Cardiopulmonary resuscitation




"CPR" redirects here. For other uses, see CPR (disambiguation).

























Cardiopulmonary resuscitation

CPR training-04.jpg
CPR being performed on a medical-training mannequin

Specialty Cardiology
ICD-9 99.60
MeSH D016887
OPS-301 code 8-771
MedlinePlus 000010
[edit on Wikidata]

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. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.[1]


CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute.[2] The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose (mouth-to-mouth resuscitation) or using a device that pushes air into the subject's lungs (mechanical ventilation). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.[3] In children, however, only doing compressions may result in worse outcomes, because in children the problem normally arises from a respiratory, rather than cardiac problem. [4] Chest compression to breathing ratios is set at 30 to 2 in adults.


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. Early shock when appropriate is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.[5]




File:How to save lives with CPR.webmPlay media

Video overview




Contents






  • 1 Medical uses


    • 1.1 Effectiveness




  • 2 Consequences


  • 3 Methods


    • 3.1 Compressions with rescue breaths


    • 3.2 Compression only


    • 3.3 Prone CPR


    • 3.4 Pregnancy


    • 3.5 Family presence


    • 3.6 Other




  • 4 Pathophysiology


  • 5 Additional devices


    • 5.1 Timing devices


    • 5.2 Manual assist devices


    • 5.3 Automatic devices


    • 5.4 Mobile apps




  • 6 Prevalence


    • 6.1 Chance of receiving CPR


    • 6.2 Chance of receiving CPR in time




  • 7 Society and culture


    • 7.1 Portrayed effectiveness


    • 7.2 Training and stage CPR


    • 7.3 Self-CPR hoax


    • 7.4 Learning from film


    • 7.5 Hands-only CPR portrayal




  • 8 History


  • 9 Other animals


  • 10 Research


  • 11 See also


  • 12 References


  • 13 External links





Medical uses




Chest compressions at 100 per minute on a dummy.


CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest.[6]:S643 If a person still has a pulse but is not breathing (respiratory arrest) artificial ventilations may be more appropriate, but, due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse.[7] In those with cardiac arrest due to trauma, CPR is considered futile but still recommended.[8] Correcting the underlying cause such as a tension pneumothorax or pericardial tamponade may help.[8]



Effectiveness

























































Type of Arrest
ROSC
 Survival
 Source
Witnessed in-hospital cardiac arrest
 52%
 19%
 [9]
Unwitnessed in-hospital cardiac arrest
 33%
 8%
 [9]
Out-of-hospital cardiac arrest overall
 59%
 10%
 [10]
Unwitnessed out-of-hospital cardiac arrest
 21%
 4%
 [10]
Witnessed out-of-hospital cardiac arrest
 41%
 15%
 [10]
Witnessed and "shockable" with bystander CPR
 53%
 37%
 [10]
Bystander compression-only resuscitation
 -
 13%
 [11]
Bystander conventional CPR
 -
 8%
 [11]

CPR preserves 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.[12]


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.[13] In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.[14]


In adults compression-only CPR by bystanders appears to be better than chest compressions with rescue breathing.[15] 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). For arrests with a cardiac cause in this cohort, there was no difference between the two techniques (OR 1.20).[16] This is consistent with American Heart Association guidelines for parents.[17]


When done by trained responders, 30 compressions interrupted by two breaths appears to have a slightly better result than continuous chest compressions with breaths being delivered while compressions are ongoing.[15]


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). However, the post-discharge quality of life for those resuscitations that are successful is often lower when compared with control groups and to pre-cardiac arrest conditions.[18][19] 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.[20]



Consequences


Main article: Do not resuscitate § Basis for choice

Performing CPR is advised as a last resort intervention, for when a person is not breathing and therefore would certainly die without it.


Survival rates: In US hospitals in 2016, 26% of patients who received CPR survived to hospital discharge.[21]
In 2017 in the US, outside hospitals, 16% of people whose cardiac arrest was witnessed survived to hospital discharge.[22]


Even among very sick patients, national US data show 10% survival among cancer patients, 12% among dialysis patients, 14% over age 80, 15% among blacks, 17% for patients who lived in nursing homes, 19% for patients with heart failure, 20% among diabetes and pacemaker patients,[23]
13% survival in the poorest neighborhoods, 12% survival over age 90, 15% survival among ages 85–89, and 17% survival among ages 80–84.[24]


A study of King County WA patients who had CPR outside hospitals in 1999-2003, where 34% survived to hospital discharge overall, found that 18% of patients with 4 or more major medical conditions survived, 24% of those with 3 major conditions, and 33% of those with 2 major medical conditions survived.[25]


Since 2003, widespread cooling of patients after CPR[26]
and other improvements have raised survival and reduced mental disabilities.


Organ donation is usually made possible by CPR, even if CPR does not save the patient. If there is a Return of spontaneous circulation (ROSC), all organs can be considered for donation. If the patient does not achieve ROSC, and CPR continues until an operating room is available, the kidneys and liver can still be considered for donation.[27]
1,000 organs per year in the US are transplanted from patients who had CPR.[28]
Donations can be taken from 40% of patients who have ROSC and later become brain dead.[29]
Up to 8 organs can be taken from each donor,[30]
and an average of 3 organs are taken from each patient who donates organs.[28]


Mental abilities are usually about the same before and after CPR. After in-hospital CPR, 0.6% of US patients (2% of survivors) developed severe mental problems, so that they needed help with daily activities. Another 0.3% of all patients (1% of survivors) developed moderate problems, but could still be independent.[31]
For CPR outside hospitals a Copenhagen study found 3% of patients (21% of survivors) developed moderate mental problems but could still be independent, and 2% (11% of survivors) developed severe mental problems, so they needed help. Two patients out of 2,504 went into comas (0.1%), and the study did not track how long the comas lasted.[32]
Most people in comas start to get better in 2–3 weeks.[33]
Mental abilities can continue to improve in the six months after discharge,[34] and for long term problems, brains can form new paths to replace damaged areas.[35][36]


Injuries from CPR vary. Broken ribs are present in 3%[37]
of those who survive to hospital discharge, and 15% of those who die in the hospital, for an average rate of 9% (2009-12 data)[37]
to 8% (1997–99).[38]
Overall, injuries are caused in 13% (2009-12 data) of patients, including broken sternum or ribs (9%), lung injuries (3%), and internal bleeding (3%).[37]
The internal injuries counted here can include heart contusion,[39]hemopericardium,[40][41][42]upper airway complications, damage to the abdominal viscera − lacerations of the liver and spleen, fat emboli, pulmonary complications − pneumothorax, hemothorax, lung contusions.[43][44]


Bones heal in 1–2 months.[45][46]
Training and experience levels have improved since the study in the 1990s which found 55% broken ribs among CPR patients who died before discharge, and the study in the 1960s which found 97%.[47]


The costal cartilage also breaks in an unknown number of additional cases, which can sound like breaking bones.[48][49]


While these health care associated injuries can require further intervention (assuming the person survives the cardiac arrest), only 0.5% of them are life-threatening in their own right.[44]


The type and frequency of injury can be affected by factors such as sex and age. A 1999 Austrian study of CPR on cadavers, using a machine which alternately compressed the chest then pulled it outward, found a higher rate of sternal fractures in female cadavers (9 of 17) than male (2 of 20), and found the risk of rib fractures rose with age, though they did not say how much.[50]
Children and infants have a low risk of rib fractures during CPR, with an incidence less than 2%, although, when they do occur, they are usually anterior and multiple.[47][51][52]


Where CPR is performed in error by a bystander, on a person not in cardiac arrest, around 2% have injury as a result (although 12% experienced discomfort).[53]


