Perform Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a combination of mouth-to-mouth resuscitation and chest compressions that delivers oxygen and artificial circulation to a person whose heart has stopped. This is referred to as being in cardiac arrest. CPR can be life-saving first aid.

If the heart stops pumping, it is known as a cardiac arrest. Cardiopulmonary resuscitation (CPR) is a combination of mouth-to-mouth resuscitation and chest compressions that delivers oxygen and artificial blood circulation to a person who is in cardiac arrest. It can be life-saving first aid.

A heart attack occurs when the heart is starved of oxygen. A heart attack can 'stun' the heart and interrupt its rhythm and ability to pump. This is because the heart does not receive enough oxygen and cannot pump blood around the body. There is no heartbeat (pulse) because the heart is not working. The medical term for a heart attack is an acute myocardial infarction (AMI).

When the blood stops circulating, the brain is starved of oxygen and the person quickly becomes unconscious and stops breathing. Without treatment the person will die.

A cardiac arrest can be caused by:

• Heart disease - this is the most common cause of cardiac arrest and is the leading cause of death in Victoria
• Drowning
• Suffocation
• Poisonous gases
• Head injury
• Drug overdose
• Electric shock

CPR can be life-saving first aid

CPR can be life-saving first aid and increases the person's chances of survival if started soon after the heart has stopped beating. If no CPR is performed, it only takes three to four minutes for the person to become brain dead due to a lack of oxygen.

By performing CPR, you circulate the blood so it can provide oxygen to the body, and the brain and other organs stay alive while you wait for the ambulance. CPR does not guarantee that the person will survive, but it does give that person a chance when otherwise there would have been none.

The basic steps of CPR

CPR is most successful when administered as quickly as possible. It should only be performed when a person shows no signs of life or when they are:

• Unconscious
• Unresponsive
• Not breathing normally
• Not moving

It is not essential to search for a pulse when a person is found with no signs of life. It can be difficult to find a person's pulse sometimes and time can be wasted searching. If CPR is necessary, it must be started without delay.

The basic steps for performing CPR can be used for adults, children and infants. They are based on guidelines updated in 2010, so they are easier to follow and remember. However, they are only a guide and not a substitute for attending a CPR course.

The basic steps are:

• D - Dangers?
• R - Responsive?
• S - Send for help
• A - Open airway
• B - Normal breathing
• C - Start CPR
• D - Attach defibrillator (AED)

1. Dangers? Check for danger, approach with care and do not put yourself in danger.

2. Responsive? Look for a response. Is the victim conscious? Gently touch and talk to them, as if you are trying to wake them up. If there is no response, get help.

3. Send for help. Dial triple zero (000) - ask for an ambulance.

4. Open airway. Check the airway. Don't move the person. Gently tilt their head back, open their mouth and look inside. If fluid and foreign matter is present, gently roll them onto their side. Tilt their head back, open their mouth and very quickly remove any foreign matter (for example, chewing gum, false teeth, vomit). It is important not to spend much time doing this as performing CPR is the priority. Chest compressions can help to push foreign material back out of the upper airway.

5. Normal breathing? Check breathing - look, listen and feel for signs of breathing. If the person is breathing, roll them onto their side. If they are not breathing, go to step 6. The patient in cardiac arrest may make occasional grunting or snoring attempts to breath and this must not be assumed to be normal breathing. Normal breathing is regular and generally quiet.

6. Start CPR

Cardiac compressions:

• Place the heel of one hand on the lower half of the person's breastbone
• Place the other hand on top of the first hand and interlock your fingers
• Press down firmly and smoothly (compressing to 1/3 of chest depth) 30 times
• Administer 2 breaths as described below in mouth-to-mouth, step 7
• The ratio of 30 chest compressions followed by 2 breaths is the same, whether CPR is being performed alone or with the assistance of a second person
• Aim for a compression rate of 100 per minute

Effective chest compressions will be tiring. It is important to get help from others if possible, to allow changeover for rest and to keep the compressions effective.

7. Mouth-to-mouth. If the person is not breathing normally, make sure they are lying on their back on a firm surface and:

• Open the airway by tilting the head back and lifting their chin.
• Close their nostrils with your finger and thumb
• Put your mouth over the person's mouth and blow into their mouth
• Give 2 full breaths to the person (this is called 'rescue breathing'). Make sure there is no air leak and the chest is rising and falling. If their chest does not rise and fall, check that you're pinching their nostrils tightly and sealing your mouth to theirs. If still no luck, check their airway again for any obstruction
• Continue CPR, repeating the cycle of 30 compressions then 2 breaths until professional help arrives. This can be tiring - ask if anyone else knows CPR and can help you

Establishing compressions is the clear priority. If a rescuer cannot coordinate the breathing or finds it too time-consuming or too unpleasant, effective chest compressions alone will still be of benefit. It is important not to avoid all resuscitation effort because of the mouth-to-mouth component.

8. Attach automated external defibrillator (AED) as soon as one becomes available.

• Only use an adult AED on any person over the age of eight years, who is unresponsive and not breathing normally. For children under the age of eight, ideally, a paediatric AED and pads should be used. Devices differ and instructions should be followed in each instance
• CPR must be continued until the AED is turned on and the pads are attached
• Place pads following the diagram instructions on the pads. Pad-to-skin contact is important for successful defibrillation. Remove any medication pads, excess moisture or excessive chest hair (if this can be done with minimum delay)
• It is important to follow the prompts on the AED. Do not touch the victim during shock delivery