can be handled using adult CPR techniques and are thus classified as adults for delivery of CPR and life support. CPR is always begun after assessing the victim and contacting EMS.

Performing CPR on an infant

For an infant, the rescuer opens the airway using a gentle head tilt/chin lift or jaw thrust, places their mouth over the infant's mouth and nose then delivers gentle breaths so that the infant's chest rises with each breath. Chest compressions are delivered by placing two fingers of one hand over the lower half of the infant's sternum slightly below the nipple line and pressing down about one half inch to one inch. Compressions are delivered at a rate of 100 times per minute, giving five chest compressions followed by one rescue breath in successive cycles.

Performing CPR on a child aged one to eight

For a child aged one to eight years, the compression rate is the same—five compressions and one rescue breath. Rescue breaths are delivered using a mouth-to-mouth seal, instead of mouth-to-mouth-and-nose. Chest compressions are delivered by placing the heel of one hand over the lower half of the sternum and depressing about one to one and one half inches per compression.

Performing CPR on a child aged eight and older

For a child aged eight years and older, and for larger children under age eight, two hands are used for compressions, with the heel of one hand on the lower half of the sternum and the heel of the other hand on top of that hand. The chest is compressed about one and one half to two inches per compression. Rescue breaths are delivered with a mouth-to-mouth seal. The compression rate is 80 to 100 per minute delivered in cycles of 15 compressions followed by two rescue breaths.

Preparation

Before administering CPR to an infant or child, laypeople should participate in hands-on training. More than 5 million Americans annually receive training in CPR through American Heart Association and American Red Cross courses. In addition to courses taught by instructors, the American Heart Association also has an interactive video called Learning System, which is available at more than 500 healthcare institutions. Both organizations teach CPR the same way, but they use different terms. CPR training should be retaken every two to three years to maintain skill level.

Precautions

CPR should not be performed based on the overview contained in this article. To prevent disease transmission during CPR, face masks and face shields are available to prevent direct contact during rescue breathing.

Aftercare

Emergency medical care is always necessary after CPR. Once a person's breathing and heartbeat have been is coming and talk positively until professionals arrive restored, the rescuer should make the person comfortable and stay there until emergency medical personnel arrive. The rescuer can continue to reassure the person that help and take over.

Risks

CPR can cause injury to a person's ribs, liver, lungs, and heart. However, these risks must be accepted if CPR is necessary to save the person's life.

Normal results

In many cases, successful CPR results in restoration of consciousness and life. Barring other injuries, a revived person usually returns to normal functions within a few hours of being revived.

Abnormal results include injuries incurred during CPR and lack of success with CPR. Possible sites for injuries include a person's ribs, liver, lungs, and heart. Partially successful CPR may result in brain damage. Unsuccessful CPR results in death.

Parental concerns

Because most cardiopulmonary arrest in infants and children occurs in or around the home and results from SIDS, trauma, drowning, choking, or poisoning , all parents and child caregivers should consider becoming trained in CPR. Training is available at local schools and community centers.

KEY TERMS

Cardiac arrest —Temporary or permanent cessation of the heartbeat.

Cardiopulmonary —Relating to the heart and lungs.

Defibrillation —A procedure to stop the type of irregular heart beat called ventricular fibrillation, usually by using electric shock.

Resuscitation —Bringing a person back to life or consciousness after he or she was apparently dead.

Ventricular fibrillation —An arrhythmia characterized by a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal.

Resources

BOOKS

Knoop, Kevin J., and Lawrence B. Stack. Atlas of Emergency Medicine, 2nd ed. New York: McGraw Hill, 2001.

Larmon, Baxter, et al. Basic Life Support Skills. Toronto, ON: Prentice Hall PTR, 2004.

PERIODICALS

Babbs, C. F., and V. Nadkarni. "Optimizing chest compression to rescue ventilation ratios during one-rescuer CPR by professionals and lay persons: children are not just little adults." Resuscitation 61, no. 2 (May 2004): 173–81

Kern, K. B., H. R. Halperin, and J. Field. "New guidelines for cardiopulmonary resuscitation and emergency cardiac care: changes in the management of cardiac arrest." Journal of the American Medical Association 285 (2001): 1267–69.

ORGANIZATIONS

American College of Emergency Physicians. PO Box 619911, Dallas, TX 75261–9911. Web site: <www.acep.org>.

American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago, IL 60611. Web site: <www.acoep.org>.

American Heart Association, National Center. 7272 Greenville Avenue, Dallas, TX 75231. Web site: <www.americanheart.org>.

WEB SITES

"Cardiopulmonary Resuscitation." American Heart Association, 2004. Available online at <www.americanheart.org/presenter.jhtml?identifier=4479> (accessed October 29, 2004).

"CPR and Emergency Cardiovascular Care." American Heart Association, 2004. Available online at <www.americanheart.org/presenter.jhtml?identifier=3011764> (accessed October 29, 2004).

"Infant First Aid for Choking and CPR: An Illustrated Guide." BabyCenter, 2004. Available online at <www.babycenter.com/general/9298.html> (accessed October 29, 2004).

Jennifer E. Sisk, MA

cardiopulmonary resuscitation (CPR), emergency procedure used to treat victims of cardiac and respiratory arrest. CPR can be done in a hospital with drugs and special equipment or as a first-aid technique. In either case it is done with great urgency to avoid the brain damage or death that result from four to six minutes without oxygen.

The first-aid procedure combines external heart massage (to keep the blood flowing through the body) with artificial respiration (to keep air flowing in and out of the lungs). The victim is placed face up and prepared for artificial respiration . The person administering CPR places his or her hands (one on top of the other, with fingers interlocked) heel down on the victim's breastbone, leans forward, and makes 30 quick, rhythmical compressions (at a rate of about two per second) of about 2 in. (5 cm). This is followed by two breaths, administered using the mouth-to-mouth method of artificial respiration. CPR for infants and children differs in the ratio of compressions to breaths, and the compression of the chest is only 1 to 1.5 in. (2.5 to 3.8 cm). Ideally the procedure is done by two people, one to give mouth-to-mouth artificial respiration and one to apply external heart massage, and special training is recommended. External heart massage alone may be given if a person is unwilling or unable to provide artificial respiration; studies have shown that heart massage alone can be as effective as both techniques combined.

Cardiopulmonary resuscitation in the hospital is an aggressive technique employing drugs and defibrillation equipment, which administers an electrical shock to the heart in an attempt to restore the heartbeat. There is some controversy surrounding its use in patients whose prognosis is poor.

cardiopulmonary resuscitation (CPR) n. an emergency procedure for life support, consisting of artificial respiration and manual external cardiac massage. It is used in cases of cardiac arrest or apparent sudden death resulting from electric shock, drowning, respiratory arrest, or other causes, to establish effective circulation and ventilation in order to prevent irreversible brain damage.