A 2004 overview said, "Chest injury is a price worth paying to achieve optimal efficacy of chest compressions. Cautious or faint-hearted chest compression may save bones in the individual case but not the patient’s life."[47]


Other side effects: The most common side effect is vomiting, which necessitates clearing the mouth so patients do not breathe it in.[54]
It happened in 16 of 35 CPR efforts in a 1989 study in King County, WA, USA.[55]



Methods




CPR technique as demonstrated on a dummy


In 2010, the American Heart Association and International Liaison Committee on Resuscitation updated their CPR guidelines.[6]:S640[56] The importance of high quality CPR (sufficient rate and depth without excessively ventilating) was emphasized.[6]:S640 The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB).[6]:S642 An exception to this recommendation is for those believed to be in a respiratory arrest (airway obstruction, drug overdose, etc.).[6]:S642 The most important aspect of CPR are: few interruptions of chest compressions, a sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much.[57] It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation.[58]



Compressions with rescue breaths





Mouth-to-mouth resuscitation


A universal compression to ventilation ratio of 30:2 is recommended for adults.[59]:8 With children, if at least 2 trained rescuers are present a ratio of 15:2 is preferred.[59]:8 According to AHA 2015 Guidelines In newborns a ratio is 30:2 if One rescuer and 15:2 if 2 rescuers.[6]:S647


If an advanced airway such as an endotracheal tube or laryngeal mask airway is in place, artificial ventilation should occur without pauses in compressions at a rate of 8–10 per minute.[60] The recommended order of interventions is chest compressions, airway, breathing or CAB in most situations,[6]:S642 with a compression rate of at least 100 per minute in all groups.[59]:8 Recommended compression depth in adults and children is at least 5 cm (2 inches) and in infants it is 4 centimetres (1.6 in).[59]:8 As of 2010 the Resuscitation Council (UK) still recommends ABC for children.[61] As it can be difficult to determine the presence or absence of a pulse, the pulse check has been removed for lay providers and should not be performed for more than 10 seconds by healthcare providers.[59]:8 In adults, rescuers should use two hands for the chest compressions, while in children they should use one, and with infants two fingers (index and middle fingers).[62]



Compression only




CPR training: CPR is being administered while a second rescuer prepares for defibrillation.


For adults with cardiac arrest, compression-only (hands-only or cardiocerebral resuscitation) CPR which involves chest compressions without artificial ventilation is recommended as the method of choice for the untrained rescuer or those who are not proficient as it is easier to perform and instructions are easier to give over a phone.[6]:S643[6]:S643[59]:8[63] In adults with out-of-hospital cardiac arrest, compression-only CPR by the lay public has an equal or higher success rate than standard CPR.[63][64] It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR.[65]


Compression-only CPR is not as good for children who are more likely to have cardiac arrest from respiratory causes. Two reviews have found that compression-only CPR had no more success than no CPR whatsoever.[64][6]:S646 Rescue breaths for children and especially for babies should be relatively gentle.[64] Either a ratio of compressions to breaths of 30:2 or 15:2 was found to have better results for children.[66] Both children and adults should receive a hundred chest compressions per minute. Other exceptions besides children include cases of drownings and drug overdose. In both these cases, compressions and rescue breaths are recommended if the bystander is trained and is willing to do so.


As per the American Heart Association, the beat of the Bee Gees song "Stayin' Alive" provides an ideal rhythm in terms of beats per minute to use for hands-only CPR.[67] One can also hum Queen's "Another One Bites The Dust", which is 110 beats-per-minute[68] and contains a memorable repeating drum pattern.[69] For those in cardiac arrest due to non heart related causes and in people less than 20 years of age, standard CPR is superior to compression-only CPR.[70][71]



Prone CPR


Standard CPR is performed with the person in supine position. Prone CPR or reverse CPR is CPR performed on a person lying on their chest, by turning the head to the side and compressing the back. Due to the head being turned, the risk of vomiting and complications caused by aspiration pneumonia may be reduced.[72]


The American Heart Association's current guideline recommends to perform CPR in the supine position, and limits prone CPR to situations where the patient cannot be turned.[73]



Pregnancy


During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return.[8] It is therefore recommended that the uterus be pushed to the woman's left; if this is not effective, either roll the woman 30° or healthcare professionals should consider emergency resuscitative hysterotomy.[8]



Family presence


Evidence generally supports family being present during CPR.[74] This includes in CPR for children.[75]



Other


Interposed abdominal compressions may be beneficial in the hospital environment.[76] There is no evidence of benefit pre-hospital or in children.[76]


Cooling during CPR is being studied as currently results are unclear whether or not it improves outcomes.[77]


Internal cardiac massage is manual squeezing of the exposed heart itself carried out through a surgical incision into the chest cavity, usually when the chest is already open for cardiac surgery.


Active compression-decompression methods using mechanical decompression of the chest have not been shown to improve outcome in cardiac arrest.[78]



Pathophysiology


CPR is used on people in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The physiology of CPR involves generating a pressure gradient between the arterial and venous vascular beds; CPR achieves this via multiple mechanisms [79] The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes.[80][81][82][83][84] Typically if blood flow ceases for one to two hours, then body cells die. Therefore, in general CPR is effective only if performed within seven minutes of the stoppage of blood flow.[85] The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings, prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain stem death, and allows the heart to remain responsive to defibrillation attempts.



Additional devices


While several adjunctive devices are available, none other than defibrillation, as of 2010, have consistently been found to be better than standard CPR for out-of-hospital cardiac arrest.[6]:S644 These devices can be split into three broad groups: timing devices; devices that assist the rescuer in achieving the correct technique, especially depth and speed of compressions; and devices that take over the process completely.



Timing devices


Timing devices can feature a metronome (an item carried by many ambulance crews) in order to assist the rescuer in achieving the correct rate. Some units can also give timing reminders for performing compressions, ventilating and changing operators.[86]



Manual assist devices


Mechanical chest compression devices have not been found to be better than standard manual compressions.[87] Their use is reasonable in situations were manual compressions are not safe to perform such as a moving vehicle.[87]


Audible and visual prompting may improve the quality of CPR and prevent the decrease of compression rate and depth that naturally occurs with fatigue,[88][89][90][91][92][93] and to address this potential improvement, a number of devices have been developed to help improve CPR technique.


These items can be devices to be placed on top of the chest, with the rescuer's hands going over the device, and a display or audio feedback giving information on depth, force or rate,[94] or in a wearable format such as a glove.[95] Several published evaluations show that these devices can improve the performance of chest compressions.[96][97]


As well as its use during actual CPR on a cardiac arrest victim, which relies on the rescuer carrying the device with them, these devices can also be used as part of training programs to improve basic skills in performing correct chest compressions.[98]



Automatic devices


Mechanical CPR has not seen as much use as mechanical ventilation. Devices on the market include LUCAS-3,[99] developed at the University Hospital of Lund,[100] and return of spontaneous circulation.[101] and AutoPulse. Both use straps around the chest, LUCAS uses a gas driven piston and motor driven constricting band.


There are several advantages to automated devices: they allow rescuers to focus on performing other interventions; they do not fatigue and begin to perform less effective compressions, as humans do; they are able to perform effective compressions in limited-space environments such as air ambulances, where manual compressions are difficult, and they allow ambulance workers to be strapped in safely rather than standing over a patient in a speeding vehicle.[102] However the disadvantages are cost to purchase, time to train emergency personnel to use them, interruption to CPR to implement, potential for incorrect application and the need for multiple device sizes.


