Basic resuscitation

Basic resuscitation

1. Maneuvers performed to restore an efficient oxygenation and circulation in an individual in PCR

   • Principles of treatment
     • Appropriate use of ‘Do Not Attempt Resuscitation’ (DNAR) orders
     • Rapid recognition of arrest, with alert of suitably trained personnel
     • Assessment of the circumstances of the collapse
     • Maintenance of cerebral perfusion to avoid permanent neurological damage
     • Adequate oxygenation
     • Restoration of a perfusing cardiac rhythm with defibrillation and drugs
     • Timely cessation of resuscitative attempts.
     • Risk assessment and prevention
     • Maintenance of coronary perfusion to allow subsequent reversal of non-perfusing cardiac rhythms
     • Careful post-resuscitation care to mitigate post-arrest cerebral and cardiac dysfunction
   • Evidence has shown soon after onset of VF, when oxygenation is usually adequate, chest compressions are more important than ventilation

2. How to perform compression?

   • Rhythmic downward pressure with the heel of the hand applied over the middle of the lower half of the sternum
     • At 100-120 per minute
     • To a depth 5-6 cm
   • A rate above 120 per minute leads to poor-quality CPR
   • The rescuer performing compressions should be changed every 2 minutes
   • Ratio of compressions to breaths within one ‘cycle of CPR’
     • 30:2 (30 chest compressions- 2 Rescue breaths)
       • Unless the airway has been secured with an (endo)tracheal tube or supraglottic device
         • Tracheal intubation often causes prolonged interruption of chest compressions and should only be attempted by skilled individuals

3. Ventilation

   • Should include an ‘inspiratory’ phase lasting 1 second with enough volume (about 500-600 ml) to make the chest rise
     • Wherever possible, supplemental oxygen should be used
     • Excessive rate and depth of ventilation
       • Increases intrathoracic pressure
       • Decreases venous return
       • Reduces coronary and cerebral perfusion.

4. When to stop?

   • Decision-making should take into account the patient’s functional state before the arrest, comorbidities, likely cause of the arrest, and responses to interventions during resuscitation
     • Also, low EtCO2 levels during CPR and the absence of cardiac movement on echocardiography can inform decisions to stop.

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