GetWiki

{{short description|Emergency procedure for cardiac arrest}}{{Redirect|CPR}}{{Redirect|Cpr|a common abbreviation of copyright|Copr.}}{{Globalize|1=article|2=United States|date=March 2021}}{{cs1 config|name-list-style=vanc|display-authors=6}}

factoids

| MeshID = D016887| MedlinePlus = 0000108-771}}| OtherCodes =}}Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation, or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.JOURNAL, Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, Meaney PA, Niles DE, Samson RA, Schexnayder SM, Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 132, 18 Suppl 2, S519–S525, November 2015, 26472999, 10.1161/CIR.0000000000000265, free, CPR involves chest compressions for adults between {{convert|5|cm|in|sigfig=2|abbr=on}} and {{convert|6|cm|in|sigfig=2|abbr=on}} deep and at a rate of at least 100 to 120 per minute.JOURNAL, Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, Kleinman ME, Kronick SL, Lavonas EJ, Link MS, Mancini ME, Morrison LJ, O'Connor RE, Samson RA, Schexnayder SM, Singletary EM, Sinz EH, Travers AH, Wyckoff MH, Hazinski MF, Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 132, 18 Suppl 2, S315–S367, November 2015, 26472989, 10.1161/cir.0000000000000252, 20651700, free, The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose (mouth-to-mouth resuscitation) or using a device that pushes air into the subject's lungs (mechanical ventilation). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving only chest compressions is recommended for untrained rescuers.JOURNAL, Leong BS, Bystander CPR and survival, Singapore Medical Journal, 52, 8, 573–575, August 2011, 21879214, With children, however, 2015 American Heart Association guidelines indicate that doing only compressions may actually result in worse outcomes, because such problems in children normally arise from respiratory issues rather than from cardiac ones, given their young age. Chest compression to breathing ratios is set at 30 to 2 in adults.CPR alone is unlikely to restart the heart. Its main purpose is to restore the partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed to restore a viable, or "perfusing", heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity, which usually requires the treatment of underlying conditions to restore cardiac function. Early shock, when appropriate, is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.BOOK, Prehospital Emergency Care, 10th, Werman HA, Karren K, Mistovich J, Shock and Resuscitation, Pearson Education, Inc., Werman HA, Mistovich J, Karren K, 410, 426, 2014, 978-0-13-336913-7, File:Save a Life Cymru - Training video.webm|thumb|upright=1.3|Welsh GovernmentWelsh Government

Medical uses

CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest.{{rp|S643}} If a person still has a pulse but is not breathing (respiratory arrest), artificial ventilations may be more appropriate, but due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse.WEB, European Resuscitation Council, Part 2: Adult basic life support, 2005, Guidelines for resuscitation,weblink The following is a summary of the evidence-based recommendations for the performance of basic life support: Rescuers begin CPR if the victim is unconscious, not moving, and not breathing (ignoring occasional gasps).[...], dead,weblink 2010-05-30, 2012-03-28, In those with cardiac arrest due to trauma, CPR is considered futile but still recommended.JOURNAL, Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A, Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 122, 18 Suppl 3, S829–S861, November 2010, 20956228, 10.1161/CIRCULATIONAHA.110.971069, free, Correcting the underlying cause such as a tension pneumothorax or pericardial tamponade may help.

Pathophysiology

CPR is used on people in cardiac arrest to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The physiology of CPR involves generating a pressure gradient between the arterial and venous vascular beds; CPR achieves this via multiple mechanisms.WEB, February 2015, ICU Physiology in 1,000 Words: Cardiopulmonary Resuscitation,weblink live,weblink" title="web.archive.org/web/20150326232456weblink">weblink 2015-03-26, 2015-03-20, The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes.WEB, Smith N, Anoxic Brain Damage,weblink dead,weblink" title="web.archive.org/web/20090129175857weblink">weblink 2009-01-29, 2018-12-07, Third Age, WEB, Tuhrim S, Anoxic Brain Injury,weblink live,weblink" title="web.archive.org/web/20120515030759weblink">weblink 2012-05-15, Mount Sinai Medical Centre, BOOK, Brass L,weblink Heart Book. Chapter 18:Stroke, Yale University,weblink" title="web.archive.org/web/20090131022504weblink">weblink 2009-01-31, live, WEB, Turkowski K, A pleas for VBAC education,weblink live,weblink" title="web.archive.org/web/20090429043723weblink">weblink 2009-04-29, WEB, Hyperbaric Oxygen Therapy,weblink dead,weblink" title="web.archive.org/web/20090429052150weblink">weblink 2009-04-29, 2018-12-07, Family Health News, Typically if blood flow ceases for one to two hours, then body cells die. Therefore, in general CPR is effective only if performed within seven minutes of the stoppage of blood flow.WEB, Cardiopulmonary resuscitation (CPR): First aid,weblink 2023-09-12, Mayo Clinic, en, 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 stem death, and allows the heart to remain responsive to defibrillation attempts.BOOK, ((Institute of Medicine)), Graham R, McCoy MA, Schultz AM,weblink Emergency Medical Services Response to Cardiac Arrest, Washington, DC, 2015-09-29, National Academies Press (US), en, If an incorrect compression rate is used during CPR, going against standing American Heart Association (AHA) guidelines of 100–120 compressions per minute, this can cause a net decrease in venous return of blood, for what is required, to fill the heart.JOURNAL, Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M, The Physiology of Cardiopulmonary Resuscitation, Anesthesia and Analgesia, 122, 3, 767–783, March 2016, 26562060, 10.1213/ANE.0000000000000926, 30360787, For example, if a compression rate of above 120 compressions per minute is used consistently throughout the entire CPR process, this error could adversely affect survival rates and outcomes for the victim.

Methods

File:CPR training-03.jpg|thumb|upright=1.25|CPR training: CPR is being administered while a second rescuer prepares for defibrillationdefibrillationIn 2010, the AHA and International Liaison Committee on Resuscitation updated their CPR guidelines.JOURNAL, Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL, Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 122, 18 Suppl 3, S640–S656, November 2010, 20956217, 10.1161/CIRCULATIONAHA.110.970889, free, {{rp|S640}}JOURNAL, Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O'Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D, Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, Circulation, 122, 16 Suppl 2, S250–S275, October 2010, 20956249, 10.1161/CIRCULATIONAHA.110.970897, free, The importance of high quality CPR (sufficient rate and depth without excessively ventilating) was emphasized.{{rp|S640}} The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB).{{rp|S642}} An exception to this recommendation is for those believed to be in a respiratory arrest (airway obstruction, drug overdose, etc.).{{rp|S642}}The most important aspects of CPR are: few interruptions of chest compressions, a sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much.JOURNAL, Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, Abella BS, Kleinman ME, Edelson DP, Berg RA, Aufderheide TP, Menon V, Leary M, Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association, Circulation, 128, 4, 417–435, July 2013, 23801105, 10.1161/CIR.0b013e31829d8654, free, It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation.JOURNAL, Huang Y, He Q, Yang LJ, Liu GJ, Jones A, Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest, The Cochrane Database of Systematic Reviews, 2014, 9, CD009803, September 2014, 25212112, 6516832, 10.1002/14651858.CD009803.pub2, Guides indicate calling for emergency medical services before starting CPR, but in the exceptions of drowning victims and children who were already unconscious when the rescuer arrived, and if the rescuer is alone, the rescuer should perform two minutes of CPR before calling.WEB, American Red Cross CPR/AED and First Aid,weblinkweblink 2021-12-19,

