Cardiopulmonary Resuscitation Health Article

Definition

Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for an infant, child, or adolescent who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest).

Purpose

CPR is performed to restore and maintain breathing and circulation and to provide oxygen and blood flow to the heart, brain, and other vital organs. CPR can be performed by trained laypeople or healthcare professionals on infants, children, adolescents, and adults. CPR should be performed if an infant, child, or adolescent is unconscious and not breathing. Respiratory and cardiac arrest can be caused by allergic reactions, an ineffective heartbeat, asphyxiation, breathing passages that are blocked, choking, drowning, drug reactions or overdoses, electric shock, exposure to cold, severe shock, or trauma. In newborns, the most common cause of cardiopulmonary arrest is respiratory failure caused by sudden infant death syndrome (SIDS), airway obstruction (usually from inhalation of a foreign body), sepsis, neurologic disease, or drowning. Cardiac arrest in children over one year of age is most commonly caused by shock and/or respiratory failure resulting from an accident or injury.

Description

CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of cardiopulmonary arrest and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advanced cardiac life support measures. When performed by a layperson, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.

CPR must be performed within four to six minutes after cessation of breathing to prevent brain damage or death. CPR consists of rescue breathing, which delivers oxygen to the victim's lungs, and external chest compressions, which help circulate blood through the heart to vital organs.

CPR technique differs for infants, children, and adolescents. The American Heart Association and the American Red Cross, the two organizations that provide CPR training and guidelines, distinguish infants, children, and adolescents for the purposes of CPR as follows:

• "Infant" includes neonates (those in the first 28 days of life) and extends to the age of one year.
• "Child" includes toddlers aged one year to children aged eight years.
• "Adult" includes children aged eight years and older.

Because infants and children under the age of eight have smaller upper and lower airways and faster heart rates than adults, CPR techniques are different for them than for older children and adults. Children and adolescents aged eight years and older have reached a body size that can be handled using adult CPR techniques and are thus classified as adults for delivery of CPR and life support. CPR is always begun after assessing the victim and contacting EMS.

Performing CPR on an infant

For an infant, the rescuer opens the airway using a gentle head tilt/chin lift or jaw thrust, places their mouth over the infant's mouth and nose then delivers gentle breaths so that the infant's chest rises with each breath. Chest compressions are delivered by placing two fingers of one hand over the lower half of the infant's sternum slightly below the nipple line and pressing down about one half inch to one inch. Compressions are delivered at a rate of 100 times per minute, giving five chest compressions followed by one rescue breath in successive cycles.

Performing CPR on a child aged one to eight

For a child aged one to eight years, the compression rate is the same—five compressions and one rescue breath. Rescue breaths are delivered using a mouth-to-mouth seal, instead of mouth-to-mouth-and-nose. Chest compressions are delivered by placing the heel of one hand over the lower half of the sternum and depressing about one to one and one half inches per compression.

Performing CPR on a child aged eight and older

For a child aged eight years and older, and for larger children under age eight, two hands are used for compressions, with the heel of one hand on the lower half of the sternum and the heel of the other hand on top of that hand. The chest is compressed about one and one half to two inches per compression. Rescue breaths are delivered with a mouth-to-mouth seal. The compression rate is 80 to 100 per minute delivered in cycles of 15 compressions followed by two rescue breaths.