ADULT CARDIOPULMONARY RESUSCITATION (CPR)

LEARNING MANUAL DESCRIPTION

This course deals with the principles, theories and techniques in the nursing care of
clients with life threatening conditions, acutely ill and multi-organ problems focusing on
emergency management. The learners are expected to provide safe, appropriate and holistic
nursing care to clients utilizing the nursing process.

COURSE LEARNING OUTCOMES

At the end of this module, the student will be able to:

1. Understand sudden cardiac arrest and CPR.
2. Identify the chain of survival for IHCA and OHCA.
3. Explain the principles and techniques in performing a quality CPR.
4. Confidently demonstrate a proper CPR.

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TOPIC: ADULT CPR

SUDDEN CARDIAC ARREST AND CPR AWARENESS
BACKGROUND
Heart diseases are the number 1 killer in our country (Philippines), accounting for close to 20% of
all causes of death according to the latest department of health statistics.
Approximately half of all deaths from cardiovascular disease occur as Sudden Cardiac Arrest.

Sudden Cardiac Arrest

 Can happen any time, to anyone, anywhere without
warning
 Most common mode of death in patients with
coronary artery disease
 Although pre-existing heart disease is a common
cause, it may strike people with no history of
cardiac disease or cardiac symptoms.
 In sudden cardiac arrest or sudden cardiac death,
the heart usually goes into a fatal arrythmia called
“Ventricular Fibrillation” (VF) wherein it suddenly
goes into very irregular fast ineffective contractions, the heart stops beating, the victim loses
consciousness, and if untreated, dies.

Despite advances in Emergency Medical Systems and in the technology of resuscitation, sudden cardiac
arrest remains a major public health problem. It is associated with low survival rate, and major long term
severe mental impairment due to delays in cardiopulmonary resuscitation (CPR) and treatment.

Majority of cardiac arrest occur outside the hospital – at home, in the workplace, in public institutions.
 Almost 70% of out-of-hospital cardiac arrests occur at home and are witnesses by a family member
and approximately 50% are unwitnessed.
 Only 10.8% of Out of Hospital Cardiac Arrest (OHCA) who have received CPR from EMS survive
to hospital discharge.
 In-Hospital Cardiac Arrest (IHCA) has a better outcome, with 22.3% to 25.5% of adults surviving
to discharge.

Unfortunately, approximately less than 10 percent of sudden cardiac arrest victims survive because majority
of those witnessing the arrest are people who do not know how to perform CPR.

Cardiopulmonary Resuscitation is an emergency procedure used when someone’s heart stops beating.
 It is a simple inexpensive procedure that can be learned by anyone, and consists of a manual
technique using repetitive pressing to the chest and breathing into the person’s airways that keeps
enough oxygen and blood flowing to the brain.
 Requires no special medical skills and training is available for the ordinary person nationwide.
 If effectively done immediately after cardiac arrest, it can double a victim’s chance of survival.
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Early CPR and defibrillation within the first 3-5 minutes after collapse, plus early advanced care can result
in high (greater than 50 percent) long-term survival rates for witnessed ventricular fibrillation (VF).

If bystander CPR is not provided, a cardiac arrest victim’s chances of survival fall 7% to 10% for every
minute of delay until defibrillation.

THE CHAIN OF SURVIVAL

This is a concept which aims to improve the outcome for victims of cardiopulmonary arrest.

It involves a series of events which are interconnected to each other like the links of a chain.
The 5 links in the Chain of Survival are described specifically as:
1) Early access
2) Early CPR
3) Early Defibrillation
4) Early ACLS
5) Integrated Post-Cardiac Arrest Care

Based on the new 2015 AHA CPR/ECC Guidelines, they have recommended Separate Chains of Survival
that identify the different pathways of care for patients who experienced Cardiac Arrest in the Hospital
(IHCA) and Out of Hospital Cardiac Arrest (OHCA) settings.

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The care for all post cardiac arrest patients (IHCA and OHCA) all converge in the hospital ICU setting.
Patients who had an OHCA depend on their community for support where Lay rescuers must recognize
the arrest, call for help and initiate CPR and apply Public AED protocols until EMS arrives and patient
ultimately transferred to hospital. The patients who had IHCA depend on a system of appropriate
surveillance (e.g., rapid response or early warning system) to prevent cardiac arrest. All IHCA patients
depend on a smooth multidisciplinary interaction among the department services and allied health
providers including physicians, nurses, respiratory therapists and others.

