resuscitation (CPR), as the name suggests, is a technique employed to artificially restore the circulation of blood in a patient who has suffered cardiac arrest or stopped breathing.
CPR acts a bridge to keep the heart functioning when it has stopped or to keep the lungs breathing when the lungs have ceased doing so. This temporary measure allows for spontaneous recovery of the functions of the heart and lungs, or at least until advanced techniques (Advanced Cardiac Life Support) can be instituted.
In patients who have stopped breathing, but whose hearts continue to beat by themselves, CPR involving giving breaths by mouth to mouth or by a bag-valve-mask device serve to maintain oxygenation of the still circulating blood until advanced breathing techniques become available. The aim, therefore, is to support the victim’s heart and lungs until (a) there is spontaneous recovery or (b) advanced medical care is instituted.
For CPR to be life-saving, it must be instituted as quickly as possible as the longer there is a delay in starting CPR, the less likely is the chance of successful resuscitation. The main function of CPR, therefore, is to ensure blood and oxygen continues circulating in a victim using techniques that are easily taught, learnt, and practised.
The importance of early, effective CPR cannot be discounted. Statistics for Jamaica are unavailable, but in the USA there are approximately 350,000 victims or cardiac arrests annually. Of this amount, only 40 per cent reach hospital alive, and only 5-10 per cent survive to discharge from hospital. This is in a country with advanced pre-hospital health-care systems (ambulance services).
In the USA, the major reason such a high proportion of victims reach hospital alive is usually because of early recognition of cardiac arrest and early initiation of CPR by bystanders. Without this bystander intervention these numbers would be much less impressive, since survival from cardiac arrest depends primarily on early CPR and less so on advanced care.
In resource-poor environments such as Jamaica, the statistics for survival rates for out of hospital cardiac arrest can be postulated to be grim. This is made worse by the poor layperson knowledge of CPR.
Imagine having the technical ability to save lives without having attended medical school. Statistically, the life you save will be more than likely a family member, close friend, or co-worker.
To perform CPR only requires our bodies and perhaps a pocket mask. No special equipment is required.
The core skills required to perform CPR are quite basic and can be learnt in a very short time. It requires being able to determine if the patient is unresponsive and calling for help if this is so. The lower half of a person’s sternum (breastbone) is then exposed as they lie on their back. The rescuer then kneels beside the victim, and with the arms extended, one hand is placed on the lower half of the sternum and the other hand placed on top of the other. The chest is then compressed to a depth of 5cm and released. This is repeated 30 times at a rate that is 100 to 120 compressions per minute. After the 30th compression two breaths are given to the patient, then compressions resume for another 30 times. This goes on until the victim recovers, help arrives with advanced medical care, or the rescuer becomes exhausted.
In the event that the rescuer does not wish to give breaths, then chest compression-only CPR is a quite acceptable alternative. This is so as it has been determined that the chest compression phase of CPR is the most important part of CPR. In this scenario chest compressions are performed without breaks.
Although the skills are easily learnt, they must be done properly so as to give the victim the maximum chance of survival. Therefore, there is a need for proper instruction in the learning of CPR.
In Jamaica a number of organisations teach CPR. At the Heart Foundation of Jamaica (HFJ) CPR is taught in different courses focused on the needs of the learner. There is Basic Life Support for persons in the medical and paramedical field. Courses appropriate for non-medical persons include Family and Friends CPR, Heart Saver CPR, and Heart Saver First Aid.
Everyone is encouraged to learn CPR. As said before, the life you save may be someone close and dear to you.
Dr Hugh Wong is the director of Emergency Cardiac Care at the Heart Foundation of Jamaica.