CPR and Basic Life Support (BLS)

by | Sep 11, 2024 | Nurse Article | 0 comments

CPR and Basic Life Support (BLS) – Updated CPR guidelines, BLS algorithms, compression techniques, and use of defibrillators.

CPR and Basic Life Support (BLS): Updated Guidelines and Techniques

Cardiopulmonary resuscitation (CPR) and Basic Life Support (BLS) are essential life-saving skills used in emergencies when someone has stopped breathing or their heart has ceased functioning. Following updated guidelines ensures the best chance of survival. Here’s an overview of the current CPR and BLS guidelines, compression techniques, and the use of defibrillators:

1. Updated CPR Guidelines

The American Heart Association (AHA) regularly updates CPR guidelines based on the latest evidence to maximize survival rates in cardiac arrest cases. Here are the key components:

a. Chain of Survival

The Chain of Survival for cardiac arrest includes the following critical steps:

  1. Early Recognition and activation of emergency response.
  2. Early CPR with an emphasis on high-quality chest compressions.
  3. Rapid Defibrillation to restore normal heart rhythm.
  4. Advanced Life Support by medical professionals.
  5. Post-Cardiac Arrest Care to stabilize the patient after return of spontaneous circulation (ROSC).

b. Compression-to-Ventilation Ratio

  • Adults: 30 compressions followed by 2 breaths (30:2).
  • Children and Infants: 30:2 for a single rescuer, but 15:2 when two rescuers are present.

c. Compression Depth and Rate

  • Adults: Compress at least 2 inches (5 cm) deep at a rate of 100-120 compressions per minute.
  • Children: Compress about 2 inches (5 cm) deep or 1/3 of the chest’s diameter.
  • Infants: Compress about 1.5 inches (4 cm) deep or 1/3 of the chest’s diameter.

d. Hands-Only CPR

For untrained bystanders or in public settings, hands-only CPR (compression-only) is encouraged:

  • Push hard and fast in the center of the chest.
  • No rescue breaths are required unless the rescuer is trained.

2. BLS Algorithms and Steps

The Basic Life Support (BLS) algorithm consists of a step-by-step approach to managing cardiac arrest.

a. BLS Algorithm for Adults

  1. Check for Responsiveness: Shake and shout to see if the person is responsive.
  2. Call for Help: Activate the emergency response system by calling for help or dialing emergency services (e.g., 911).
  3. Check for Breathing and Pulse:
    • If no breathing or only gasping, and no pulse is felt within 10 seconds, start CPR immediately.
  4. Start Chest Compressions:
    • Perform high-quality compressions: 30 compressions followed by 2 rescue breaths.
    • Ensure chest recoil between compressions.
  5. Defibrillation: As soon as an AED (Automated External Defibrillator) is available, apply it and follow its prompts.

b. BLS Algorithm for Children and Infants

  1. Check for Responsiveness: Tap the child/infant gently and shout.
  2. Call for Help: If alone, perform 2 minutes of CPR before calling emergency services if the collapse was unwitnessed.
  3. Check Breathing and Pulse: If there is no breathing or only gasping, and no pulse, begin CPR immediately.
  4. Perform Chest Compressions:
    • For children: Use one or two hands depending on size, with a compression depth of at least 2 inches.
    • For infants: Use two fingers or encircling hands technique with a depth of 1.5 inches.
  5. Defibrillation: Use an AED with pediatric pads if available.

3. High-Quality Chest Compressions

High-quality chest compressions are the most critical component of CPR and include the following characteristics:

  • Depth: At least 2 inches (5 cm) for adults, 1.5 inches (4 cm) for infants.
  • Rate: 100-120 compressions per minute.
  • Minimize Interruptions: Limit interruptions in compressions to less than 10 seconds.
  • Allow Full Chest Recoil: Ensure the chest fully returns to its normal position between compressions.
  • Adequate Hand Placement: Hands should be placed on the lower half of the sternum in adults, and in infants, use either the two-finger technique or the encircling hands method.

4. Rescue Breaths and Airway Management

While compressions are the priority, rescue breaths are still important in certain scenarios (e.g., drowning, pediatric cases).

a. Opening the Airway

  • Use the Head-Tilt/Chin-Lift technique to open the airway.
  • For suspected spinal injury, use the Jaw-Thrust without head extension.

b. Rescue Breaths

  • Give 2 rescue breaths after every 30 compressions (15:2 for two-rescuer CPR in infants and children).
  • Ensure each breath lasts about 1 second and causes visible chest rise.
  • Avoid excessive ventilation, which can reduce the effectiveness of CPR.

5. Use of Defibrillators (AED)

An Automated External Defibrillator (AED) is a life-saving device that delivers an electrical shock to restore normal heart rhythm in cases of sudden cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).

a. Steps for Using an AED

  1. Power on the AED: Turn on the device and follow the voice prompts.
  2. Attach the Pads:
    • Apply the AED pads to the victim’s bare chest: one pad on the right side below the collarbone, the other pad on the lower left side.
    • For children under 8 years old, use pediatric AED pads.
  3. Clear the Area: Ensure no one is touching the patient while the AED analyzes the heart rhythm.
  4. Shock Delivery: If the AED advises a shock, ensure everyone is clear and press the shock button.
  5. Resume CPR: Immediately continue CPR after the shock for 2 minutes, or until the AED prompts you to stop.

6. Post-Resuscitation Care (Return of Spontaneous Circulation – ROSC)

a. Signs of ROSC:

  • Return of pulse.
  • Normal breathing or gasping.
  • Improved color.

b. Post-Resuscitation Care:

  • Continue to monitor the patient for changes in condition.
  • Ensure adequate airway management and oxygenation.
  • Transfer the patient to advanced care (e.g., ICU) for further stabilization and monitoring.

7. Special Considerations

a. Drowning Victims

  • For victims of drowning, give rescue breaths first before starting chest compressions.

b. Choking

  • For a choking victim who is unconscious, begin CPR immediately.

c. Pregnant Victims

  • For cardiac arrest in pregnancy, perform left lateral tilt to relieve pressure on the vena cava and improve blood flow during resuscitation.

Summary

  • High-quality CPR and early defibrillation are the most critical interventions in cardiac arrest.
  • The updated guidelines emphasize compression-only CPR for untrained bystanders and ensure a high compression rate and depth.
  • The use of an AED can significantly increase the chances of survival if applied early.
  • Regular CPR and BLS certification and training are essential for maintaining proficiency in these life-saving techniques.