The First Link – Early Access

 A well-informed person – key in the early access link.
 Recognition of signs of heart attack and respiratory failure.
 Call for help immediately if needed
 Activate the Emergency Medical System

The Second Link – Early CPR

 Lifesaving technique for cardiac and respiratory arrest
 Chest compressions +/- Rescue breathing

Why is early CPR important?

 CPR is the best treatment for cardiac arrest until the arrival of Advanced Life Support.
o Prevents VF from deteriorating to asystole
o May increase the chance of defibrillation
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o Significantly improves survival

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STEPS IN BASIC LIFE SUPPORT FOR HEALTHCARE PROVIDERS

IF YOU SEE A PERSON DROP DEAD, OR LOSE CONSCIOUSNESS, WITH PRESUMED

SUDDEN CARDIAC ARREST

1. Check area safety.

 Survey the scene.
 See if the scene is safe to do CPR.
 Get an idea of what happened.

2. Check unresponsiveness.
 Tap or gently shake the victim.
 Rescuer shouts “Are you OK?”
 Quick check for normal breathing.
 If the victim is unconscious, rescuer calls for help.

3. Call for help: (Ambulance, Emergency Services, Doctor)

 Rescuer activates the Emergency Medical Services.
 Get AED/ Defibrillator.

Pulse Check:
o Palpate for carotid pulse within 10 seconds
o At the same time, check for breathing.

If with definite pulse but no breathing:

o Do mouth to mouth breathing.
o Give one breath every 5-6 secs (about 12 breaths/min)
o Recheck pulse every 2 minutes.

Mouth to Mouth Breathing and Pulse Check

o For trained healthcare providers only.
o As short and quick as possible
o Pulse check not more than 10 seconds
o If unsure, proceed directly to CHEST
COMPRESSION.

After determining unconsciousness, C – A – B.

o C-ompression
 Do chest compression first
o A-irway
 Does the victim have an open airway (air passage that allows the victim to
breathe)?
o B-reathing
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 Is the victim breathing?

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4. CHEST COMPRESSION
a) Kneel facing victim’s chest
b) Place the heel of your hand on the center of the victim’s chest. Put your other hand on top
of the fist with your fingers interlaced.
c) Position shoulders over hands with elbows locked and arms straight.
d) Compress down and release pressure smoothly, keeping hand contact with chest at all
times.
e) Give chest compressions at 100-120 per
minute
 Push hard and fast.
 Compress breast bone 2-2.4
inches deep (5-6 cm)
 Compress at a rate of 100-120
per minute or more
 Compress 30 times initially
o 30 compressions should
take 15-18 secs
o Count aloud
“1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27
,28,29, and ONE.
o Minimize interruptions
 Allow chest recoil after each compression.

5. AIRWAY
 Open the airway: Use the
head tilt/ chin lift method
 Place on hand on
the victim’s
forehead
 Place the fingers of
other hand under
the bony part of
lower jaw near chin
 Tilt head and lift
jaw – avoid closing
victim’s mouth.

6. BREATHING
 Give 2 one-second breaths
 Maintain airway
 Pinch nose shut
 Open your mouth wide, take a normal breath, and make a tight seal around
outside of the victim’s mouth
 Give 2 full breaths (1 sec/breath)
 Observe chest rise & fall; listen & feel for escaping air
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 Repeat cycles of 30 compressions & 2 breaths

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7. Recheck Pulse
 Recheck pulse every 2 minutes (equivalent to 5 cycles CPR)
 Very brief pulse check – should take less than 10 seconds (at the same time check for
normal breathing)
 In case there is any doubt about the presence or absence of pulse, continue chest
compressions.
 For trained healthcare providers only.
8. Continue CPR until help arrives.
9. Victim is revived:
 Return of Spontaneous Circulation (ROSC)
10. If the victim is breathing:
 Put him in a RECOVERY POSITION:
 The unresponsive victim with spontaneous respirations should be placed in the
recovery position if no cervical trauma is suspected.
 Placement in this position consists of rolling the victim onto his or her side to
help protect the airway.

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REFERENCE

AHA Updates CPR Guidelines, 2020

https://www.pharmacytoday.org/article/S1042-0991(20)31201-9/fulltext#relatedArticles
Manual on Basic and Advanced Cardiac Life Support, Philippine Heart Association, Inc. 2018

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