Several studies have shown little or no improvement in survival rates[103][104][105] but acknowledge the need for more study.[106]



Mobile apps


To support training and incident management, mobile apps have been published on the largest app markets. An evaluation of 61 available apps has revealed that a large number do not follow international guidelines for basic life support and many apps are not designed in a user-friendly way.[107] As a result, the Red Cross updated and endorsed its emergency preparedness application, which uses pictures, text and videos to assist the user.


The UK Resuscitation Council, has an app, called Lifesaver, which shows how to perform CPR.[108]



Prevalence



Chance of receiving CPR


Various studies suggest that in out-of-home cardiac arrest, bystanders in the US attempt CPR in between 14%[109] and 45%[110] of the time, with a median of 32%.[111] Globally, rates of bystander CPR reported to be as low as 1% and as high as 44%.[112] However, the effectiveness of this CPR is variable, and the studies suggest only around half of bystander CPR is performed correctly.[113][114] One study found that members of the public having received CPR training in the past lack the skills and confidence needed to save lives. The report's authors suggested that better training is needed to improve the willingness to respond to cardiac arrest.[111] Factors that influence bystander CPR in out-of-hospital cardiac arrest include:



  • Affordable training.

  • Target CPR training to family members of potential cardiac arrest

  • CPR classes should be simplified and shortened.

  • Offer reassurance and education about CPR.

  • Provide clearer information about legal implications for specific regions.

  • Focus on reducing the stigma and fears around providing bystander CPR.[115]


There is a relation between age and the chance of CPR being commenced. Younger people are far more likely to have CPR attempted on them before the arrival of emergency medical services.[109][116] Bystanders more commonly administer CPR when in public than when at the person's home, although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts.[110] People with no connection to the person are more likely to perform CPR than are a member of their family.[117]


There is also a clear relation between cause of arrest and the likelihood of a bystander initiating CPR. Lay persons are most likely to give CPR to younger people in cardiac arrest in a public place when it has a medical cause; those in arrest from trauma, exsanguination or intoxication are less likely to receive CPR.[117]


It is believed that there is a higher chance that CPR will be performed if the bystander is told to perform only the chest compression element of the resuscitation.[65][118]



Chance of receiving CPR in time


CPR is likely to be effective only if commenced within 6 minutes after the blood flow stops[119] because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4–6 minutes in an oxygen deprived environment and, therefore, cannot survive the reintroduction of oxygen in a traditional resuscitation. Research using cardioplegic blood infusion resulted in a 79.4% survival rate with cardiac arrest intervals of 72±43 minutes, traditional methods achieve a 15% survival rate in this scenario, by comparison. New research is currently needed to determine what role CPR, electroshock, and new advanced gradual resuscitation techniques will have with this new knowledge.[120]


A notable exception is cardiac arrest that occurs in conjunction with exposure to very cold temperatures. Hypothermia seems to protect by slowing down metabolic and physiologic processes, greatly decreasing the tissues' need for oxygen.[121] There are cases where CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia.[122]



Society and culture



Portrayed effectiveness


CPR is often severely misrepresented in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation.


A 1996 study published in the New England Journal of Medicine showed that CPR success rates in television shows was 75% for immediate circulation, and 67% survival to discharge.[123] This gives the general public an unrealistic expectation of a successful outcome.[123] When educated on the actual survival rates, the proportion of patients over 60 years of age desiring CPR should they suffer a cardiac arrest drops from 41% to 22%.[124]



Training and stage CPR


It is dangerous to perform CPR on a person who is breathing normally. These chest compressions create significant local blunt trauma, risking bruising or fracture of the sternum or ribs.[125] If a patient is not breathing, these risks still exist but are dwarfed by the immediate threat to life. For this reason, training is always done with a manikin, such as the well-known Resusci Anne model.


The portrayal of CPR technique on television and film often is purposely incorrect. Actors simulating the performance of CPR may bend their elbows while appearing to compress, to prevent force from reaching the chest of the actor portraying the victim.



Self-CPR hoax


A form of "self-CPR" termed "cough CPR" was the subject of a hoax chain e-mail entitled "How to Survive a Heart Attack When Alone," which wrongly cited "ViaHealth Rochester General Hospital" as the source of the technique. Rochester General Hospital has denied any connection with the technique.[126][127]


"Cough CPR" in the sense of resuscitating oneself is impossible because a prominent symptom of cardiac arrest is unconsciousness,[128] which makes coughing impossible. In cases of myocardial infarction (heart attack), during which the person may well remain conscious but which is not by itself a form of arrest, attempting "cough CPR" will increase the workload on the heart and will likely prove harmful.


The American Heart Association (AHA) and other resuscitation bodies[129] do not endorse "cough CPR", which it terms a misnomer as it is not a form of resuscitation. The AHA does recognize a limited legitimate use of the coughing technique: "This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital, particularly during cardiac catheterization. In such cases the patient's ECG is monitored continuously, and a physician is present."[130] When coughing is used on trained and monitored patients in hospitals, it has been shown to be effective only for 90 seconds.[129]



Learning from film


In at least one case, it has been alleged that CPR learned from a film was used to save a person's life. In April 2011, it was claimed that nine-year-old Tristin Saghin saved his sister's life by administering CPR on her after she fell into a swimming pool, using only the knowledge of CPR that he had gleaned from a motion picture, Black Hawk Down.[131]



Hands-only CPR portrayal


Less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location have CPR performed on them. Most bystanders are worried that they might do something wrong.[132] On October 28, 2009 the American Heart Association and the Ad Council launched a Hands-Only CPR public service announcement and website as a means to address this issue.[133] In July 2011, new content was added to the website including a digital app that helps a user learn how to perform Hands-Only CPR.[134]



History


Main article: History of cardiopulmonary resuscitation

In the 19th century, Doctor H. R. Silvester described a method (The Silvester Method) of artificial ventilation in which the patient is laid on their back, and their arms are raised above their head to aid inhalation and then pressed against their chest to aid exhalation.[135] The procedure is repeated sixteen times per minute. This type of artificial ventilation is occasionally seen in films made in the early 20th century.


A second technique, called the Holger Nielsen technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, was a form of artificial ventilation where the person was laid face down, with their head to the side, resting on the palms of both hands. Upward pressure applied at the patient’s elbows raised the upper body while pressure on their back forced air into the lungs, in essence the Silvester Method with the patient flipped over. This form is seen well into the 1950s (it is used in an episode of Lassie during the mid-1950s), and was often used, sometimes for comedic effect, in theatrical cartoons of the time (see Tom and Jerry's "The Cat and the Mermouse" [1949]). This method would continue to be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in 1979. The technique was later banned from first-aid manuals in the UK.


