CPR why get certified?

Cardiopulmonary resuscitation, commonly known as CPR, is an emergency procedure 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 who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

According to the International Liaison Committee on Resuscitation guidelines, CPR involves chest compressions at least 5 cm (2 in) 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 and thus the body. The rescuer may also provide breaths by either exhaling into the subject’s mouth or nose or using a device that pushes air into the subject’s lungs. This process of externally providing ventilation is termed artificial 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 and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject’s heart, termed defibrillation, is usually needed in order to restore a viable or “perfusing” heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the patient has a return of spontaneous circulation (ROSC) or is declared dead.

Type of Arrest ROSC Survival Source
Witnessed In-Hospital Cardiac Arrest 52% 19% [19]
Unwitnessed In-Hospital Cardiac Arrest 33% 8% [19]
Out-of-Hospital Cardiac Arrest Overall 59% 10% [20]
Unwitnessed Out-of-Hospital Cardiac Arrest 21% 4% [20]
Witnessed Out-of-Hospital Cardiac Arrest 41% 15% [20]
Witnessed and “Shockable” with Bystander CPR 53% 37% [20]
Bystander Compression-only Resuscitation – 13% [21]
Bystander Conventional CPR – 8% [21]

CPR serves as the foundation of successful cardiopulmonary resuscitation, preserving the body for defibrillation and advanced life support. Even in the case of a “non-shockable” rhythm, such as Pulseless Electrical Activity (PEA) where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.[22]

Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed “shockable” arrest.[23] In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.[24]

Compression-only CPR may be 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 than did compression-only CPR (OR 5.54; 95% confidence interval 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).[25] This is consistent with American Heart Association guidelines for parents.[26]

There is a higher proportion of patients who achieve spontaneous circulation (ROSC), where their heart starts beating on its own again, than ultimately survive to be discharged from hospital (see table above). This may be due to medical staff being ultimately unable to address the cause of the cardiac arrest, to other co-morbidities, or to the patient being gravely ill in more than one way. Ultimately, only 5–10% of patients in cardiac arrest will survive after an attempted resuscitation.

The info in this post is from Wikipedia

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