Compressions with rescue breaths

(File:Chest compressions.gif|thumb|Chest compressions performed at 100 per minute (proper rhythm)) File:Insulfation2.jpg|thumb|Mouth-to-mouth rescue breaths ]]A normal CPR procedure uses chest compressions and ventilations (rescue breaths) for any victim of cardiac arrest, who would be unresponsive (usually unconscious or approximately unconscious), not breathing or only gasping because of the lack of heart beats.BOOK, American Heart Association (AHA), Guidelines for CPR and ECC, 2010, However, the ventilations could be omitted for untrained rescuers aiding adults who suffer a cardiac arrest.In CPR, the chest compressions push on the lower half of the sternum —the bone that is along the middle of the chest from the neck to the belly— and leave it rise up until recovering its normal position. The rescue breaths are made by pinching the victim's nose and blowing air mouth-to-mouth. If the victim is a baby, the rescuer would compress the chest with only 2 fingers and would make the ventilations using their own mouth to cover the baby's mouth and nose at the same time. The recommended compression-to-ventilation ratio, for all victims of any age, is 30:2 (a cycle that alternates continually 30 rhythmic chest compressions series and 2 rescue breaths series).WEB, Highlights of the 2010 American Heart Association Guidelines for CPR and ECC,weblink live,weblink" title="web.archive.org/web/20101121152639weblink">weblink 2010-11-21, American Heart Association, {{rp|8}}As an exception for the normal compression-to-ventilation ratio of 30:2, if at least two trained rescuers are present and the victim is a child, the preferred ratio is 15:2.WEB, Highlights of the 2010 American Heart Association Guidelines for CPR and ECC,weblink live,weblink" title="web.archive.org/web/20101121152639weblink">weblink 2010-11-21, American Heart Association, {{rp|8}} Equally, in newborns, the ratio is 30:2 if one rescuer is present, and 15:2 if two rescuers are present (according to the AHA 2015 Guidelines).{{rp|S647}} In an advanced airway treatment, such as an endotracheal tube or laryngeal mask airway, the artificial ventilation should occur without pauses in compressions at a rate of 1 breath every 6 to 8 seconds (8–10 ventilations per minute).JOURNAL, Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA, Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 122, 18 Suppl 3, S685–S705, November 2010, 20956221, 10.1161/CIRCULATIONAHA.110.970939, free, Victims of drowning require 5 initial rescue breaths before the first of the compressions series. After that, the rescuer would alternate the normal series of 30 chest compressions and 2 rescue breaths.In all victims, the compression speed is of at least 100 compressions per minute.WEB, Highlights of the 2010 American Heart Association Guidelines for CPR and ECC,weblink live,weblink" title="web.archive.org/web/20101121152639weblink">weblink 2010-11-21, American Heart Association, {{rp|8}} Recommended compression depth in adults and children is of 5 cm (2 inches), and in infants it is 4 cm (1.6 inches).{{rp|8}} In adults, rescuers should use two hands for the chest compressions (one on the top of the other), while in children one hand could be enough (or two, adapting the compressions to the child's constitution), and with babies the rescuer must use only two fingers.BOOK, Autin M, Crawford R, Klaassen D, First Aid Manual, St. John Ambulance; St. Andrew's First Aid; British Red Cross Society, There exist some plastic shields and respirators that can be used in the rescue breaths between the mouths of the rescuer and the victim, with the purposes of sealing a better vacuum and avoiding infections.WEB, Department of Health & Human Services, Cardiopulmonary resuscitation (CPR),weblink 2022-10-20, www.betterhealth.vic.gov.au, en, In some cases, the patient suffers one of the failures in the rhythm of the heart (ventricular fibrillation and ventricular tachycardia) that can be corrected with the electric shock of a defibrillator. When a victim is falling unconscious because of a cardiac arrest, it is important that someone asks for a defibrillator to use it in a defibrillation process. The common model of defibrillator (the AED) is an automatic portable machine that guide to the user with recorded voice instructions along the process, and analyze the victim, and apply the correct shocks if they are needed.The time in which a cardiopulmonary resuscitation can still work is not clear, and it depends on many factors. Many official guides recommend continuing a cardiopulmonary resuscitation until emergency medical services arrive (for trying to keep the patient alive, at least).BOOK, American Red Cross, CPR/AED and First Aid, The same guides also indicate asking for any emergency defibrillator (AED) near, to try an automatic defibrillation as soon as possible before considering that the patient has died.A normal cardiopulmonary resuscitation has a recommended order named 'CAB': first 'Chest' (chest compressions), followed by 'Airway' (attempt to open the airway by performing a head tilt and a chin lift), and 'Breathing' (rescue breaths).{{rp|S642}} As of 2010, the Resuscitation Council (UK) was still recommending an 'ABC' order, with the 'C' standing for 'Circulation' (check for a pulse), if the victim is a child.WEB, Resuscitation Council UK Paediatric Advanced Life Support Guidelines,weblink live,weblink" title="web.archive.org/web/20110527145122weblink">weblink 2011-05-27, 2010-10-24, It can be difficult to determine the presence or absence of a pulse, so the pulse check has been removed for common providers and should not be performed for more than 10 seconds by healthcare providers.WEB, Highlights of the 2010 American Heart Association Guidelines for CPR and ECC,weblink live,weblink" title="web.archive.org/web/20101121152639weblink">weblink 2010-11-21, American Heart Association, {{rp|8}}