Similar techniques were described in early 20th century ju-jutsu and judo books, as being used as far back as the early 17th century. A New York Times correspondent reported those techniques being used successfully in Japan in 1910. In ju-jutsu (and later on, judo) those techniques were called Kappo or Kutasu.[136][137][138][139]


However, it was not until the middle of the 20th century that the wider medical community started to recognize and promote artificial ventilation in the form of mouth-to-mouth resuscitation combined with chest compressions as a key part of resuscitation following cardiac arrest. The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude, Guy Knickerbocker, and Peter Safar. Jude and Knickerbocker, along with William Kouwenhoven and Joseph S. Redding had recently discovered the method of external chest compressions, whereas Safar had worked with Redding and James Elam to prove the effectiveness of mouth-to-mouth resuscitation. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Pearson. Soon afterward, the technique was used to save the life of a child.[140] Their combined findings were presented at the annual Maryland Medical Society meeting on September 16, 1960 in Ocean City, and gained widespread acceptance over the following decade, helped by the video and speaking tour they undertook. Peter Safar wrote the book ABC of Resuscitation in 1957. In the U.S., it was first promoted as a technique for the public to learn in the 1970s.[141]


Mouth-to-mouth resuscitation was combined with chest compressions based on the assumption that active ventilation is necessary to keep circulating blood oxygenated, and the combination was accepted without comparing its effectiveness with chest compressions alone. However, research over the past decade has shown that assumption to be in error, resulting in the AHA's acknowledgment of the effectiveness of chest compressions alone (see Compression only in this article).[142] On June 4, 2011 Jeremiah Kliesing "coded" at the Michael DeBakey VA hospital in Houston, TX. Jeremiah underwent 5 1/2 hours of CPR by 20 doctors and nurses before being stabilized and transferred to St. Luke's Episcopal Hospital, where he's the second patient to receive the SYNCARDIA artificial heart. One of the doctors who performed CPR was Dr. Donald Lazarus.[143]


CPR has continued to advance, with recent developments including an emphasis on constant, rapid heart stimulation, and a de-emphasis on the respiration aspect. Studies have shown that people who had rapid, constant heart-only chest compression are 22% more likely to survive than those receiving conventional CPR that included breathing. What's more, because people tend to be reluctant to do mouth-to-mouth, chest-only CPR nearly doubles the chances of survival overall, by increasing the odds of receiving CPR in the first place.[144]



Other animals


It is feasible to perform CPR on animals, including cats and dogs. The principles and practices are similar to CPR for humans, except that resuscitation is usually done through the animal's nose, not the mouth. CPR should only be performed on unconscious animals to avoid the risk of being bitten; a conscious animal would not require chest compressions. Animals, depending on species, may have a lower bone density than humans and so CPR can cause bones to become weakened after it is performed.[145]



Research


Cerebral performance category (CPC scores) are used as a research tool to describe "good" and "poor" outcomes. Level 1 is conscious and alert with normal function. Level 2 is only slight disability. Level 3 is moderate disability. Level 4 is severe disability. Level 5 is comatose or persistent vegetative state. Level 6 is brain dead or death from other causes.[146]



See also



  • Impedance threshold device

  • Slow code


  • Lazarus syndrome, spontaneous autoresuscitation where attempts at artificial resuscitation have failed



References





  1. ^ Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, et al. (November 2015). "Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S519–25. doi:10.1161/CIR.0000000000000265. PMID 26472999..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output .citation q{quotes:"""""""'""'"}.mw-parser-output .citation .cs1-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/6/65/Lock-green.svg/9px-Lock-green.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .citation .cs1-lock-limited a,.mw-parser-output .citation .cs1-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Lock-gray-alt-2.svg/9px-Lock-gray-alt-2.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .citation .cs1-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Lock-red-alt-2.svg/9px-Lock-red-alt-2.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/12px-Wikisource-logo.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{font-size:100%}.mw-parser-output .cs1-maint{display:none;color:#33aa33;margin-left:0.3em}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}


  2. ^ Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. (November 2015). "Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S315–67. doi:10.1161/cir.0000000000000252. PMID 26472989.


  3. ^ Leong BS (August 2011). "Bystander CPR and survival". Singapore Medical Journal. 52 (8): 573–5. PMID 21879214.


  4. ^ Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, Meaney PA, Niles DE, Samson RA, Schexnayder SM (November 2015). "Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S519–25. doi:10.1161/CIR.0000000000000265. PMID 26472999.


  5. ^ Werman HA, Karren K, Mistovich J (2014). "Shock and Resuscitation". In Werman A. Howard, Mistovich J, Karren K. Prehospital Emergency Care (10th ed.). Pearson Education, Inc. pp. 410, 426. ISBN 978-0-13-336913-7.


  6. ^ abcdefghijk Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, et al. (November 2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.


  7. ^ (), "European Resuscitation Council (2005). "Part 2: Adult basic life support". Guidelines for resuscitation. Archived from the original on 2010-05-30. Retrieved 2012-03-28. The following is a summary of the evidence-based recommendations for the performance of basic life support: Rescuers begin CPR if the victim is unconscious, not moving, and not breathing (ignoring occasional gasps).[...]


  8. ^ abcd Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, et al. (November 2010). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S829–61. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228.


  9. ^ ab Brady WJ, Gurka KK, Mehring B, Peberdy MA, O'Connor RE (July 2011). "In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge". Resuscitation. 82 (7): 845–52. doi:10.1016/j.resuscitation.2011.02.028. PMID 21454008.


  10. ^ abcd "2012 National Utstein Report". CARES Cardiac Arrest Registry to Enhance Survival. Archived from the original on 2013-10-19. Retrieved 2013-10-18.


  11. ^ ab Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, et al. (October 2010). "Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest". JAMA. 304 (13): 1447–54. doi:10.1001/jama.2010.1392. PMID 20924010.


  12. ^ Sarver Heart Center. "Frequently Asked Questions about Chest-Compression-Only CPR". Archived from the original on 2013-10-19. Retrieved 2013-10-18.


  13. ^ Public Health - Seattle; King County. "Heart attack survival rate continues to climb in King County". Archived from the original on 2013-10-22. Retrieved 2013-10-18.


  14. ^ Resuscitation Academy. "About". Archived from the original on 2013-10-19. Retrieved 2013-10-18.


  15. ^ ab Zhan L, Yang LJ, Huang Y, He Q, Liu GJ (March 2017). "Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest". The Cochrane Database of Systematic Reviews. 3: CD010134. doi:10.1002/14651858.CD010134.pub2. PMID 28349529.


  16. ^ Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM, Berg RA, Hiraide A (April 2010). "Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study". Lancet. 375 (9723): 1347–54. doi:10.1016/S0140-6736(10)60064-5. PMID 20202679.


  17. ^ "Checklist for Parents of Children with Arrhythmias". American Heart Association. 2009-01-16. Archived from the original on 2010-02-12. Retrieved 2010-04-11.


  18. ^ de Vos R, de Haes HC, Koster RW, de Haan RJ (February 1999). "Quality of survival after cardiopulmonary resuscitation". Archives of Internal Medicine. 159 (3): 249–54. doi:10.1001/archinte.159.3.249. PMID 9989536.


  19. ^ Lim C, Verfaellie M, Schnyer D, Lafleche G, Alexander MP (July 2014). "Recovery, long-term cognitive outcome and quality of life following out-of-hospital cardiac arrest". Journal of Rehabilitation Medicine. 46 (7): 691–7. doi:10.2340/16501977-1816. PMC 4111096. PMID 24849762.


  20. ^ WebMD Medical News. "Real CPR isn't everything it seems to be". Retrieved 2007-06-13.


  21. ^ Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. (March 2018). "Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association". Circulation. 137 (12): e67–e492. doi:10.1161/CIR.0000000000000558. PMID 29386200.


  22. ^ "National Reports by Year « MyCares". mycares.net. Retrieved 2018-12-12.


  23. ^ Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS, et al. (Investigators for the American Heart Association's Get With the Guidelines-Resuscitation) (January 2014). "Hospital variation in survival after in-hospital cardiac arrest". Journal of the American Heart Association. 3 (1): e000400. doi:10.1161/JAHA.113.000400. PMC 3959682. PMID 24487717.


  24. ^ Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD (July 2009). "Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly". The New England Journal of Medicine. 361 (1): 22–31. doi:10.1056/NEJMoa0810245. PMC 2917337. PMID 19571280.


  25. ^ Carew HT, Zhang W, Rea TD (June 2007). "Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest". Heart. 93 (6): 728–31. doi:10.1136/hrt.2006.103895. PMC 1955210. PMID 17309904.


