3.3 Resuscitation and CPR

CPR is given to a casualty when they are not breathing, not responding, and not moving. CPR is the technique of chest compression (pushing down on the lower half of the casualty’s breastbone) combined with rescue breathing/mouth to mouth (inflation of the lungs).

The purpose of giving CPR is to temporarily maintain circulation sufficiently to preserve brain function through a reduced oxygen supply until specialised treatment is available. As brain cells begin to die within 3 minutes of being deprived of oxygen, it is important chest compression and rescue breathing is commenced as soon as possible.

Give 30 compression’s (1/3 of chest depth)
After 30 chest compression’s, tilt head and lift chin.
Give 2 breaths.
Return your hands (fingers for infants) immediately to the correct position on the sternum.
Give a further 30 compressions.
Continue compressions and breaths in a ratio of 30:2 at approximately 5 cycles in 2 minutes until medical assistance arrives.

ANZCOR guideline 5 – Breathing
ANZCOR guideline 8 – Cardiopulmonary Resuscitation

Differences between adults, children and infants related to CPR.

Basic understanding of anatomy and physiology is essential for effective CPR, particularly concerning the differences between adults, children, and infants. Here’s a breakdown:

Anatomy:

Adults: Adults generally have larger bodies and organs compared to children and infants. The chest cavity is larger and more robust.
Children: Children have smaller chests and less developed musculature compared to adults. Their airways are proportionally narrower.
Infants: Infants have even smaller bodies and airways compared to children and adults. Their chests are much more compliant, meaning they are easier to compress during CPR.

Physiology:

Adults: Adults have fully developed cardiovascular and respiratory systems.
Children: Children have a higher metabolic rate and oxygen demand compared to adults. Their cardiovascular systems are still developing.
Infants: Infants have rapidly developing bodies and high metabolic rates. Their airways are more susceptible to obstruction due to their smaller size. CPR for infants involves special considerations due to their unique anatomy and physiology.

Differences in CPR Techniques:

Compression Depth: The depth of chest compressions varies between age groups. For adults, compressions should be at least 5-6cm deep, for children about 3-4cm, and for infants about 3cm.
Compression Rate: adults, children and infants benefit from a similar compression rate of around 100-120 compressions per minute.
Airway Management: Airway management techniques vary depending on the size of the patient. For adults a head tilt-chin lift or jaw thrust manoeuvre may be used to open the airway. For children, open the airway to a slightly past-neutral position using the head-tilt/chin-lift technique and for infants, the head remains in a neutral position due to their large heads and small necks.
Breath Delivery: Adults, children, and infants require ventilation during CPR to provide oxygen to the lungs. The ventilation technique involves tilting the head back to open the airway in adults and children, pinching the nose shut, and giving a breath that causes the chest to rise visibly. Maintain a ratio of 30 compressions to 2 ventilations for both adults and children.
AED: When using an AED on a child, it’s important to use paediatric pads or select the child setting to ensure the appropriate energy levels are administered.

Understanding these differences in anatomy, physiology, and CPR techniques for adults, children, and infants is crucial for providing effective life-saving interventions during cardiac emergencies. Proper training and regular practice are essential for healthcare professionals and laypersons alike.

Video resources on cardiopulmonary resuscitation (CPR):

How to Perform Emergency CPR on an adult – Australian Resuscitation Council https://www.youtube.com/watch?v=IVIxQk8OPkg&t=129s
How to Perform Emergency CPR on a Child – Royal Life Saving Training Video https://www.youtube.com/watch?v=qRNNCkVgRQY
How to Perform Emergency CPR on an Infant – Royal Life Saving Training Video https://www.youtube.com/watch?v=NSzsMRzS1C4

Rescue breathing and compressions

Cardiopulmonary resuscitation and rescue breathing are skills used when a person has fallen victim to sudden cardiac or respiratory arrest.

