Massage Table Carrying Case
Massage Table Carrying Case
Cardiopulmonary resuscitation ( CPR ) is an emergency procedure for people in cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed both in hospitals and in pre-hospital settings.
CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to ventilate the lungs and pass oxygen in to the blood, called artificial respiration. Some protocols now downplay the importance of the artificial respirations, and focus on the chest compressions only (CCR).
Despite its name, CPR is unlikely to restart the heart; its main purpose is to maintain a flow of oxygenated blood to the brain and the heart, which are both the most essential organs to life and the most vulnerable to damage from lack of oxygen (hypoxia). Effective CPR helps by delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage. Advanced life support, including intravenous drugs and defibrillation (the administration of an electric shock to the heart) is usually needed to restore a viable rhythm. This only works for patients in certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than the 'flat line' asystolic patient, although CPR can help induce a shockable rhythm in an asystolic patient.
CPR is generally continued, usually in the presence of advanced life support (such as from EMS providers), until the patient regains a heart beat (called "return of spontaneous circulation" or "ROSC") or is declared dead.
Indications
The main indication for CPR is cardiac arrest (a condition in which a person's heart has stopped). 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 absolute requirements in transporting oxygen to the tissues. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. If blood flow ceases for one to two hours, the cells of the body die unless they get an adequately gradual blood flow, (provided by cooling and gradual warming, rarely, in nature or by an advanced medical team). Because of that CPR is generally only effective if performed within seven minutes of the stoppage of blood flow. 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 death, and allows the heart to remain responsive to defibrillation attempts.
If the patient still has a pulse, but is not breathing, this is called respiratory arrest and artificial respiration is more appropriate. However, since people often have difficulty detecting a pulse, CPR may be used in both cases, especially when taught as first aid.
Methods
ILCOR
In 2005, CPR guidelines were published by the International Liaison Committee on Resuscitation (ILCOR), agreed at the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The primary goal of these changes was to simplify CPR for lay rescuers and health care providers alike, to maximize the potential for early resuscitation. The important changes for 2005 were:
- A universal compression-ventilation ratio (30:2) recommended for all single rescuers of infant (less than one year old), child (1 year old to puberty), and adult (puberty and above) victims (excluding newborns). The primary difference between the age groups is that with adults the rescuer uses two hands for the chest compressions, while with children it is only one, and with infants only two fingers (index and middle fingers). While this simplification has been introduced, it has not been universally accepted, and especially amongst healthcare professionals, protocols may still vary.
- The removal of the emphasis on lay rescuers assessing for pulse or signs of circulation for an unresponsive adult victim, instead taking the absence of normal breathing as the key indicator for commencing CPR.
- The removal of the protocol in which lay rescuers provide rescue breathing without chest compressions for an adult victim, with all cases such as these being subject to CPR.
Research has shown that lay personnel cannot accurately detect a pulse in about 40% of cases and cannot accurately discern the absence of pulse in about 10%. The pulse check step has been removed from the CPR procedure completely for lay persons and de-emphasized for health care professionals.
Compression only resuscitation / Cardiocerebral resuscitation (CCR)
The traditional International Liaison Committee on Resuscitation approach described above has been challenged in recent years by advocates for compression-only CPR, also known as cardiocerebral resuscitation (CCR) . This technique is simply chest compressions without artificial respiration. The respiration component of CPR has been a topic of major controversy over the past decade. The CCR method has been championed by the University of Arizona's Sarver Heart Center. A study by the university claimed a 300% greater success rate over standard CPR. The exceptions were in the case of drowning or drug overdose.
In March 2007, a Japanese study in the medical journal The Lancet presented strong evidence that compressing the chest, not mouth-to-mouth (MTM) ventilation, is the key to helping someone recover from cardiac arrest. An editorial by Gordon Ewy MD (a proponent of CCR) in the same issue of The Lancet called for an interim revision of the ILCOR Guidelines based on the results of the Japanese study, but the next scheduled revision of the Guidelines was not until 2010. However, on March 30, 2008, the American Heart Association broke away from the ILCOR position and stated that compression-only CPR works as well as, and sometimes better than, traditional CPR.
The method of delivering chest compressions remains the same, as does the rate (100 per minute), but the rescuer delivers only the compression element which, the University of Arizona claims, keeps the bloodflow moving without the interruption caused by MTM respiration. It has also been claimed that the use of compression only delivery increases the chances of lay person delivering CPR.
Rhythmic abdominal compressions
Rhythmic abdominal compression-CPR works by forcing blood from the blood vessels around the abdominal organs, an area known to contain about 25 percent of the body's total blood volume. This blood is then redirected to other sites, including the circulation around the heart. Findings published in the September 2007 issue of the American Journal of Emergency Medicine using pigs found that 60 percent more blood was pumped to the heart using rhythmic abdominal compression-CPR than with standard chest compression-CPR, using the same amount of effort. There was no evidence that rhythmic abdominal compressions damaged the abdominal organs and the risk of rib fracture was avoided. Avoiding mouth-to-mouth breathing and chest compressions eliminates the risk of rib fractures and transfer of infection.
Internal cardiac massage
Internal cardiac massage is the process of cardiac massage carried out through a surgical incision into the chest cavity. This distinguishes the process from conventional, external cardiac massage, which is carried out by compression near the sternum during cardiopulmonary resuscitation.
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.
Rapid coughing has been used in hospitals for brief periods of cardiac arrhythmia on monitored patients. One researcher has recommended that it be taught broadly to the public.
However, “cough CPR” cannot be used outside the hospital because the first symptom of cardiac arrest is unconsciousness in which case coughing is impossible, although myocardial infarction (heart attack) may occur to give rise to the cardiac arrest, so a patient may not be immediately unconscious. Further, the vast majority of people suffering chest pain from a heart attack will not be in cardiac arrest and CPR is not needed. In these cases attempting “cough CPR” will increase the workload on the heart and may be harmful. When coughing is used on trained and monitored patients in hospitals, it has only been shown to be effective for 90 seconds.
The American Heart Association (AHA) and other resuscitation bodies do not endorse "Cough CPR", which it terms a mi
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