Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation 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.

1. ARDIOPULMONARY RESUSCITATO
Dr. K. Ambareesha PhD
Assistant Professor, Department of Physiology, Gandhi
Medical College & Hospital, Secunderabad, Telangana.

2. Introduction
The supportive treatment given immediately to patients, in whom the
cardiac and the ventilatory activities have stopped, is called
cardiopulmonary resuscitation (CPR).
It requires adequate life-saving procedures which should be carried out
by a well-trained and experienced team.

3. Indications
CPR is indicated in conditions of cardiorespiratory arrest that include:
Primary cardiac arrhythmias, Arrhythmias associated with acute
myocardial infarction, Electrical shock, Poisoning, Trauma, Drowning,
Head injury, Cardiac surgery, Acute pulmonary edema and Chronic lung
disease.
Cardiac arrest or cessation of heart action are cardiac asystole, and
ventricular fibrillation.

4. Diagnosis
Features of cardiac arrest are the absence of heart beats and the absence
of pulsation of large arteries. Pallor, cyanosis, gasping movements
followed by total arrest of respiration and dilated pupils are the signs.
.

5. Objectives
To provide adequate pulmonary ventilation so that partial pressure of
oxygen in the arterial blood is maintained.
To facilitate pumping of the heart so that effective circulation in
maintained.

6. Methods
CPR can be divided into two
broad supportive measures.
1.Basic life support
2.Advanced life support

7. I Basic Life Support: Includes ABC
A- AIRWAYS
B- BREATHING
C- CIRCULATION

8. A- AIRWAYS: The steps are: head tilt-chin lift maneuver
1. Assess the responsiveness of the patient by gently shaking
the subject.
2. Position the patient on a firm, flat surface.
3. Open the mouth and remove vomitus, mucus or debris if
visible.
4. To extend the neck, place the palm of one hand on the
patient’s forehead and apply firm pressure to tilt the head
backward. At the same time, place the palm of the other hand
under the chin to support it (head tilt-chin lift maneuver).
Mechanism of Action: This raises the tongue away from the
spine and opens the airway.

9. A- AIRWAYS: head tilt-chin lift maneuver

10. B-BREATHING: a. Mouth-to-mouth respiration
• Clear the airway.
• Extend the neck.
• Close the nostrils (of the patient) by pinching with the
thumb and the index finger of the right hand.
• Take a deep breath.
• Apply your mouth close to the patient’s mouth and exhale
forcefully into the subject’s Mouth.
• Look for chest expansion and abdominal distension.
• Repeat and maintain the breathing at a rate of 10-15 per
minute.

11. B-BREATHING: a. Mouth-to-mouth respiration

12. b. Manual manipulation of the thorax
(Holger-Nielson method or back pressure-arm lift method)
• Lay down the patient in prone position.
• Abduct the arms at the shoulder and flex the
elbows.
• Turn the head to one side resting on the hands.
• Kneel down with one knee near the patient’s
head.
• Hold the patient’s arm and straighten yourself to
raise the subject’s arm until resistance is felt.

13. b. Manual manipulation of the thorax
(Holger-Nielson method or back pressure-arm lift method)

14. b. Manual manipulation of the thorax
(Holger-Nielson method or back pressure-arm lift method)
During this maneuver, the thorax of the patient expands and the
intrathoracic pressure drops and inspiration takes place.
• Then gently drop the patient’s arm
• Place your hands with fingers spread apart on the back of
the subject in the maxillary space, and slightly compress to
produce expiration.
• Repeat the whole cycle 10-12 times per minute.
• Palpate the carotid pulse. Palpation for at least 10 seconds is
recommended

15. C- CIRCULATION - External cardiac massage
1. If the carotid pulse is not felt, perform external cardiac
massage.
2. If the patient is in bed, place a hard board under the
patient.
3. The hands are then positioned about 3cm above the
xiphoid process and to the left with the shoulders of
the rescuer vertically above the chest of the subject.
4. With the heel of the hand and the fingers off the chest,
the sternum is compressed 4-5cm thrusting straight
down towards the spine.

16. C- CIRCULATION - External cardiac
massage
5. The recommended
compression rate is 80-
100 per minute. The
rescuer responsible for
airway management
should assess the
adequacy of compression
by periodically palpating
for the carotid pulse.
The compression
ventilation ratio is 5:1
6. If pulse returns,
ventilation should be
continued as required.

17. II ADVANCED LIFE SUPPORT:
Advanced life support comprises primary and
adjunctive therapies.
Primary therapies for advanced life support
include:
1.Defibrillation
2.Airway management and oxygen therapy

18. 1.Defibrillation:
1. This is one of the most important modalities of treatment of CPR.
2. It should be started as early as possible. The time between the onset
of the arrest to the successful defibrillation is the major determinant of
survival in cardiac arrest due to ventricular fibrillation.
3. A fibrillating heart cannot pump blood; as effective contractions do
not occur.
4. Defibrillation converts fibrillation into flutter or normal rhythm so that
effective ventricular contractions occur and heart pumps blood.
5. Adrenaline and sodium bicarbonate are administered intravenously.

19. 1.Defibrillation:

20. 2.Airway management and oxygen therapy
Hundred per cent oxygen should be
administered and endotracheal intubation
should be carried out by a qualified
individual as soon as possible.
But, the basic life support should not be
delayed or interrupted for more than 30
seconds for intubation.

21. 2. Adjunctive Therapies:
1. Self-induced cough
When the arrest is detected before
loss of consciousness, self induced
vigorous coughing can produce
minimum blood flow to the brain
required to maintain consciousness
temporarily until definitive
treatment is initiated.

22. 2. Precordial thump
A quickly applied
solitary precordial
thump may convert
ventricular
fibrillation or
asystole to a normal
rhythm.

23. 3.Atropine sulphate
Atropine sulphate (0.5mg) is
injected intravenously every 5
minutes for the treatment of
bradycardia. It may also help in
the treatment of cardiac
asystole.

24. 4.Sodium bicarbonate
It is given as 1mEq/kg
intravenously every 10
minutes for the treatment of
cardiac arrest due to
hyperkalemia or acidosis.

25. 5.Pacemakers
It helps in patients with
problems of abnormal
impulse formation. Packing is
carried out early during
resuscitation in conditions of
refractory Brady arrhythmias
or persistent asystole.