Compression only

For the untrained rescuers helping adult victims of cardiac arrest, it is recommended a compression-only CPR (chest compressions hands-only or cardiocerebral resuscitation, without artificial ventilation), as it is easier to perform and instructions are easier to give over a phone.JOURNAL, Ali S, Athar M, Ahmed SM, A randomised controlled comparison of video versus instructor-based compression only life support training, Indian Journal of Anaesthesia, 63, 3, 188–193, March 2019, 30988532, 6423949, 10.4103/ija.IJA_737_18, free, {{rp|S643}}{{rp|S643}}WEB, Highlights of the 2010 American Heart Association Guidelines for CPR and ECC,weblink live,weblink" title="web.archive.org/web/20101121152639weblink">weblink 2010-11-21, American Heart Association, {{rp|8}}JOURNAL, Hüpfl M, Selig HF, Nagele P, Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis, Lancet, 376, 9752, 1552–1557, November 2010, 20951422, 2987687, 10.1016/S0140-6736(10)61454-7, In adults with out-of-hospital cardiac arrest, compression-only CPR by the lay public has an equal or higher success rate than standard CPR.WEB,weblink Highlights of the 2015 American Heart Association: Guidelines Update for CPR and ECC, dead,weblink" title="web.archive.org/web/20160313233123weblink">weblink 2016-03-13, Hazinski MF, Shuster M, Donnino MW, etal, 2015, "The 2015 AHA Guidelines Update for CPR and ECC is based on an international evidence evaluation process that involved 250 evidence reviewers from 39 countries."JOURNAL, Ewy GA, June 2008, Cardiocerebral Resuscitation: Could this new model of CPR hold promise for better rates of neurologically intact survival?, 2008-08-02,weblink$7857, EMS Magazine, 37, 6, 41–49, dead,weblink" title="web.archive.org/web/20080803153326weblink">weblink 2008-08-03, (File:2002 CPR Technique.jpg|thumb|upright=1.25|CPR technique as demonstrated on a dummy)The CPR 'compressions only' procedure consists only of chest compressions that push on the lower half of the bone that is in the middle of the chest (the sternum).Compression-only CPR is not as good for children who are more likely to have cardiac arrest from respiratory causes. Two reviews have found that compression-only CPR had no more success than no CPR whatsoever.{{rp|S646}} Rescue breaths for children and especially for babies should be relatively gentle. Either a ratio of compressions to breaths of 30:2 or 15:2 was found to have better results for children.JOURNAL, Ashoor HM, Lillie E, Zarin W, Pham B, Khan PA, Nincic V, Yazdi F, Ghassemi M, Ivory J, Cardoso R, Perkins GD, de Caen AR, Tricco AC, Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review, Resuscitation, 118, 112–125, September 2017, 28583860, 10.1016/j.resuscitation.2017.05.032, 207518670,weblink Both children and adults should receive 100 chest compressions per minute. Other exceptions besides children include cases of drownings and drug overdose; in both these cases, compressions and rescue breaths are recommended if the bystander is trained and is willing to do so.WEB, Steinson B, 2023-08-29, Compression-Only CPR vs. CPR with Rescue Breaths,weblink 2023-08-29, Fundamental First Aid Ltd., en-CA, As per the AHA, the beat of the Bee Gees song "Stayin' Alive" provides an ideal rhythm in terms of beats per minute to use for hands-only CPR, which is 104 beats-per-minute.WEB, Blendist LLC, BPM for Stayin' Alive by Bee Gees,weblink 2020-12-31, SONG BPM, en, One can also hum Queen's "Another One Bites the Dust", which is 110 beats-per-minuteWEB,weblink Another One Bites The Dust by Queen, 2024-01-24, beatdetect.com, en, WEB, Blendist LLC, BPM for Another One Bites The Dust by Queen,weblink 2020-12-31, SONG BPM, en, and contains a repeating drum pattern.NEWS, From Queen, The Best Song For CPR – Except For The Lyrics, 2012-05-29,weblinkweblink" title="web.archive.org/web/20131102063841weblink">weblink November 2, 2013, live, For those in cardiac arrest due to non-heart related causes and in people less than 20 years of age, standard CPR is superior to compression-only CPR.JOURNAL, Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T, Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study, BMJ, 342, c7106, January 2011, 21273279, 10.1136/bmj.c7106, free, free, 10564/1584, JOURNAL, Koenig KL, Compression-Only CPR Is Less Effective Than Conventional CPR in Some Patients, JW Emerg Med, March 4, 2011,weblink 2011, 304, 1, dead,weblink" title="web.archive.org/web/20110724151702weblink">weblink 2011-07-24, 2018-12-07,

Prone CPR

(File:Supine and prone diagrams-en.svg|thumb|Supine and prone positions)Standard CPR is performed with the victim in supine position. Prone CPR, or reverse CPR, is performed on a victim in prone position, lying on the chest. This is achieved by turning the head to the side and compressing the back. Due to the head being turned, the risk of vomiting and complications caused by aspiration pneumonia may be reduced.JOURNAL, Wei J, Tung D, Sue SH, Wu SV, Chuang YC, Chang CY, Cardiopulmonary resuscitation in prone position: a simplified method for outpatients, Journal of the Chinese Medical Association, 69, 5, 202–206, May 2006, 16835981, 10.1016/S1726-4901(09)70219-9, 43391072, free, May 2006, The American Heart Association's current guidelines recommend performing CPR in the supine position, and limits prone CPR to situations where the patient cannot be turned.JOURNAL, Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF, Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 122, 18 Suppl 3, S720–S728, November 2010, 20956223, 3741663, 10.1161/CIRCULATIONAHA.110.970970, When the patient cannot be placed in the supine position, it may be reasonable for rescuers to provide CPR with the patient in the prone position, particularly in hospitalized patients with an advanced airway in place (Class IIb, LOE C).,

Pregnancy

During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left. This can be done by placing a pillow or towel under her right hip so that she is on an angle of 15–30 degrees, and making sure their shoulders are flat to the ground. If this is not effective, healthcare professionals should consider emergency resuscitative hysterotomy.

Family presence

Evidence generally supports family being present during CPR.JOURNAL, Flanders SA, Strasen JH, Review of evidence about family presence during resuscitation, Critical Care Nursing Clinics of North America, 26, 4, 533–550, December 2014, 25438895, 10.1016/j.ccell.2014.08.010, This includes in CPR for children.JOURNAL, McAlvin SS, Carew-Lyons A, Family presence during resuscitation and invasive procedures in pediatric critical care: a systematic review, American Journal of Critical Care, 23, 6, 477–84; quiz 485, November 2014, 25362671, 10.4037/ajcc2014922,

Other

Interposed abdominal compressions may be beneficial in the hospital environment.JOURNAL, Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF, Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 122, 18 Suppl 3, S720–S728, November 2010, 20956223, 3741663, 10.1161/CIRCULATIONAHA.110.970970, There is no evidence of benefit pre-hospital or in children.Cooling during CPR is being studied as currently results are unclear whether or not it improves outcomes.JOURNAL, Dell'anna AM, Scolletta S, Donadello K, Taccone FS, Early neuroprotection after cardiac arrest, Current Opinion in Critical Care, 20, 3, 250–258, June 2014, 24717694, 10.1097/mcc.0000000000000086, 10088805, Internal cardiac massage is manual squeezing of the exposed heart itself carried out through a surgical incision into the chest cavity, usually when the chest is already open for cardiac surgery.Active compression-decompression methods using mechanical decompression of the chest have not been shown to improve outcome in cardiac arrest.JOURNAL, Lafuente-Lafuente C, Melero-Bascones M, Active chest compression-decompression for cardiopulmonary resuscitation, The Cochrane Database of Systematic Reviews, 2013, 9, CD002751, September 2013, 24052483, 7100575, 10.1002/14651858.CD002751.pub3,