Rescue breathing is used when an adult, child or infant has a pulse but is not breathing effectively, and is a skill performed for a victim who is not breathing at all, or whose breaths are too slow or irregular to be effective. In rescue breathing, breaths are delivered to the victim by pinching the nose shut and breathing into the victim’s mouth. This is done to deliver oxygen to the victim to help their brain and vital organs survive.

A casualty should not be routinely rolled onto their side to assess airway and breathing.

However, there is an exception.

In an event where there is airway obstruction – roll the casualty onto their side and use the finger sweep method to clear any foreign material, the most common cause of airway obstruction is the tongue.

Once you have cleared any foreign material from the airway, a head tilt should be applied to open the airways. This can be achieved by placing one hand at the top of the head (hairline) and the other on the chin (pistol grip), and gently tilting the head back. Wherever possible, a barrier should be used to avoid direct contact between you and the casualty. The following techniques can be applied to ensure effective rescue breathing techniques on a casualty.

Mouth to Mouth

Open the casualty’s mouth and cover it with your mouth. Seal the nose with your cheek, or with a nose pinch.

Mouth to Mask

Use a resuscitation mask to provide a barrier. Ensure correct hand tolt is maintained and apply adequate pressure on the mask to maintain a complete seal. Rescue breathing to a casualty

Leave or place casualty onto their back.
Open airway.

Adult/child (over 1 year)

Place your hand on the casualty’s forehead, tilt the head back and pinch the soft part of the nose closed with the index finger and thumb, or seal nose with your cheek.
Open the casualty’s mouth and maintain chin lift – place thumb over the chin below the lip, supporting the tip of the jaw with the knuckle of the middle finger.
Place your index finger along the jawline.

Infant (under 1 year)

Tilt the head back very slightly and lift chin to bring tongue away from the back of throat avoiding pressure under chin.
Take a breath and place your lips over the infant’s mouth, ensuring a good seal. If it is a small child or infant, place you lips over the mouth and nose and blow steadily for about one second.
Watch for ‘the infant’s chest to rise.
Maintain head tilt and chin lift.
Turn your mouth away from the infant’s mouth, watch for the chest to fall, listen, and feel for signs of air being expelled.
Take another breath and repeat the sequence.

Age

Backward head tilt

Strength

Number of breaths

Adult 8+ years

Full

Full breaths

Child 1-8 years

Slight

Gentle breaths

Adult 8+ years

Infant 0-1 year

Neutral

Puffs (mouth/nose)

Adult 8+ years

Complications of rescue breathing

If the chest does not rise, check:
- Tilt head and jaw support.
- Mouth and nose seal.
- Any obstruction of the airway.
- The adequate volume of inflation.

If casualty begins to vomit or regurgitate
- Turn the casualty on their side.
- Clear the mouth using a finger sweep.

Check for breathing, if no breathing present, continue CPR.

If there is air in the stomach:
- It may be caused by a partially blocked airway or over inflation.
- Check the head tilt, jaw support and reduce the volume and force of inflation.

Vomiting is an active process indicative of recovery.
Regurgitation is a passive process involving the outflow of stomach contents

Chest compressions

To start compressions:

Kneel beside the casualty, one knee level with the head and the other with the casualty’s chest.
Locate lower half of the sternum (breastbone) in the centre of the chest.
Compressions should always be 1/3 of the depth of the chest of the casualty. Adult (1 year and older)
Place heel of hand on the lower half of sternum (breastbone) and place heel of the other hand on top of first
Interlock fingers of both hands and raise fingers to ensure that pressure is applied over casualty’s ribs, upper abdomen, or bottom part of the sternum.

Child

Chest compression can be performed with the ‘heel’ of one hand or the two-handed technique.

Infant (under 1)

Position yourself vertically above the casualty (infant’s) chest.
Chest compression for an infant can be performed with the two-thumb technique or two-finger technique. Press down on the sternum (breastbone) to depress about one-third of the chest and then release the pressure (compressions and release should take equal amounts of time).
Repeat to complete 30 compressions at a rate of approximately 100-120 per minute.