  26. ^ Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloeck WG, Billi J, et al. (International Liaison Committee on Resuscitation) (July 2003). "Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation". Circulation. 108 (1): 118–21. doi:10.1161/01.CIR.0000079019.02601.90. PMID 12847056.


  27. ^ "Part 8: Post-Cardiac Arrest Care – ECC Guidelines". Resuscitation Science, Section 11. 2015.


  28. ^ ab Orioles A, Morrison WE, Rossano JW, Shore PM, Hasz RD, Martiner AC, et al. (December 2013). "An under-recognized benefit of cardiopulmonary resuscitation: organ transplantation". Critical Care Medicine. 41 (12): 2794–9. doi:10.1097/CCM.0b013e31829a7202. PMID 23949474.


  29. ^ Sandroni C, D'Arrigo S, Callaway CW, Cariou A, Dragancea I, Taccone FS, Antonelli M (November 2016). "The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis". Intensive Care Medicine. 42 (11): 1661–1671. doi:10.1007/s00134-016-4549-3. PMC 5069310. PMID 27699457.


  30. ^ Hawryluk, Markian (2017-11-03). "How can one organ donor save eight lives?". Retrieved 2018-12-23.


  31. ^ Girotra, S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. (2012). "Supplementary Appendix to "Trends in survival after inhospital cardiac arrest"" (PDF). NEJM. 367 (20): 1912–1920. doi:10.1056/NEJMoa1109148. PMC 3517894. PMID 23150959.


  32. ^ Søholm, Helle, John Bro-Jeppesen, Freddy K. Lippert, Lars Køber, Michael Wanscher, Jesper Kjaergaard, Christian Hassager (March 2014). "Resuscitation". Resuscitation. 85 (3): 369–375. doi:10.1016/j.resuscitation.2013.10.033. PMID 24269866.


  33. ^ Katz DI, Polyak M, Coughlan D, Nichols M, Roche A (2009-01-01). Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-4 year follow-up. Progress in Brain Research. 177. pp. 73–88. doi:10.1016/S0079-6123(09)17707-5. ISBN 9780444534323. PMID 19818896.


  34. ^ Tong JT, Eyngorn I, Mlynash M, Albers GW, Hirsch KG (December 2016). "Functional Neurologic Outcomes Change Over the First 6 Months After Cardiac Arrest". Critical Care Medicine. 44 (12): e1202–e1207. doi:10.1097/CCM.0000000000001963. PMC 5115936. PMID 27495816.


  35. ^ "New Insight Into How The Brain Regenerates After Stroke". Science Daily. 2006-12-23.


  36. ^ Phillips, Helen (2006-07-03). "'Rewired brain' revives patient after 19 years". New Scientist.


  37. ^ abc Boland LL, Satterlee PA, Hokanson JS, Strauss CE, Yost D (January–March 2015). "Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest". Prehospital Emergency Care. 19 (1): 23–30. doi:10.3109/10903127.2014.936636. PMID 25076024.


  38. ^ Oschatz E, Wunderbaldinger P, Sterz F, Holzer M, Kofler J, Slatin H, et al. (July 2001). "Cardiopulmonary resuscitation performed by bystanders does not increase adverse effects as assessed by chest radiography". Anesthesia and Analgesia. 93 (1): 128–33. PMID 11429353.


  39. ^ "Myocardial contusion injury: redefining the diagnostic algorithm", M K Bansal, S Maraj, D Chewaproug, A Amanullah. Emerg Med J 2005;22:465−469 doi:10.1136/emj.2004.015339 ; Bansal MK, Maraj S, Chewaproug D, Amanullah A (July 2005). "Myocardial contusion injury: redefining the diagnostic algorithm". Emergency Medicine Journal. 22 (7): 465–9. doi:10.1136/emj.2004.015339. PMC 1726836. PMID 15983078. Archived from the original on 2015-07-25. Retrieved 2012-10-16.


  40. ^ Aurel Mogoseanu. "Implicatii medico-legale in resuscitarea cardio-respiratorie" [Medical-legal implications in cardio-respiratory resuscitation] (PDF) (in Romanian). Archived from the original (PDF) on 2013-05-22. Retrieved 2012-10-16.


  41. ^ AHA, The Textbook of Emergency Cardiovascular Care and CPR, page 541


  42. ^ Forensic Pathology: Principles And Practice, David Dolinak, Evan W. Matshes, Emma O. Lew, page 322


  43. ^ AHA, Part 3: Adult Basic Life Support, "Part 3: Adult Basic Life Support". Circulation. 102 (suppl_1): I–22. 2000-08-22. doi:10.1161/circ.102.suppl_1.I-22 (inactive 2019-02-12). Archived from the original on 2012-10-20. Retrieved 2012-10-16.; Circulation. 2000; 102: I-22-I-59 doi:10.1161/01.CIR.102.suppl_1.I-22


  44. ^ ab Krischer JP, Fine EG, Davis JH, Nagel EL (August 1987). "Complications of cardiac resuscitation". Chest. 92 (2): 287–91. doi:10.1378/chest.92.2.287. PMID 3608599.


  45. ^ "Broken or bruised ribs". nhs.uk. 2017-10-17. Retrieved 2018-12-23.


  46. ^ "Fractured Ribs Still Painful After 2 Months? You May Need Surgery". healthcare.utah.edu. Retrieved 2018-12-23.


  47. ^ abc Hoke, Robert, and Douglas Chamberlain (2004). "Skeletal chest injuries secondary to cardiopulmonary resuscitation" (PDF). Resuscitation. 63 (3): 327–338. doi:10.1016/j.resuscitation.2004.05.019. PMID 15582769.
    [permanent dead link]


  48. ^ "CPR Review - Keeping It Real". HEARTSAVER (BLS Training Site) CPR/AED & First Aid (Bellevue, NE). Retrieved 2018-12-12.


  49. ^ "CPR Breaking Bones". EMTLIFE. Retrieved 2018-12-12.


  50. ^ Baubin M, Rabl W, Pfeiffer KP, Benzer A, Gilly H (December 1999). "Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers". Resuscitation. 43 (1): 9–15. doi:10.1016/S0300-9572(99)00110-0. PMID 10636312.


  51. ^ Maguire S, Mann M, John N, Ellaway B, Sibert JR, Kemp AM (July 2006). "Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review". Child Abuse & Neglect. 30 (7): 739–51. doi:10.1016/j.chiabu.2005.12.007. PMID 16857258.


  52. ^ Dolinak D (June 2007). "Rib fractures in infants due to cardiopulmonary resuscitation efforts". The American Journal of Forensic Medicine and Pathology. 28 (2): 107–10. doi:10.1097/01.paf.0000257392.36528.b8. PMID 17525558. Archived from the original on 2012-10-30.


  53. ^ White L, Rogers J, Bloomingdale M, Fahrenbruch C, Culley L, Subido C, et al. (January 2010). "Dispatcher-assisted cardiopulmonary resuscitation: risks for patients not in cardiac arrest". Circulation. 121 (1): 91–7. doi:10.1161/CIRCULATIONAHA.109.872366. PMID 20026780. Archived from the original on 2014-07-12.


  54. ^ "CPR - you CAN do it!". depts.washington.edu. Retrieved 2018-12-12.


  55. ^ McCormack AP, Damon SK, Eisenberg MS (March 1989). "Disagreeable physical characteristics affecting bystander CPR". Annals of Emergency Medicine. 18 (3): 283–5. doi:10.1016/S0196-0644(89)80415-9. PMID 2646999.


