Learn CPR - You can do it
By Dr. Rajesh T. Eapen, MBBS, DA

Cardiopulmonary Resuscitation (CPR) is a technique used to save anyone from breathing and circulatory failure resulting from conditions like Heart attack and accidents (drowning, automobile accidents, smoke poisoning, choking burns etc).

CPR consists of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). BLS is a rescue procedure that can be done by any layperson trained in this first-aid procedure, to keep a non-breathing person (who has no heart beat) alive, without the use of equipment, other than a simple airway device or protective shield, until professional interventions are made available. This intervention by trained medical personnel with the support of advanced equipments is termed as ACLS.

Basic Life Support procedure is a combination of ventilation of lungs with air breathed out and chest compression. The three elements of basic life support after initial assessment are commonly referred as ABC – short for Airway and Assessment - Breathing - Circulation.

The most sensitive cells in the human body are brain cells. If brain cells are deprived of oxygen and nutrients for a period of four to six minutes, brain death occurs. “Brain Death” is followed by death of the patient. Once the brain cells are destroyed, they cannot be replaced or regenerated. For this very reason Basic Life Support is of vital importance.

The chances of survival of a person who has had a sudden stoppage of the heart (cardiac arrest) is maximized when someone who is a witness to this event summons help and starts resuscitation; and when medical services arrive and help is instituted early. Basic life support is one link in this chain of survival.

Why learn BLS?
Nearly 50% of all deaths worldwide are due to cardiovascular disease and 60-70% occur before hospitalization, often within the first two hours. "The community has the potential for being the ultimate coronary care unit."

Basic life support (BLS) comprises of following elements: initial assessment, then airway maintenance, expired air ventilation (rescue breathing), and chest compression. Basic life support implies that no equipment is employed. The purpose of BLS is to maintain adequate ventilation and circulation until means can be obtained to reverse the underlying cause of the arrest. Failure of the circulation for three to four minutes will lead to irreversible brain damage. Delay, even within that time, will lessen the eventual chances of a successful outcome. Emphasis must therefore be placed on rapid institution of basic life support by a rescuer, who nonetheless should follow the recommended sequence of action.

It is often said that the earliest reference to mouth-to-mouth ventilation is the biblical account of the revival of an apparently dead child by the prophet Elisha (1 Kings 4: 32-35). The first medical report of success was in 1744 by Tossach. It is possible that the prudery of the Victorian era prevented acceptance as it involved lip contact. It was not until the 1950s that mouth-to-mouth ventilation was rediscovered and became accepted universally as the method of choice. 1960 could be considered the year in which modern cardiopulmonary resuscitation was born.

The sooner resuscitation is started after ventilatory or circulatory arrest, the better the chances of survival. Immediate initiation of life support measures is highly desirable and can in most cases be achieved only through action by bystanders. Direct mouth-to-mouth ventilation and CPR Steps A-B-C can be taught effectively to the lay public even to school children 10-11 years old. In the future, schools should play a fundamental role in the dissemination of first aid and CPR basic life support proficiency to the public at large. School age is excellent for learning the necessary knowledge and simple psychomotor skills. Teaching school children also allows for annual retraining.

Adult CPR can be performed on anyone over the age of eight. The basics here will apply with minor modifications to children and infants as well.

Researchers have observed that neurological and psychological recovery from cardiac arrest depends on the time within which these critical interdependent treatment modalities are delivered. Therefore, high resuscitation rates will also lead to a high percentage of patients who recover to the neurological level they had before their arrest.

Another approach to early CPR is the concept of targeted CPR training. Such programs are for persons who have an increased likelihood of having to perform CPR, including middle-aged persons, residents and staff of senior centers, survivors of heart attacks, and family members of persons identified as having cardiac arrest risk factors. These programs are slowly becoming more widespread and represent an important change in the focus of CPR training. Much CPR training focuses on the young, especially school-age children and young adults, who are easy to train and show energetic interest. However, they are not likely to witness a cardiac arrest or to take a CPR course. They do, of course, become the "future" performers of CPR as they enter the age group where risk increases.

For almost 3 decades, the chest compressions and positive pressure ventilations of standard CPR have helped return pulseless, nonbreathing patients to spontaneous respiration and cardiac perfusion. The value of early CPR is that it can buy time for the primary cardiac arrest patient by producing enough blood flow to the brain and heart to maintain temporary viability.