In respiratory arrest, the brain is no longer supplied with sufficient oxygen. After only a short time, the first brain cells die. Two to three minutes later, cardiac arrest occurs. Therefore, rapid action with the help of cardiopulmonary resuscitation is required when respiratory and cardiovascular arrest has been detected.
What is cardiopulmonary resuscitation?
During chest compressions, pressure is applied to the heart. This increases pressure in the chest, and blood is pumped out of the heart and into the circulation. In the unloading phase, the heart fills with blood again. The aim of cardiopulmonary resuscitation is to oxygenate the blood through ventilation and to build up blood pressure through cardiac massage. In this way, vital organs, such as the brain, can be supplied with sufficient oxygen. This creates the basis for the rescue service to restart the heart with the help of medication and by defibrillation. In cardiopulmonary resuscitation, basic measures, which can also be performed by laypersons as part of immediate life-saving measures, are distinguished from advanced measures.
Function, effect, and goals
Cardiopulmonary resuscitation is performed in emergencies in which respiratory or circulatory arrest has occurred. For the latter, sudden cardiac death is the most common cause. This can be caused by cardiac arrhythmias, strokes, heart attacks or external factors such as accidents, suicide attempts, allergic reactions, foreign bodies in the airways, poisoning or electric shocks. Basic cardiopulmonary resuscitation can be performed by laypersons as well as by professional medical personnel. These include recognizing circulatory arrest, calling 911, clearing the airway, and the actual resuscitation measures such as chest compressions and ventilation. The use of an automated external defibrillator is also one of the basic measures of cardiopulmonary resuscitation. Circulatory arrest can be recognized by the fact that the victim is not conscious, is not breathing, has no vital signs, and has no pulse. Other signs include a pale appearance and a blue discoloration of the lips. Before performing CPR, lay the patient flat on his or her back and ensure that the airway is clear. Foreign bodies, vomit or dentures must be removed from the oral cavity. The so-called life-saving handhold (see also: Stable lateral position) ensures that the airway is kept clear. To do this, the patient is grasped by the chin and forehead and the head is carefully bent back by lifting the chin. As soon as it can be assumed that the affected person is not breathing, even if there is no complete certainty about this, cardiopulmonary resuscitation should be started immediately. Performing CPR as a combination of chest compressions and mouth-to-mouth or mouth-to-nose resuscitation can be done by emergency witnesses who are trained and confident in this measure. Adult resuscitation begins with 30 presses to the sternum, followed by two rescue breaths lasting one second each, and then 30 chest compressions again. The rhythm of 30 chest compressions and two breaths applies whether one or two rescuers are present. For cardiopulmonary resuscitation of children, five breaths are started and then resuscitation is also continued at a ratio of 30 : 2. Every one to two minutes, it should be checked whether the cardiopulmonary resuscitation is effective. Cardiopulmonary resuscitation should be performed until the person begins to breathe again on his own or until the arrival of the emergency physician. Circulatory arrest is often accompanied by ventricular fibrillation. Under certain circumstances, this condition can be reversed by electric shocks. Here, the chances of success are greatest in the first minute. More and more frequently, cases with defibrillation devices can be found on walls or pillars in subway stations and in busy public places. These AED devices, AED stands for automated external defibrillation, function fully automatically. Voice instructions lead from one action to the next. Therefore, these devices for cardiopulmonary resuscitation can also be operated by laypersons.
Risks and dangers
Cardiopulmonary resuscitation is not without its dangers. For example, the patient may suffer rib or sternum fractures and liver and spleen injuries. In addition, air or blood can enter the pleural space between the pleura and the lung pleura (pneumothorax or hematothorax). Cardiopulmonary resuscitation can also result in blood entering the pericardium (pericardial tamponade) or vomiting and aspiration. Despite these risks, cardiopulmonary resuscitation should be started as soon as possible in an emergency. It is the only way to provide effective help to the victim. If the patient waits until the ambulance arrives out of fear of the consequences, the ambulance has little chance of doing anything for the patient.