  56. ^ Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, et al. (October 2010). "Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation. 122 (16 Suppl 2): S250–75. doi:10.1161/CIRCULATIONAHA.110.970897. PMID 20956249.


  57. ^ Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. (July 2013). "Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association". Circulation. 128 (4): 417–35. doi:10.1161/CIR.0b013e31829d8654. PMID 23801105.


  58. ^ Huang Y, He Q, Yang LJ, Liu GJ, Jones A (September 2014). "Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest". The Cochrane Database of Systematic Reviews. 9 (9): CD009803. doi:10.1002/14651858.CD009803.pub2. PMID 25212112.


  59. ^ abcdef "Highlights of the 2010 American Heart Association Guidelines for CPR and ECC" (PDF). American Heart Association. Archived (PDF) from the original on 2010-11-21.


  60. ^ Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, et al. (November 2010). "Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S685–705. doi:10.1161/CIRCULATIONAHA.110.970939. PMID 20956221.


  61. ^ "Resuscitation Council UK Paediatric Advanced Life Support Guidelines" (PDF). Archived (PDF) from the original on 2011-05-27. Retrieved 2010-10-24.


  62. ^ Mohun, Janet; et al. First Aid Manual. St John Ambulance, St Andrews Ambulance and British Red Cross.


  63. ^ ab Hüpfl M, Selig HF, Nagele P (November 2010). "Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis". Lancet. 376 (9752): 1552–7. doi:10.1016/S0140-6736(10)61454-7. PMC 2987687. PMID 20951422.


  64. ^ abc "Highlights of the 2015 American Heart Association: Guidelines Update for CPR and ECC" (PDF). Archived from the original (PDF) on 2016-03-13. Acknowledgements include: Mary Fran Hazinski, RN, MSN; Michael Shuster, MD; Michael W. Donnino, MD; et al., 2015. "The 2015 AHA Guidelines Update for CPR and ECC is based on an international evidence evaluation process that involved 250 evidence reviewers from 39 countries."


  65. ^ ab Ewy GA (June 2008). "Cardiocerebral Resuscitation: Could this new model of CPR hold promise for better rates of neurologically intact survival?". EMS Magazine. 37 (6): 41–49. Archived from the original on 2008-08-03. Retrieved 2008-08-02.


  66. ^ Ashoor HM, Lillie E, Zarin W, Pham B, Khan PA, Nincic V, et al. (September 2017). "Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review" (PDF). Resuscitation. 118: 112–125. doi:10.1016/j.resuscitation.2017.05.032. PMID 28583860.


  67. ^ "Save a Life: Hands-Only CPR". Crowdrise.com. Archived from the original on June 20, 2011. Retrieved 2011-06-16.


  68. ^ "Another One Bites The Dust" in songbpm.com


  69. ^ "From Queen, The Best Song For CPR — Except For The Lyrics". Archived from the original on November 2, 2013. Retrieved 2012-05-29.


  70. ^ Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T (January 2011). "Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study". BMJ. 342: c7106. doi:10.1136/bmj.c7106. PMID 21273279.


  71. ^ Koenig KL (March 4, 2011). "Compression-Only CPR Is Less Effective Than Conventional CPR in Some Patients". JW Emerg Med. 2011 (304): 1. Archived from the original on 2011-07-24. Retrieved 2018-12-07.


  72. ^ Wei J, Tung D, Sue SH, Wu SV, Chuang YC, Chang CY (May 2006). "Cardiopulmonary resuscitation in prone position: a simplified method for outpatients". Journal of the Chinese Medical Association. 69 (5): 202–6. doi:10.1016/S1726-4901(09)70219-9. PMID 16835981.


  73. ^ Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF (November 2010). "Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S720–8. doi:10.1161/CIRCULATIONAHA.110.970970. PMC 3741663. PMID 20956223. When the patient cannot be placed in the supine position, it may be reasonable for rescuers to provide CPR with the patient in the prone position, particularly in hospitalized patients with an advanced airway in place (Class IIb, LOE C).


  74. ^ Flanders SA, Strasen JH (December 2014). "Review of evidence about family presence during resuscitation". Critical Care Nursing Clinics of North America. 26 (4): 533–50. doi:10.1016/j.ccell.2014.08.010. PMID 25438895.


  75. ^ McAlvin SS, Carew-Lyons A (November 2014). "Family presence during resuscitation and invasive procedures in pediatric critical care: a systematic review". American Journal of Critical Care. 23 (6): 477–84, quiz 485. doi:10.4037/ajcc2014922. PMID 25362671.


  76. ^ ab Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, et al. (November 2010). "Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S720–8. doi:10.1161/CIRCULATIONAHA.110.970970. PMC 3741663. PMID 20956223.


  77. ^ Dell'anna AM, Scolletta S, Donadello K, Taccone FS (June 2014). "Early neuroprotection after cardiac arrest". Current Opinion in Critical Care. 20 (3): 250–8. doi:10.1097/mcc.0000000000000086. PMID 24717694.


  78. ^ Lafuente-Lafuente C, Melero-Bascones M (September 2013). "Active chest compression-decompression for cardiopulmonary resuscitation". The Cochrane Database of Systematic Reviews (9): CD002751. doi:10.1002/14651858.CD002751.pub3. PMID 24052483.


  79. ^ "ICU Physiology in 1,000 Words: Cardiopulmonary Resuscitation". February 2015. Archived from the original on 2015-03-26. Retrieved 2015-03-20.


  80. ^ Smith N. "Anoxic Brain Damage". Third Age. Archived from the original on 2009-01-29. Retrieved 2018-12-07.


  81. ^ Tuhrim S. "Anoxic Brain Injury". Mount Sinai Medical Centre. Archived from the original on 2012-05-15.


  82. ^ Brass L. Heart Book. Chapter 18:Stroke (PDF). Yale University. Archived (PDF) from the original on 2009-01-31.


  83. ^ Turkowski K. "A pleas for VBAC education". Archived from the original on 2009-04-29.


  84. ^ "Hyperbaric Oxygen Therapy". Family Health News. Archived from the original on 2009-04-29. Retrieved 2018-12-07.


  85. ^ Newsweek 2007-05-07


  86. ^ "Silicon Chip Article". Archived from the original on 2007-09-02.


  87. ^ ab Wang PL, Brooks SC (August 2018). "Mechanical versus manual chest compressions for cardiac arrest". The Cochrane Database of Systematic Reviews. 8: CD007260. doi:10.1002/14651858.CD007260.pub4. PMID 30125048.


  88. ^ Hightower D, Thomas SH, Stone CK, Dunn K, March JA (September 1995). "Decay in quality of closed-chest compressions over time". Annals of Emergency Medicine. 26 (3): 300–3. doi:10.1016/S0196-0644(95)70076-5. PMID 7661418.


  89. ^ Chiang WC, Chen WJ, Chen SY, Ko PC, Lin CH, Tsai MS, et al. (March 2005). "Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts". Resuscitation. 64 (3): 297–301. doi:10.1016/j.resuscitation.2004.09.010. PMID 15733757.


  90. ^ Berg RA, Sanders AB, Milander M, Tellez D, Liu P, Beyda D (1994). "Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children". Academic Emergency Medicine. 1 (1): 35–40. PMID 7621151.
    [permanent dead link]


  91. ^ Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA (August 1995). "Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance". Academic Emergency Medicine. 2 (8): 708–13. doi:10.1111/j.1553-2712.1995.tb03622.x. PMID 7584749.


  92. ^ Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, O'Hearn N, Hoek TL, Becker LB (April 2007). "CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system". Resuscitation. 73 (1): 54–61. doi:10.1016/j.resuscitation.2006.10.027. PMID 17258853.