During CPR, combining chest compressions with rescue breathing, you would expect to achieve 5 sets of 30 compression’s and 2 breaths in about 2 minutes. Some of the complications of compression’s include rib fractures and other injuries are common but acceptable consequences of CPR given the alternative of death. Access the ANZCOR guideline 6 – Compressions to learn more about the guideline used by first aiders and health professionals.

Two operators during resuscitation

Chest compressions during CPR are strenuous, tiring, and difficult to maintain over an extended period. The Australian Resuscitation Council adopts research which suggests that rescuer fatigue during CPR is a likely contributor to ineffective CPR during extended resuscitation efforts. Due to this, if another operator or bystander is available and willing it is recommended that they relieve the first rescuer from performing CPR. Whilst the first rescuer completes two rescue breaths the second rescuer positions themselves with their hands on the casualty’s chest to commence compressions once the second breath is delivered. This improves the quality of chest compressions and gives the casualty the best chance for survival.

Resuscitation in pregnancy

When resuscitating a casualty believed to be pregnant, complications may occur resulting from pressure on the stomach, diaphragm, and lungs from the baby. To provide an optimal situation for resuscitation, padding should be placed under the right buttock of the casualty to create a ‘left lateral tilt’, ensuring reduced pressure on blood vessels and therefore the unrestricted flow of blood back to the heart.

There are special considerations when performing CPR on a pregnant woman. There is an increased risk of aspiration of stomach contents into the lungs and the pressure from the uterus causes pressure on the major abdominal veins when a pregnant woman is lying flat on her back. This impairs venous blood flow back to the heart and is termed ‘aortocaval compression’.

Sufficient padding needs be placed under the right buttock to provide an obvious pelvic tilt to the left. This position helps reduce pressure on the major abdominal organs and allows better blood supply to the heart.

Maintaining respectful behaviour

As a First Aider, it’s essential to maintain professionalism and respectfulness consistently. This entails treating others as you would want to be treated, by:

Securing consent and introducing yourself courteously.
Ensuring dignity and respect in your interactions.
Demonstrating compassion and empathy.
Employing a calm and reassuring tone of voice.
Safeguarding their privacy and confidentiality.
Establishing a connection with them.

Respectful conduct also encompasses cultural appropriateness. A culturally aware individual can communicate sensitively and effectively with people from diverse backgrounds, encompassing various languages, cultures, religions, genders, ethnicities, disabilities, ages, and sexual orientations. Cultural awareness entails considerations such as:

Adapting communication methods appropriately.
Being mindful of body language cues.
Maintaining appropriate levels of eye contact.
Considering preferences regarding the gender of the caregiver, among other factors.

First aiders who exhibit respectful and culturally aware behaviour foster trust, leading to enhanced outcomes by establishing positive rapport with their casualties.

Cessation of CPR

A person administering CPR should stop under certain conditions, which include:

Professional Help Arrives: CPR can be stopped if trained medical personnel arrive at the scene and take over.
Defibrillator (AED) Ready: If an AED becomes available, CPR should pause while the AED pads are being applied, and during the analysis and shock delivery if advised by the device.
Signs of Life: CPR should be stopped if the person shows obvious signs of life, such as breathing, movement, or a pulse.
Rescuer Exhaustion: If the rescuer becomes too fatigued to continue performing effective CPR, they may need to switch with another trained individual if available or wait for emergency medical services to take over.
Scene Becomes Unsafe: If the scene becomes unsafe for the rescuer (e.g., risk of fire, structural collapse, hazardous materials), they should cease CPR and move to a safe location.

It’s important to note that the decision to stop CPR should be made carefully, and if in doubt, it’s generally safer to continue CPR until professional help arrives. Additionally, CPR guidelines may vary slightly depending on the specific protocols and training of the rescuer.

Summary

In this section, you learnt how to respond in an emergency situation.

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