Use of devices

Defibrillators

Defibrillators produce a defibrillation (electric shocks) that can restore the normal heart function of the victim.(File:AED Oimachi 06z1399sv.jpg|thumb|253x253px|A briefcase with a public defibrillator, at a station. Its universal symbol appears above.)(File:AED open cutout.jpg|thumb|242x242px|A model of automatic defibrillator (AED)|left)(File:Defibrillation Electrode Position.jpg|thumb|245x245px|Position of the electrodes of a defibrillator|left)They are only indicated for some arrhythmias (abnormal heart beatings), specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Defibrillation is not indicated if the patient is conscious or has a normal pulse. Defibrillation is also not indicated in asystole or pulseless electrical activity (PEA), in those cases a normal CPR would be used to oxygenate the brain until the heart function can be restored. Improperly given electrical shocks can cause dangerous arrhythmias, such as the ventricular fibrillation (VF). When the patients are already unconscious and do not have heart beatings (or they present a sort of arrhythmia that will stop the heart immediately), it is recommended that someone asks for a defibrillator (because they are quite common in the present time), for trying a defibrillation in case it is successful.The standard defibrillation device, prepared for a fast use out of the medical centres, is the automated external defibrillator (AED), a portable machine of small size (similar to a briefcase) that can be used by any user with no previous training. That machine produces recorded voice instructions that guide to the user along the defibrillation process. It also checks the victim's condition to automatically apply electric shocks at the correct level, if they are needed. Other models are semi-automatic and require the user to push a button before producing an electric shock.A defibrillator would be used after having made 1 to 2 minutes of cardiopulmonary resuscitation (CPR) maneuvers (chest compressions and rescue breaths). But, when it is known that the problem is clearly cardiac, it should be used immediately, as soon as possible, doing those CPR maneuvers while the defibrillator comes. The defibrillator itself would indicate if CPR maneuvers are required.There are several devices for improving CPR but, only defibrillators (as of 2010)WEB, 2015-02-07, Cardiopulmonary resuscitation (CPR): First aid - Mayo Clinic, Mayo Clinic,weblink 2024-02-01,weblink 2015-02-07, have been found better than standard CPR for an out-of-hospital cardiac arrest.

Devices for timing CPR

Timing devices can feature a metronome (an item carried by many ambulance crews) to assist the rescuer in achieving the correct rate. Some units can also give timing reminders for performing compressions, ventilating and changing operators.WEB, Silicon Chip Article,weblink live,weblink" title="web.archive.org/web/20070902155833weblink">weblink 2007-09-02,

Devices for assisting in manual CPR

File:2002 CPR Technique.jpg|The ejection of blood from the heart is conditioned by the compression of the sternum by a third of the height of the chestFile:Internationaal Chirurgencongres te Wenen. Een automatisch hartmassageapparaat, 6 september 1967, Bestanddeelnr 920-6802 (cropped).jpg|Demonstrating a mechanical heart massage device, Vienna, 1967File:Mechanische Reanimationshilfe.jpg|AutoPulseFile:JASDF Automatic cardiopulmonary resuscitation device at Komaki Air Base February 23, 2014.jpg|LUCASMechanical chest compression devices have not been found to be better than standard manual compressions.JOURNAL, Wang PL, Brooks SC, Mechanical versus manual chest compressions for cardiac arrest, The Cochrane Database of Systematic Reviews, 8, 8, CD007260, August 2018, 30125048, 6513574, 10.1002/14651858.CD007260.pub4, Their use is reasonable in situations where manual compressions are not safe to perform, such as in a moving vehicle.Audible and visual prompting may improve the quality of CPR and prevent the decrease of compression rate and depth that naturally occurs with fatigue,JOURNAL, Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, O'Hearn N, Hoek TL, Becker LB, CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system, Resuscitation, 73, 1, 54–61, April 2007, 17258853, 10.1016/j.resuscitation.2006.10.027, JOURNAL, Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L, Sørebø H, Steen PA, Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study, Resuscitation, 71, 3, 283–292, December 2006, 17070980, 10.1016/j.resuscitation.2006.05.011,weblink and to address this potential improvement, a number of devices have been developed to help improve CPR technique.These items can be devices to be placed on top of the chest, with the rescuer's hands going over the device, and a display or audio feedback giving information on depth, force or rate,WEB,weblink CPREzy, 2007-08-18, live,weblink" title="web.archive.org/web/20070929230350weblink">weblink 2007-09-29, or in a wearable format such as a glove.WEB,weblink CPR Glove Website, 2009-01-05, live,weblink" title="web.archive.org/web/20090131055552weblink">weblink 2009-01-31, Several published evaluations show that these devices can improve the performance of chest compressions.JOURNAL, Perkins GD, Augré C, Rogers H, Allan M, Thickett DR, CPREzy: an evaluation during simulated cardiac arrest on a hospital bed, Resuscitation, 64, 1, 103–108, January 2005, 15629562, 10.1016/j.resuscitation.2004.08.011, JOURNAL, Boyle AJ, Wilson AM, Connelly K, McGuigan L, Wilson J, Whitbourn R, Improvement in timing and effectiveness of external cardiac compressions with a new non-invasive device: the CPR-Ezy, Resuscitation, 54, 1, 63–67, July 2002, 12104110, 10.1016/s0300-9572(02)00049-7, As well as its use during actual CPR on a cardiac arrest victim, which relies on the rescuer carrying the device with them, these devices can also be used as part of training programs to improve basic skills in performing correct chest compressions.WEB,weblink Public Health Initiative Uses PocketCPR to Help Improve Cardiac Arrest Survival Rates,weblink" title="web.archive.org/web/20090319171525weblink">weblink 19 March 2009, 20 October 2008,

