What Are CPR Standards?

Once cardiac arrest occurs, if immediate rescue is not available, the patient's brain and other important organs and tissues will be irreversibly damaged after 4 to 6 minutes. Therefore, cardiopulmonary resuscitation (CPR) after cardiac arrest ) Must be done immediately at the scene.

CPR

Once cardiac arrest occurs, if immediate rescue is not available, the patient's brain and other important organs and tissues will be irreversibly damaged after 4 to 6 minutes. Therefore, cardiopulmonary resuscitation (CPR) after cardiac arrest ) Must be done immediately at the scene.

Basic life support (BLS), also known as initial or on-site first aid, is designed to resuscitate patients with cardiac arrest, brain, and important organs in the cardiac arrest system immediately after a cardiac arrest. Obtain a minimum of emergency oxygen supply (usually providing 25% -30% of the normal blood supply according to formal training techniques) The basis of BLS includes identification of sudden cardiac arrest (SCA), activation of emergency response systems, early cardiopulmonary resuscitation (CPR), and rapid use of automatic external defibrillator (AED) defibrillation. Early recognition and response to heart attacks and strokes are also listed as part of the BLS. The 2010 Adult BLS Guidelines set this requirement for both lay rescuers and medical staff. The BLS step consists of a series of continuous assessments and actions (Figure 3):

Figure 3 Summary of key basic life support steps for adults, children and infants

Advanced life support (ALS), also known as second-stage resuscitation or advanced life maintenance, is based on the application of devices and drugs on the basis of BLS to establish and maintain effective ventilation and circulation, identify and control arrhythmias, and remove asynchronous DC power. Tremor, establish effective venous access and treat primary diseases. ALS should start as early as possible.

Many patients with cardiac arrest cannot fully recover their brain function even after autonomous circulation is restored, and about 80% of patients who have successfully resuscitated are unconscious for more than 1 hour. Among patients admitted to the hospital, the neurological outcome rate was 1% to 18%, while others were either dead or persistently vegetative. Studies have shown that various drugs have little effect in the field of cerebral resuscitation, and mild hypothermia (32 ~ 35 ° C) has a protective effect on the brain without significant adverse reactions. There are a variety of cooling techniques for cerebral resuscitation in patients with cardiac arrest, such as ice bags, ice blankets, and ice caps that cool the body surface, but the cooling rate is slow. Rapid injection of a large amount (30mL / kg) of cooled (4 ° C) liquid (such as lactate solution) can significantly reduce the core temperature, but it is easy for patients to infuse excess liquid. An intravascular heat exchange device has recently appeared, which can quickly cool down and maintain the patient's low temperature state, and can also accurately control the temperature. Based on the results of some clinical trials, the International Society for Resuscitation proposed that for comatose adults with out-of-hospital VF cardiac arrest, ROSC (restoration of spontaneous circulation) patients should be cooled to 32-34 degrees Celsius and maintained for 12 to 24 hours. For any in-hospital cardiac arrest due to arrhythmia or having one of the following arrhythmias: Patients with coma after ROSC due to arrhythmic point activity or cardiac arrest in adults should also consider artificial hypothermia. During the first 48 hours after ROSC, patients with coma with spontaneous mild hypothermia (> 32 degrees Celsius) after resuscitation of cardiac arrest should not begin rewarming.

Non-professional first responders should continue CPR until they receive AED and are replaced by EMS personnel, or the patient begins to have activities. CPR should not be arbitrarily discontinued in order to check the cycle or check for response recovery. For medical personnel, the following effective indicators for CPR and the criteria for termination of rescue should be followed.

Cardiopulmonary resuscitation

(1) Carotid artery pulsation: When the compression is effective, you can touch the carotid artery every time you press it. If the compression pulsation also disappears, you should continue chest compressions. If the pulse is still present after stopping the compression, it means that the patient's heartbeat has restore.

(2) Complexion (lips): When resuscitation is effective, the complexion changes from purple to ruddy. If it turns gray, it means that the recovery is not effective.

(3) Others: When resuscitation is effective, spontaneous breathing may occur, or the pupils may change from large to small with reflection of light, or even eye movements and limb tics.

CPR Rescue Criteria

On-site CPR should be carried out uninterruptedly, and a decision to stop recovery should not be made easily. On-site rescue personnel may consider terminating recovery if they meet the following conditions:

(1) The patient's breathing and circulation have been effectively restored.

(2) Without heartbeat and spontaneous breathing, CPR lasted for more than 30 minutes at room temperature, and EMS personnel arrived to confirm that the patient had died.

(3) Have EMS personnel take over to undertake recovery or other personnel to take over the rescue.