  93. ^ Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L, Sørebø H, Steen PA (December 2006). "Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study". Resuscitation. 71 (3): 283–92. doi:10.1016/j.resuscitation.2006.05.011. PMID 17070980.


  94. ^ "CPREzy". Archived from the original on 2007-09-29. Retrieved 2007-08-18.


  95. ^ "CPR Glove Website". Archived from the original on 2009-01-31. Retrieved 2009-01-05.


  96. ^ Perkins GD, Augré C, Rogers H, Allan M, Thickett DR (January 2005). "CPREzy: an evaluation during simulated cardiac arrest on a hospital bed". Resuscitation. 64 (1): 103–8. doi:10.1016/j.resuscitation.2004.08.011. PMID 15629562.


  97. ^ Perkins GD, Augré C, Rogers H, Allan M, Thickett DR (January 2005). "CPREzy: an evaluation during simulated cardiac arrest on a hospital bed". Resuscitation. 64 (1): 103–8. doi:10.1016/s0300-9572(02)00049-7. PMID 15629562.


  98. ^ Public Health Initiative Uses PocketCPR to Help Improve Cardiac Arrest Survival Rates Archived 2009-03-19 at the Wayback Machine, October 20, 2008.


  99. ^ "Product specifications - LUCAS - Chest Compression System".


  100. ^ Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T (December 2002). "Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation". Resuscitation. 55 (3): 285–99. doi:10.1016/S0300-9572(02)00271-X. PMID 12458066.


  101. ^ Rubertsson; et al. (2006). "Increased restoration of spontaneous circulation after cardiac arrest with the LUCAS device compared to manual chest compressions". Resuscitation. 69: 46. doi:10.1016/j.resuscitation.2006.01.011.


  102. ^ Keseg, David P. (29 Aug 2012). "The Merits of Mechanical CPR". Journal of Emergency Medical Services. Archived from the original on 2016-08-20.


  103. ^ Wik L, Olsen JA, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, van Grunsven PM, Travis DT, Whitehead A, Herken UR, Lerner EB (June 2014). "Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial". Resuscitation. 85 (6): 741–8. doi:10.1016/j.resuscitation.2014.03.005. PMID 24642406.


  104. ^ Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther AM, Woollard M, Carson A, Smyth M, Whitfield R, Williams A, Pocock H, Black JJ, Wright J, Han K, Gates S (March 2015). "Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial". Lancet. 385 (9972): 947–55. doi:10.1016/s0140-6736(14)61886-9. PMID 25467566.


  105. ^ Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN, et al. (June 2006). "Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial" (PDF). JAMA. 295 (22): 2620–8. doi:10.1001/jama.295.22.2620. PMID 16772625. Archived from the original (PDF) on 2007-09-29. Retrieved 2018-12-18.


  106. ^ Navarro, Kenny (28 March 2016). "Prove It: Mechanical chest compression devices vs. manual compressions". EMS1.com. Archived from the original on 16 July 2016. Retrieved 25 July 2016.


  107. ^ Kalz M, Lenssen N, Felzen M, Rossaint R, Tabuenca B, Specht M, Skorning M (March 2014). "Smartphone apps for cardiopulmonary resuscitation training and real incident support: a mixed-methods evaluation study". Journal of Medical Internet Research. 16 (3): e89. doi:10.2196/jmir.2951. PMC 3978555. PMID 24647361.


  108. ^ "Lifesaver". Archived from the original on 15 September 2015. Retrieved 19 October 2015.


  109. ^ ab Swor RA, Jackson RE, Cynar M, Sadler E, Basse E, Boji B, Rivera-Rivera EJ, Maher A, Grubb W, Jacobson R (June 1995). "Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest". Annals of Emergency Medicine. 25 (6): 780–4. doi:10.1016/S0196-0644(95)70207-5. PMID 7755200.


  110. ^ ab Wik L, Steen PA, Bircher NG (December 1994). "Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest". Resuscitation. 28 (3): 195–203. doi:10.1016/0300-9572(94)90064-7. PMID 7740189.


  111. ^ ab "Members of the public lack skills, confidence necessary to save lives with CPR, research shows". November 12, 2011. Archived from the original on January 12, 2012. Retrieved November 12, 2011.


  112. ^ Comilla Sasson et al. on behalf of the American Heart Association Council on Quality of Care and Outcomes Research et al. Circulation 2013; 127: 1342-1350, "Archived copy". Archived from the original on 2015-02-23. Retrieved 2015-01-03.CS1 maint: Archived copy as title (link)


  113. ^ Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, Delooz H (August 1993). "Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group". Resuscitation. 26 (1): 47–52. doi:10.1016/0300-9572(93)90162-J. PMID 8210731.


  114. ^ Gallagher EJ, Lombardi G, Gennis P (December 1995). "Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest". JAMA. 274 (24): 1922–5. doi:10.1001/jama.274.24.1922. PMID 8568985.


  115. ^ Carragher R, Johnson J, Harder M (2017). "Factors that influence bystander CPR: A narrative review". International Journal of Current Research. 9 (6): 52100–52103. hdl:10613/5277.


  116. ^ Jackson RE, Swor RA (June 1997). "Who gets bystander cardiopulmonary resuscitation in a witnessed arrest?". Academic Emergency Medicine. 4 (6): 540–4. doi:10.1111/j.1553-2712.1997.tb03574.x. PMID 9189184.


  117. ^ ab Bossaert L, Van Hoeyweghen R (1989). "Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest. The Cerebral Resuscitation Study Group". Resuscitation. 17 Suppl (Suppl S55–69): S55–69, discussion S199–206. doi:10.1016/0300-9572(89)90091-9. PMID 2551021.


  118. ^ Tilton B (2007). "CPR". In Buck Tilton. First Aid and Extended Care, 5e. Morris Book Publishing, LLC. & Falcon Guides. p. 20. ISBN 978-0-7627-4357-5.


  119. ^ Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE (March 1985). "Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation". The American Journal of Emergency Medicine. 3 (2): 114–9. doi:10.1016/0735-6757(85)90032-4. PMID 3970766.


  120. ^ Athanasuleas CL, Buckberg GD, Allen BS, Beyersdorf F, Kirsh MM (July 2006). "Sudden cardiac death: directing the scope of resuscitation towards the heart and brain" (PDF). Resuscitation. 70 (1): 44–51. doi:10.1016/j.resuscitation.2005.11.017. PMID 16759784. Archived from the original on 2007-07-16.


  121. ^ Kondratiev TV, Flemming K, Myhre ES, Sovershaev MA, Tveita T (July 2006). "Is oxygen supply a limiting factor for survival during rewarming from profound hypothermia?". American Journal of Physiology. Heart and Circulatory Physiology. 291 (1): H441–50. doi:10.1152/ajpheart.01229.2005. PMID 16461371. [Heart has enough oxygen to survive hypothermia Lay summary] Check |laysummary= value (help) – EurekAlert! (18 July 2006).


  122. ^ Eich C, Bräuer A, Kettler D (October 2005). "Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation" (PDF). Resuscitation. 67 (1): 145–8. doi:10.1016/j.resuscitation.2005.05.002. PMID 16129537. Archived (PDF) from the original on 2008-01-25.


  123. ^ ab Diem SJ, Lantos JD, Tulsky JA (June 1996). "Cardiopulmonary resuscitation on television. Miracles and misinformation". The New England Journal of Medicine. 334 (24): 1578–82. doi:10.1056/NEJM199606133342406. PMID 8628340.


  124. ^ Jones GK, Brewer KL, Garrison HG (January 2000). "Public expectations of survival following cardiopulmonary resuscitation". Academic Emergency Medicine. 7 (1): 48–53. doi:10.1111/j.1553-2712.2000.tb01891.x. PMID 10894242.