Devices for providing automatic CPR

Mechanical CPR has not seen as much use as mechanical ventilation; however, use in the prehospital setting is increasing.JOURNAL, Kahn PA, Dhruva SS, Rhee TG, Ross JS, Use of Mechanical Cardiopulmonary Resuscitation Devices for Out-of-Hospital Cardiac Arrest, 2010-2016, JAMA Network Open, 2, 10, e1913298, October 2019, 31617923, 6806423, 10.1001/jamanetworkopen.2019.13298, Devices on the market include the LUCAS device,WEB,weblink Product specifications – LUCAS – Chest Compression System, developed at the University Hospital of Lund,JOURNAL, Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T, Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation, Resuscitation, 55, 3, 285–299, December 2002, 12458066, 10.1016/S0300-9572(02)00271-X, and AutoPulse. Both use straps around the chest to secure the patient. The first generation of the LUCAS uses a gas-driven piston and motor-driven constricting band, while later version are battery operated.Liao, Q. (2011). LUCAS – Lund University Cardiopulmonary Assist System. Department of Cardiothoracic Surgery, Clinical Sciences, Lund University.There are several advantages to automated devices: they allow rescuers to focus on performing other interventions; they do not fatigue and begin to perform less effective compressions, as humans do; they are able to perform effective compressions in limited-space environments such as air ambulances,JOURNAL, Lesser FD, Yakubi M, Rochester S, Evans J, Highgate J, Compartment syndrome of the hand as a complication of prolonged mechanical cardiopulmonary resuscitation, Anaesthesia Reports, 8, 1, 10–13, January 2020, 32154512, 7052311, 10.1002/anr3.12025, where manual compressions are difficult, and they allow ambulance workers to be strapped in safely rather than standing over a patient in a speeding vehicle.JOURNAL, Keseg DP, The merits of mechanical CPR: Do mechanical devices improve compression consistency and resuscitation outcomes?, Journal of Emergency Medical Services, 37, 9, 24–29, September 2012, 23342692,weblink live,weblink" title="web.archive.org/web/20160820153547weblink">weblink 2016-08-20, However the disadvantages are cost to purchase, time to train emergency personnel to use them, interruption to CPR to implement, potential for incorrect application and the need for multiple device sizes.JOURNAL, Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C, European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators, Resuscitation, 81, 10, 1277–1292, October 2010, 20956051, 7116923, 10.1016/j.resuscitation.2010.08.009, JOURNAL, Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF, Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 122, 18 Suppl 3, S720–S728, November 2010, 20956223, 3741663, 10.1161/CIRCULATIONAHA.110.970970, Several studies have shown little or no improvement in survival ratesJOURNAL, Wik L, Olsen JA, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, van Grunsven PM, Travis DT, Whitehead A, Herken UR, Lerner EB, Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial, Resuscitation, 85, 6, 741–748, June 2014, 24642406, 10.1016/j.resuscitation.2014.03.005, free, JOURNAL, Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther AM, Woollard M, Carson A, Smyth M, Whitfield R, Williams A, Pocock H, Black JJ, Wright J, Han K, Gates S, Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial, Lancet, 385, 9972, 947–955, March 2015, 25467566, 10.1016/s0140-6736(14)61886-9, free, JOURNAL, Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN, Van Ottingham L, Olsufka M, Pennington S, White LJ, Yahn S, Husar J, Morris MF, Cobb LA, Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial, JAMA, 295, 22, 2620–2628, June 2006, 16772625, 10.1001/jama.295.22.2620, free, but acknowledge the need for more study.WEB, Navarro K, Prove It: Mechanical chest compression devices vs. manual compressions,weblink EMS1.com, 25 July 2016, 28 March 2016, live,weblink" title="web.archive.org/web/20160716091621weblink">weblink 16 July 2016,

Mobile apps for providing CPR instructions

To support training and incident management, mobile apps have been published on the largest app markets. An evaluation of 61 available apps has revealed that a large number do not follow international guidelines for basic life support and many apps are not designed in a user-friendly way.JOURNAL, Kalz M, Lenssen N, Felzen M, Rossaint R, Tabuenca B, Specht M, Skorning M, Smartphone apps for cardiopulmonary resuscitation training and real incident support: a mixed-methods evaluation study, Journal of Medical Internet Research, 16, 3, e89, March 2014, 24647361, 3978555, 10.2196/jmir.2951, free, As a result, the Red Cross updated and endorsed its emergency preparedness application, which uses pictures, text and videos to assist the user.WEB, Red Cross First Aid App Can Help Save Lives,weblink 2022-10-20, www.redcross.org, en, The UK Resuscitation Council, has an app, called Lifesaver, which shows how to perform CPR.WEB, Lifesaver,weblink 19 October 2015, live,weblink 15 September 2015,

Effectivity rate

CPR oxygenates the body and brain, which favours making a later defibrillation and the advanced life support. Even in the case of a "non-shockable" rhythm, such as pulseless electrical activity (PEA) where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.WEB, Sarver Heart Center, Frequently Asked Questions about Chest-Compression-Only CPR,weblink dead,weblink" title="web.archive.org/web/20131019140312weblink">weblink 2013-10-19, 2013-10-18, Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent for a witnessed "shockable" arrest.WEB, Public Health – Seattle, King County, Heart attack survival rate continues to climb in King County,weblink dead,weblink" title="web.archive.org/web/20131022153223weblink">weblink 2013-10-22, 2013-10-18, In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.WEB, Resuscitation Academy, About,weblink live,weblink" title="web.archive.org/web/20131019125337weblink">weblink 2013-10-19, 2013-10-18, Similarly, in-hospital CPR is more successful when arrests are witnessed, occur in the ICU, or occur in patients wearing heart monitors.JOURNAL, Brady WJ, Gurka KK, Mehring B, Peberdy MA, O'Connor RE, In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge, Resuscitation, 82, 7, 845–852, July 2011, 21454008, 10.1016/j.resuscitation.2011.02.028, {| class="wikitable" style = "text-align:center" Adults' outcomes after CPR!! colspan="2" |CPR in US hospitals! colspan="4" |USA, CPR outside hospitalsWEB, National Reports by Year,weblink 2019-06-26, mycares.net, !!Total in hospitals!Source!CPR where an AED was used by bystander*!All witnessed arrests with CPR, with or without bystander AED!Unwitnessed arrest with CPR!Total outside hospitalsReturn of spontaneous circulation (ROSC):2018>49%>41.9%>|31.3%Survival to hospital discharge:|10.4% JOURNAL = CIRCULATION ISSUE = 10 DATE = MARCH 2019 DOI = 10.1161/CIR.0000000000000659 |10.4%|10.8% JOURNAL = CIRCULATION ISSUE = 10 DATE = MARCH 2017 PMC = 5408160 |10.6% JOURNAL = CIRCULATION ISSUE = 4 DATE = JANUARY 2016 DOI = 10.1161/CIR.0000000000000350 |10.8%|10.8%| JOURNAL = CIRCULATION ISSUE = 3 DATE = JANUARY 2014 PMC = 5408159 || JOURNAL = THE NEW ENGLAND JOURNAL OF MEDICINE ISSUE = 20 DATE = NOVEMBER 2012 PMC = 3517894 ||

• AED data here exclude health facilities and nursing homes, where patients are sicker than average.

In adults compression-only CPR by bystanders appears to be better than chest compressions with rescue breathing.JOURNAL, Zhan L, Yang LJ, Huang Y, He Q, Liu GJ, Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest, The Cochrane Database of Systematic Reviews, 3, 3, CD010134, March 2017, 28349529, 6464160, 10.1002/14651858.CD010134.pub2, Compression-only CPR may be less effective in children than in adults, as cardiac arrest in children is more likely to have a non-cardiac cause. In a 2010 prospective study of cardiac arrest in children (age 1–17) for arrests with a non-cardiac cause, provision by bystanders of conventional CPR with rescue breathing yielded a favorable neurological outcome at one month more often than did compression-only CPR (OR 5.54). For arrests with a cardiac cause in this cohort, there was no difference between the two techniques (OR 1.20).JOURNAL, Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM, Berg RA, Hiraide A, Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study, Lancet, 375, 9723, 1347–1354, April 2010, 20202679, 10.1016/S0140-6736(10)60064-5, free, 205957423, 2433/142462, This is consistent with American Heart Association guidelines for parents.WEB, 2009-01-16, Checklist for Parents of Children with Arrhythmias,weblink live,weblink" title="web.archive.org/web/20100212110620weblink">weblink 2010-02-12, 2010-04-11, American Heart Association, When done by trained responders, 30 compressions interrupted by two breaths appears to have a slightly better result than continuous chest compressions with breaths being delivered while compressions are ongoing.Measurement of end-tidal carbon dioxide during CPR reflects cardiac outputJOURNAL, Kolar M, Krizmaric M, Klemen P, Grmec S, Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field: a prospective observational study, Critical Care, 12, 5, R115, 2008, 18786260, 2592743, 10.1186/cc7009, free, and can predict chances of ROSC.JOURNAL, Garnett AR, Ornato JP, Gonzalez ER, Johnson EB, End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation, JAMA, 257, 4, 512–515, 1987-01-23, 3098993, 10.1001/jama.1987.03390040128031, In a study of in-hospital CPR from 2000 to 2008, 59% of CPR survivors lived over a year after hospital discharge and 44% lived over 3 years.JOURNAL, Chan PS, Nallamothu BK, Krumholz HM, Spertus JA, Li Y, Hammill BG, Curtis LH, Long-term outcomes in elderly survivors of in-hospital cardiac arrest, The New England Journal of Medicine, 368, 11, 1019–1026, March 2013, 23484828, 3652256, 10.1056/NEJMoa1200657,

