Basic principles of CPR by a single rescuer
Assistance can be provided by one or two rescuers positioned at the victim's side. If resuscitation is performed by a single person, their actions include:
- Confirming cardiac arrest.
- Clearing the oral cavity of foreign matter.
- Performing initial ventilation: 4 deep breaths into the airways must be delivered using mouth-to-mouth or mouth-to-nose methods.
- Proceeding to the CPR cycle: strict alternation of 15 chest compressions and 2 ventilations.
Chest compression technique
To ensure adequate blood circulation, it is important to follow the correct compression technique:
- Point of application: lower third of the sternum.
- Hand placement: the heel of one palm rests on the sternum, with the second hand placed on top parallel to it or interlocked.
- Biomechanics: arms must be straightened at the elbow joints. Compressions are performed strictly perpendicular to the chest wall using the rescuer's body weight, not just arm strength.
Performing CPR with two rescuers
Working in pairs allows tasks to be divided and improves the quality of resuscitation. One person performs compressions, while the other provides artificial ventilation.
In this case, the rhythm changes: 5 chest compressions are followed by 1 ventilation (a 1:5 ratio).
To monitor efficacy, rescuers observe the victim's condition. The person performing ventilation checks the carotid pulse during compressions (to assess compression quality). The person performing chest compressions monitors pupillary response. To prevent fatigue and a drop in compression quality, participants are recommended to periodically switch roles.
Assessing efficacy and terminating CPR
During resuscitation, continuous monitoring of pupillary status and regular assessment of cardiac activity are necessary. Every 2–3 minutes, compressions are paused to check the carotid pulse.
The procedure is considered effective if:
- Spontaneous heartbeats have recovered.
- Pupils have constricted and begun to react to light.
- Skin color has normalized (cyanosis has disappeared).
- Systolic blood pressure remains at or above 70 mm Hg.
Important: The return of spontaneous breathing is not a mandatory condition for declaring CPR successful at this stage. If a pulse appears, chest compressions are stopped, but artificial ventilation is continued.
Resuscitation efforts are terminated upon the appearance of unequivocal signs of biological death.
Advanced life support (physicians only)
Differential diagnosis and pharmacologic support are performed exclusively by specialized professionals (paramedics, emergency physicians, intensivists). At this stage, the following are used:
- ECG monitoring to assess rhythm.
- Pharmacotherapy: intravenous, intracardiac, or endotracheal administration of medications. A 0.1% epinephrine solution (1 ml in 10 ml of saline), 10% calcium chloride solution (10 ml), and 2% sodium bicarbonate solution (20 ml) are used.
- Electrical defibrillation: indicated for coarse ventricular fibrillation. The initial discharge energy is 3 kW.
Briefly: answers to topical questions
To what depth should the chest be compressed during external cardiac massage in adults?
During external cardiac massage in adults, the chest should be compressed to a depth of 4–5 cm. An alternative landmark is compressing the chest by approximately 1/3 of its anteroposterior diameter. Compressions are performed with straight arms using the weight of the entire body, and the applied force should be 8–9 kg. An important condition is maintaining constant contact of the hands with the chest without lifting them during the decompression phase.
What should be the frequency per minute of chest compressions during CPR?
The frequency of chest compressions during cardiopulmonary resuscitation depends on the victim's age and the chosen technique.
- Adults — 60 compressions per minute.
- Children under 10 — 80 compressions per minute.
- Neonates — 120 compressions per minute.
There is also a basic technique where a total of 120 actions are performed per minute, of which 90 are chest compressions and 30 are rescue breaths.
What does the triple airway maneuver (Safar maneuver) entail?
The Safar maneuver consists of sequentially performing three actions aimed at restoring airway patency.
The maneuver includes:
- Head tilt — maximum extension of the cervical spine (one hand is placed on the forehead, the other under the neck or on the chin).
- Chin lift — grasping the angles of the jaw with both hands and pulling it forward and upward to displace the tongue base.
- Mouth opening — ensuring free access to the airways.
This set of measures allows the base of the tongue to be displaced away from the posterior pharyngeal wall and opens the entrance to the larynx.
What are the reversible causes of cardiac arrest (4H-4T rule)?
Potentially reversible causes of cardiac arrest include:
- cardiogenic shock of any type;
- hypothermia;
- cardiotoxic drug overdose;
- acute electrolyte disturbances unrelated to chronic pathology.
The "4H-4T" rule is not described in the provided sources.
Class and exam questions
What is the compression-to-ventilation ratio if I am performing resuscitation alone?
You need to alternate 15 chest compressions with 2 ventilations (15:2).
Should chest compressions be continued if the patient's skin turns pink, but they have not started breathing?
If the skin pinking is accompanied by the appearance of a spontaneous carotid pulse, cardiac massage must be stopped, but artificial ventilation must be continued.
How can I make sure my partner is performing chest compressions correctly?
The person performing ventilation must palpate the carotid artery: with each correct compression by the partner, a pulsation should be felt there.
What else to study on this topic
- Specifics of CPR in neonates
- Routes of drug administration during CPR
- Differential diagnosis of causes of cardiac arrest
- Indications and contraindications for defibrillation
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