  125. ^ "Chicago CPR Classes". Archived from the original on 2013-12-14.


  126. ^ "ViaHealth Rochester General Hospital statement on 'Cough CPR' email". Archived from the original on 2005-11-20. Retrieved 2007-06-13.


  127. ^ "Snopes Urban Legends Reference - Cough CPR". Retrieved 2007-06-13.


  128. ^ "Cough CPR" (PDF). Newsletter. 27 (3): 2. 2003. Archived (PDF) from the original on 2007-06-28.


  129. ^ ab "Cough CPR" (PDF). Newsletter. 29 (3): 2. 2005. Archived (PDF) from the original on 2007-06-28.


  130. ^ "Cough CPR". American Heart Association. Archived from the original on 2007-04-04. Retrieved 2007-06-13.


  131. ^ "Arizona 9-year-old boy, Tristin Saghin, Saved Sister With CPR, Congratulated by Movie Producer Jerry Bruckheimer". ABC News. 2011-04-22. Archived from the original on 2011-05-11. Retrieved 2011-04-24.


  132. ^ American Heart Association Archived 2012-02-17 at the Wayback Machine


  133. ^ American Heart Association, Ad Council launch Hands-Only CPR campaign Archived 2011-08-08 at the Wayback Machine


  134. ^ Americans can learn Hands-Only CPR with a new digital application Archived 2011-07-17 at the Wayback Machine


  135. ^ "Silvester's method". University College London. Archived from the original on 2007-10-14. Retrieved 2007-06-12.


  136. ^ Special Correspondence THE NEW YORK TIMES. (1910-09-04). "REVIVED BY JIU-JITSU. - A Strange Story from Japan - Apparently Dead Man Resuscitated. - View Article - NYTimes.com" (PDF). New York Times. Archived (PDF) from the original on 2013-05-23. Retrieved 2013-05-28.


  137. ^ Warshaw AL, Swanson RS (November 1988). "Pancreatic cancer in 1988. Possibilities and probabilities". Annals of Surgery. 208 (5): 541–53. doi:10.1136/bmj.2.3893.318-a. PMC 2461172. PMID 2461172.
    "Corrections". BMJ. 2 (5653): 394. 1969. doi:10.1136/bmj.2.5653.394.


  138. ^ Kim Taylor. "JCS: Japanese Fighting: Self-Defence By Sleight Of Body". Ejmas.com. Archived from the original on 2013-06-19. Retrieved 2013-05-28.


  139. ^ Neil Ohlenkamp (2005-01-01). "Judo Chokes (shimewaza) - choking techniques". Judoinfo.com. Archived from the original on 2013-07-02. Retrieved 2013-05-28.


  140. ^ "Arrhythmias". Johns Hopkins Medicine. Archived from the original on 2008-07-05. Retrieved 2008-09-06.


  141. ^ See, e.g., "Award of the Heart", TIME magazine, November 28, 1973, retrieved on 05-28-2008 from time.com


  142. ^ Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD (April 2008). "Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest". Circulation. 117 (16): 2162–7. doi:10.1161/CIRCULATIONAHA.107.189380. PMID 18378619.


  143. ^ "Total Artificial Heart Recipient Heads Home for the Holidays with New Donor Heart & Kidney" (Press release). SynCardia Systems. December 15, 2011. Archived from the original on 2013-05-20. Retrieved 2012-07-28.


  144. ^ Steve Sternberg (2010). "American Heart Association revises CPR guidelines". USA Today. An analysis of 3,700 cardiac arrests published Friday in the journal Lancet found that hands-only CPR saved 22% more lives than the conventional method. All told, the switch could save up to 3,000 additional lives a year in the USA and 5,000 to 10,000 in North America and Europe, says lead author Peter Nagele of Washington University in St. Louis. A landmark study published Oct. 6 in The Journal of the American Medical Association found that bystanders who applied hands-only CPR were able to boost survival to 34% from 18% for those who got conventional CPR or none at all. In addition, the percentage of people willing to provide CPR rose from 28% in 2005 to 40% in 2009.


  145. ^ "CPR for Cats & Dogs". University of Washington School of Medicine. Archived from the original on 2008-01-07.


  146. ^ Wheeler DS, Wong HR, Shanley TP, eds. (2009). The central nervous system in pediatric critical illness and injury. New York: Springer. p. 68. ISBN 9781848009936. Archived from the original on 2016-08-10.




External links







  • 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

  • ERC European Resuscitation Council


  • CPR: NHS Choices


  • How to resuscitate a child: NHS Choices

  • 5 Components of High Quality CPR: AED Philippines













-

Popular posts from this blog

Bressuire

Image
Subprefecture and commune in Nouvelle-Aquitaine, France Bressuire Subprefecture and commune Chateau de Bressuire and the Eglise Notre-Dame Coat of arms Location of Bressuire Bressuire Show map of France Bressuire Show map of Nouvelle-Aquitaine Coordinates: 46°50′27″N 0°29′14″W  /  46.8408°N 0.4872°W  / 46.8408; -0.4872 Coordinates: 46°50′27″N 0°29′14″W  /  46.8408°N 0.4872°W  / 46.8408; -0.4872 Country France Region Nouvelle-Aquitaine Department Deux-Sèvres Arrondissement Bressuire Canton Bressuire Government  • Mayor .mw-parser-output .nobold{font-weight:normal} (2014–20) Jean Michel Bernier Area 1 180.59 km 2 (69.73 sq mi) Population (2014) 2 19,300  • Density 110/km 2 (280/sq mi) Time zone UTC+01:00 (CET)  • Summer (DST) UTC+02:00 (CEST) INSEE/Postal code 79049 /79300 Elevation 98–236 m (322–774 ft) (avg. 173 m or 568 ft) 1 French Land Register data, which exclude
Read more

Vorschmack

Image
Vorschmack Ukrainian Jewish-style vorschmack served on rye bread Course Hors d'oeuvre Region or state Eastern Europe Associated national cuisine Ashkenazi Jewish, Finnish, German, Ukrainian, Polish, Russian Main ingredients Ground meat and/or fish Cookbook: Vorschmack   Media: Vorschmack Vorschmack or forshmak (Yiddish: פֿאָרשמאַק ‎, from archaic German Vorschmack , "foretaste" [1] or "appetizer" [2] ) is an originally East European dish made of salty minced fish or meat. Different variants of this dish are especially common in Ashkenazi Jewish and Finnish cuisine. Some varieties are also known in Russian and Polish cuisine. Contents 1 In Jewish cuisine 2 In Russian cuisine 3 In Polish cuisine 4 In Finnish cuisine 5 See also 6 References In Jewish cuisine According to Gil Marks, the German name points to the possible Germanic origin of this dish. [1] William Pokhlyobkin descr
Read more

Quarantine

Image
For other uses, see Quarantine (disambiguation). Signal flag "Lima" called the "Yellow Jack" which when flown in harbor means ship is under quarantine. A simple yellow flag (also called the "Yellow Jack") had historically been used to signal quarantine (it stands for Q among signal flags), but now indicates the opposite, as a signal of a ship free of disease that requests boarding and inspection. A quarantine is used to separate and restrict the movement of people; it is 'a restraint upon the activities or communication of persons or the transport of goods designed to prevent the spread of disease or pests', for a certain period of time. [1] This is often used in connection to disease and illness, such as those who may possibly have been exposed to a communicable disease. [2] The term is often erroneously used to mean medical isolation, which is "to separate ill persons who have a communicable disease from those who are healthy
Read more