Consequences

Survival rates: In US hospitals in 2017, 26% of patients who received CPR survived to hospital discharge.JOURNAL, Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MS, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UK, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association, Circulation, 139, 10, e56–e528, March 2019, 30700139, 10.1161/CIR.0000000000000659, free, {{rp|e381, e390}}JOURNAL, Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UK, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association, Circulation, 137, 12, e67–e492, March 2018, 29386200, 10.1161/CIR.0000000000000558, free, In 2017 in the US, outside hospitals, 16% of people whose cardiac arrest was witnessed survived to hospital discharge.WEB,weblink National Reports by Year, mycares.net, 2018-12-12, Since 2003, widespread cooling of patients after CPRJOURNAL, Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloeck WG, Billi J, Böttiger BW, Morley PT, Nolan JP, Okada K, Reyes C, Shuster M, Steen PA, Weil MH, Wenzel V, Hickey RW, Carli P, Vanden Hoek TL, Atkins D, Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation, Circulation, 108, 1, 118–121, July 2003, 12847056, 10.1161/01.CIR.0000079019.02601.90, International Liaison Committee on Resuscitation, free, and other improvements have raised survival and reduced mental disabilities.

Organ donation

Organ donation is usually made possible by CPR, even if CPR does not save the patient. If there is a return of spontaneous circulation (ROSC), all organs can be considered for donation. If the patient does not achieve ROSC, and CPR continues until an operating room is available, the kidneys and liver can still be considered for donation.JOURNAL, 2015, Part 8: Post-Cardiac Arrest Care – ECC Guidelines,weblink Resuscitation Science, Section 11, en-US, 1,000 organs per year in the US are transplanted from patients who had CPR.JOURNAL, Orioles A, Morrison WE, Rossano JW, Shore PM, Hasz RD, Martiner AC, Berg RA, Nadkarni VM, An under-recognized benefit of cardiopulmonary resuscitation: organ transplantation, Critical Care Medicine, 41, 12, 2794–2799, December 2013, 23949474, 10.1097/CCM.0b013e31829a7202, 30112782, Donations can be taken from 40% of patients who have ROSC and later become brain dead.JOURNAL, Sandroni C, D'Arrigo S, Callaway CW, Cariou A, Dragancea I, Taccone FS, Antonelli M, The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis, Intensive Care Medicine, 42, 11, 1661–1671, November 2016, 27699457, 5069310, 10.1007/s00134-016-4549-3, Up to 8 organs can be taken from each donor,NEWS,weblink How can one organ donor save eight lives?, Hawryluk M, 2017-11-03, 2018-12-23, en, and an average of 3 organs are taken from each patient who donates organs.

Mental abilities

Mental abilities are about the same for survivors before and after CPR for 89% of patients, based on before and after counts of 12,500 US patients' Cerebral-Performance Category (CPCWEB,weblink Cerebral Performance Categories Scale, Safar, Food and Drug Administration, 1981,weblink" title="web.archive.org/web/20180126203858weblink">weblink 2019-01-24, 2018-01-26, ) codes in a 2000–2009 study of CPR in hospitals. 1% more survivors were in comas than before CPR. 5% more needed help with daily activities. 5% more had moderate mental problems and could still be independent.JOURNAL, Chan PS, Spertus JA, Krumholz HM, Berg RA, Li Y, Sasson C, Nallamothu BK, A validated prediction tool for initial survivors of in-hospital cardiac arrest, Archives of Internal Medicine, 172, 12, 947–953, June 2012, 22641228, 3517176, 10.1001/archinternmed.2012.2050, For CPR outside hospitals, a Copenhagen study of 2,504 patients in 2007-2011 found 21% of survivors developed moderate mental problems but could still be independent, and 11% of survivors developed severe mental problems, so they needed daily help. Two patients out of 2,504 went into comas (0.1% of patients, or 2 out of 419 survivors, 0.5%), and the study did not track how long the comas lasted.JOURNAL, Søholm H, Bro-Jeppesen J, Lippert FK, Køber L, Wanscher M, Kjaergaard J, Hassager C, Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile, Resuscitation, 85, 3, 369–375, March 2014, 24269866, 10.1016/j.resuscitation.2013.10.033, Most people in comas start to recover in 2–3 weeks.BOOK, Katz DI, Polyak M, Coughlan D, Nichols M, Roche A, Coma Science: Clinical and Ethical Implications, Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up, Progress in Brain Research, 177, 73–88, 2009-01-01, 19818896, 10.1016/S0079-6123(09)17707-5, 978-0-444-53432-3, 2018 guidelines on disorders of consciousness say it is no longer appropriate to use the term "permanent vegetative state."JOURNAL, Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, Barbano R, Hammond FM, Laureys S, Ling GS, Nakase-Richardson R, Seel RT, Yablon S, Getchius TS, Gronseth GS, Armstrong MJ, Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research, Neurology, 91, 10, 450–460, September 2018, 30089618, 6139814, 10.1212/WNL.0000000000005926, Mental abilities can continue to improve in the six months after discharge,JOURNAL, Tong JT, Eyngorn I, Mlynash M, Albers GW, Hirsch KG, Functional Neurologic Outcomes Change Over the First 6 Months After Cardiac Arrest, Critical Care Medicine, 44, 12, e1202–e1207, December 2016, 27495816, 5115936, 10.1097/CCM.0000000000001963, and in subsequent years. For long-term problems, brains form new paths to replace damaged areas.JOURNAL, Ohab JJ, Fleming S, Blesch A, Carmichael ST, A neurovascular niche for neurogenesis after stroke, The Journal of Neuroscience, 26, 50, 13007–13016, December 2006, 17167090, 6674957, 10.1523/JNEUROSCI.4323-06.2006,

• {{lay source |template=cite press release|url =weblink|title = New Insight Into How The Brain Regenerates After Stroke |date= December 23, 2006 |website = Science Daily}}JOURNAL, Phillips H, 2006-07-03, 'Rewired brain' revives patient after 19 years,weblink New Scientist,

Injuries

Injuries from CPR vary. 87% of patients are not injured by CPR. Overall, injuries are caused in 13% (2009–12 data) of patients, including broken sternum or ribs (9%), lung injuries (3%), and internal bleeding (3%).The internal injuries counted here can include heart contusion,JOURNAL, Bansal MK, Maraj S, Chewaproug D, Amanullah A, Myocardial contusion injury: redefining the diagnostic algorithm, Emergency Medicine Journal, 22, 7, 465–469, July 2005, 15983078, 1726836, 10.1136/emj.2004.015339, hemopericardium,WEB, Implicatii medico-legale in resuscitarea cardio-respiratorie, Aurel M, ro, Medical-legal implications in cardio-respiratory resuscitation,weblink 2012-10-16, dead,weblink" title="web.archive.org/web/20130522021659weblink">weblink 2013-05-22, AHA, The Textbook of Emergency Cardiovascular Care and CPR, p. 541Forensic Pathology: Principles And Practice, David Dolinak, Evan W. Matshes, Emma O. Lew, p. 322 upper airway complications, damage to the abdominal viscera âˆ’ lacerations of the liver and spleen, fat emboli, pulmonary complications âˆ’ pneumothorax, hemothorax, lung contusions.AHA, Part 3: Adult Basic Life Support, JOURNAL,weblink Part 3: Adult Basic Life Support, Circulation, 102, suppl_1, I–22, 2012-10-16, live,weblink" title="web.archive.org/web/20121020135751weblink">weblink 2012-10-20, 10.1161/circ.102.suppl_1.I-22, 2000-08-22, 247578012, JOURNAL, Krischer JP, Fine EG, Davis JH, Nagel EL, Complications of cardiac resuscitation, Chest, 92, 2, 287–291, August 1987, 3608599, 10.1378/chest.92.2.287, Most injuries did not affect care; only 1% of those given CPR received life-threatening injuries from it.Broken ribs are present in 3%JOURNAL, Boland LL, Satterlee PA, Hokanson JS, Strauss CE, Yost D, Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest, Prehospital Emergency Care, 19, 1, 23–30, January–March 2015, 25076024, 10.3109/10903127.2014.936636, 9438700, of those who survive to hospital discharge, and 15% of those who die in the hospital, for an average rate of 9% (2009-12 data)to 8% (1997–99).JOURNAL, Oschatz E, Wunderbaldinger P, Sterz F, Holzer M, Kofler J, Slatin H, Janata K, Eisenburger P, Bankier AA, Laggner AN, Cardiopulmonary resuscitation performed by bystanders does not increase adverse effects as assessed by chest radiography, Anesthesia and Analgesia, 93, 1, 128–133, July 2001, 11429353, 10.1097/00000539-200107000-00027, 23211883, In the 2009-12 study, 20% of survivors were older than 75. A study in the 1990s found 55% of CPR patients who died before discharge had broken ribs, and a study in the 1960s found 97% did; training and experience levels have improved.JOURNAL, Hoke RS, Chamberlain D, Skeletal chest injuries secondary to cardiopulmonary resuscitation, Resuscitation, 63, 3, 327–338, December 2004, 15582769, 10.1016/j.resuscitation.2004.05.019, Lung injuries were caused in 3% of patients and other internal bleeding in 3% (2009–12).Bones heal in 1–2 months.WEB,weblink Broken or bruised ribs, 2017-10-17, nhs.uk, en, 2018-12-23, WEB,weblink Fractured Ribs Still Painful After 2 Months? You May Need Surgery, healthcare.utah.edu, 14 June 2018, en, 2018-12-23, The costal cartilage also breaks in an unknown number of additional cases, which can sound like breaking bones.WEB,weblink CPR Review – Keeping It Real, Heartsaver (BLS Training Site) CPR/AED & First Aid (Bellevue, NE), en, 2018-12-12, 2018-12-15,weblink" title="web.archive.org/web/20181215222028weblink">weblink dead, WEB,weblink CPR Breaking Bones, EMTLIFE, 25 May 2011, en-US, 2018-12-12, The type and frequency of injury can be affected by factors such as sex and age. A 1999 Austrian study of CPR on cadavers, using a machine which alternately compressed the chest then pulled it outward, found a higher rate of sternal fractures in female cadavers (9 of 17) than male (2 of 20), and found the risk of rib fractures rose with age, though they did not say how much.JOURNAL, Baubin M, Rabl W, Pfeiffer KP, Benzer A, Gilly H, Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers, Resuscitation, 43, 1, 9–15, December 1999, 10636312, 10.1016/S0300-9572(99)00110-0, Children and infants have a low risk of rib fractures during CPR, with an incidence less than 2%, although, when they do occur, they are usually anterior and multiple.JOURNAL, Maguire S, Mann M, John N, Ellaway B, Sibert JR, Kemp AM, Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review, Child Abuse & Neglect, 30, 7, 739–751, July 2006, 16857258, 10.1016/j.chiabu.2005.12.007, JOURNAL, Dolinak D, Rib fractures in infants due to cardiopulmonary resuscitation efforts, The American Journal of Forensic Medicine and Pathology, 28, 2, 107–110, June 2007, 17525558, 10.1097/01.paf.0000257392.36528.b8, 43512744, Where CPR is performed in error by a bystander, on a person not in cardiac arrest, around 2% have injury as a result (although 12% experienced discomfort).JOURNAL, White L, Rogers J, Bloomingdale M, Fahrenbruch C, Culley L, Subido C, Eisenberg M, Rea T, Dispatcher-assisted cardiopulmonary resuscitation: risks for patients not in cardiac arrest, Circulation, 121, 1, 91–97, January 2010, 20026780, 10.1161/CIRCULATIONAHA.109.872366, free, A 2004 overview said, "Chest injury is a price worth paying to achieve optimal efficacy of chest compressions. Cautious or faint-hearted chest compression may save bones in the individual case but not the patient's life."

Other side effects

The most common side effect is vomiting, which necessitates clearing the mouth so patients do not breathe it in.WEB,weblink CPR – you CAN do it!, depts.washington.edu, 2018-12-12, It happened in 16 of 35 CPR efforts in a 1989 study in King County, Washington.JOURNAL, McCormack AP, Damon SK, Eisenberg MS, Disagreeable physical characteristics affecting bystander CPR, Annals of Emergency Medicine, 18, 3, 283–285, March 1989, 2646999, 10.1016/S0196-0644(89)80415-9, (File:CPR-groups.png|thumb|350px|Survival from CPR among various groups)

Survival differences, based on prior illness, age or location

The American Heart Association guidelines say that survival rates below 1% are "futility,"WEB,weblink Part 3: Ethical Issues – ECC Guidelines, section 3.2, American Heart Association, 2019-01-24, but all groups have better survival than that. Even among very sick patients at least 10% survive: A study of CPR in a sample of US hospitals from 2001 to 2010,JOURNAL, Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS, Hospital variation in survival after in-hospital cardiac arrest, EN, Journal of the American Heart Association, 3, 1, e000400, January 2014, 24487717, 3959682, 10.1161/jaha.113.000400, where overall survival was 19%, found 10% survival among cancer patients, 12% among dialysis patients, 14% over age 80, 15% among blacks, 17% for patients who lived in nursing homes, 19% for patients with heart failure, and 25% for patients with heart monitoring outside the ICU.Another study, of advanced cancer patients, found the same 10% survival mentioned above.JOURNAL, Bruckel JT, Wong SL, Chan PS, Bradley SM, Nallamothu BK, Patterns of Resuscitation Care and Survival After In-Hospital Cardiac Arrest in Patients With Advanced Cancer, Journal of Oncology Practice, 13, 10, e821–e830, October 2017, 28763260, 5640412, 10.1200/JOP.2016.020404, A study of Swedish patients in 2007–2015 with ECG monitors found 40% survived at least 30 days after CPR at ages 70–79, 29% at ages 80–89, and 27% above age 90.JOURNAL, Hirlekar G, Karlsson T, Aune S, Ravn-Fischer A, Albertsson P, Herlitz J, Libungan B, Survival and neurological outcome in the elderly after in-hospital cardiac arrest, Resuscitation, 118, 101–106, September 2017, 28736324, 10.1016/j.resuscitation.2017.07.013, free, An earlier study of Medicare patients in hospitals 1992–2005, where overall survival was 18%, found 13% survival in the poorest neighborhoods, 12% survival over age 90, 15% survival among ages 85–89, and 17% survival among ages 80–84.JOURNAL, Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD, Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly, The New England Journal of Medicine, 361, 1, 22–31, July 2009, 19571280, 2917337, 10.1056/NEJMoa0810245, Swedish patients 90 years or older had 15% survival to hospital discharge, 80–89 had 20%, and 70–79 had 28%.A study of King County WA patients who had CPR outside hospitals in 1999–2003, where 34% survived to hospital discharge overall, found that among patients with 4 or more major medical conditions, 18% survived; with 3 major conditions 24% survived, and 33% of those with 2 major medical conditions survived.JOURNAL, Carew HT, Zhang W, Rea TD, Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest, Heart, 93, 6, 728–731, June 2007, 17309904, 1955210, 10.1136/hrt.2006.103895, Nursing home residents' survival has been studied by several authors,JOURNAL, Abbo ED, Yuen TC, Buhrmester L, Geocadin R, Volandes AE, Siddique J, Edelson DP, Cardiopulmonary resuscitation outcomes in hospitalized community-dwelling individuals and nursing home residents based on activities of daily living, Journal of the American Geriatrics Society, 61, 1, 34–39, January 2013, 23311551, 10.1111/jgs.12068, 36483449, JOURNAL, Pape M, Rajan S, Hansen SM, Mortensen RN, Riddersholm S, Folke F, Karlsson L, Lippert F, Køber L, Gislason G, Søholm H, Wissenberg M, Gerds TA, Torp-Pedersen C, Kragholm K, Survival after out-of-hospital cardiac arrest in nursing homes - A nationwide study, Resuscitation, 125, 90–98, April 2018, 29425977, 10.1016/j.resuscitation.2018.02.004,weblink 2019-08-20, dead, 262015800,weblink 2022-04-04, JOURNAL, Shah MN, Fairbanks RJ, Lerner EB, Cardiac arrests in skilled nursing facilities: continuing room for improvement?, Journal of the American Medical Directors Association, 8, 3 Suppl 2, e27–e31, March 2007, 17352981, 10.1016/j.jamda.2006.12.005, JOURNAL, Becker LJ, Yeargin K, Rea TD, Owens M, Eisenberg MS, Resuscitation of residents with do not resuscitate orders in long-term care facilities, Prehospital Emergency Care, 7, 3, 303–306, July 2003, 12879377, 10.1080/10903120390936464, 43824006, and is measured annually by the Cardiac Arrest Registry to Enhance Survival (CARES). CARES reports CPR results from a catchment area of 115 million people, including 23 state-wide registries, and individual communities in 18 other states as of 2019.WEB,weblink CARES Fact Sheet, mycares.net, 2019-06-27, CARES data show that in health care facilities and nursing homes where AEDs are available and used, survival rates are double the average survival found in nursing homes overall.Geographically, there is wide variation state-to-state in survival after CPR in US hospitals, from 40% in Wyoming to 20% in New York, so there is room for good practices to spread, raising the averages.For CPR outside hospitals, survival varies even more across the US, from 3% in Omaha to 45% in Seattle in 2001. This study only counted heart rhythms which can respond to defibrillator shocks (tachycardia).NEWS, Special report: Many lives are lost across USA because emergency services fail (data for 2001, corrected 7/29/2003), Davis R, July 28, 2003, USA Today, A major reason for the variation has been delay in some areas between the call to emergency services and the departure of medics, and then arrival and treatment. Delays were caused by lack of monitoring, and the mismatch between recruiting people as firefighters, though most emergency calls they are assigned to are medical, so staff resisted and delayed on the medical calls. Building codes have cut the number of fires, but staff still think of themselves as firefighters.(File:CPR-Geo.png|thumb|left|350px|CPR success varies widely, so most places can learn from the best practices){| class="wikitable mw-collapsible mw-collapsed" style="font-size: 95%; text-align: left; width: auto;" Table Showing How Well Groups with Different Illnesses Survive to Hospital Discharge after CPR(USA national data, except where noted)!||Survival Rate of Group at Left||Average Survival in Study||Group Rate as Fraction of Average||Subgroup Sample Size! style="width:90px;"|PatientsCurrent Total, Adults Outside Hospitals>10%>10%>1.0 >79,356>|2018|2018|2018|2018OUTSIDE HOSPITALS, MULTIPLE CONDITIONS, King County WA|1999–2003|1999–2003|1999–2003|1999–2003|1999–2003OUTSIDE HOSPITALS, NURSING HOMES|2018|2017|2016|2015|2014|2013|2018|2017|2016|2015|2014|1999–2000|2001–14|2001–14|2007–11|2001–14|1998–2001.Current Total, Inside Hospitals>26%>26%>1.0>26,178>|2017IN HOSPITALS, NURSING HOME RESIDENTS|2000–08|1992–2005|2000–08|2001–10IN HOSPITALS, BURDEN OF CHRONIC ILLNESS, Deyo-Charlson score|1992–2005|1992–2005|1992–2005|1992–2005IN HOSPITALS, INDIVIDUAL CONDITIONS|2001–10|2006–10|2001–10|2001–10|2000–08|2001–10|2001–10|2001–10|2001–10|2001–10|2001–10IN HOSPITALS, LOCATION OF CARE|2001–10|2001–10|2001–10|2007–15|2007–15|2007–15IN HOSPITALS, PATIENT TRAITS|2007–15|2007–15|2007–15|1992–2005|1992–2005|1992–2005|1992–2005|1992–2005|1992–2005|2001–10|