Cardiopulmonary resuscitation - when, how and what to do

Injuries, wounds, and poisoning can trigger the stoppage of the body’s main “motor”—the human heart. Stopping blood circulation entails the cessation of tissue and gas exchanges. Without blood flow, waste products accumulate inside the cells, and carbon dioxide accumulates in the blood. Metabolism stops, cells begin to die due to lack of oxygen and intoxication with metabolic products.

In this case, it is very important to at least try to carry out resuscitation measures - cardiac massage. There is a limited time allotted for this procedure - only thirty minutes. After this period, clinical death becomes irreversible.

Symptoms of cardiac arrest

Signs indicating cardiac arrest are: stopping the pulse (inability to feel the pulse in the carotid artery); respiratory arrest (the patient’s chest is motionless, a mirror brought to the mouth and nose does not fog); dilated pupils that do not respond to light; loss of consciousness, and the person does not come to his senses when hearing loud sounds or patting on the face; bluish-gray skin tone.

If there are fresh wounds on the body, then when the heart stops bleeding from them stops.

Content:

• Symptoms of cardiac arrest
• Types of heart massage
• The essence and algorithm of massage
• Rules for performing massage

Indications: who really needs this procedure

The most important thing in cardiac massage is to determine whether a person needs it or not. There is only one indication – complete cardiac arrest. This means that even if an unconscious patient has severe rhythm disturbances, but at least some cardiac activity is preserved, it is better to refrain from the procedure. Compressing the contracting heart can cause it to stop.

The exception is cases of severe ventricular fibrillation, in which they seem to tremble (about 200 times per minute), but do not perform a single full contraction, as well as weakness of the sinus node and atrioventricular block, in which the heartbeat is less than 25 beats per minute. If such patients are not helped, the condition will inevitably worsen and cardiac arrest will occur. Therefore, they can also be given indirect massage if there is no other way to help.

The rationale for the feasibility of this procedure is described in the table:

Clinical death is the stage of dying after the cessation of cardiac activity lasting 3–4 minutes. After this time, irreversible processes occur in the organs (primarily in the brain) - biological death occurs. Therefore, the only time when you need to do cardiac massage is the period of clinical death. Even if you don't know when your heart stopped and you're not sure if there's a heartbeat, look for other signs of cardiac arrest.

Types of heart massage

Today, there are two methods of cardiac massage: direct (open) and indirect (closed).

Direct massage is carried out exclusively by qualified medical professionals and only in certain conditions: in particular, during surgery on the thoracic or abdominal organs. The essence of the procedure is to directly compress the heart muscle with your hands through an incision in the chest or abdomen (in this case, the massage is carried out through the diaphragm). Due to the complexity of performing direct massage of the heart muscle, it cannot be performed by people without appropriate medical education and training.

Indirect (closed) massage of the heart muscle can be performed in any conditions. This is the simplest way to help restore cardiac activity. No medical devices are required to perform it.

Indirect cardiac massage provides that during pressure on the chest, the chambers of the heart will also be compressed. As a result, blood will enter the ventricles from the atria through the valves, and then go into the vessels. Thanks to rhythmic pressure on the chest, the movement of blood through the vessels will not stop. As a result, the organ’s own electrical activity and independent functioning are activated.

Of course, a cardiac massage can only be successful if the algorithm of action is carefully followed and the rescuer follows the approved technique for carrying out resuscitation measures. Massage must be combined with artificial ventilation. Each pressure on the victim’s chest provokes the release of about five hundred milliliters of air. When the compression stops, the same portion of air is sucked into the lungs. As a result, passive inhalation and exhalation occur.

RULES FOR CONDUCTING INDIRECT HEART MASSAGE
AND NON-VENTILATION RESUSCITATION OPTION
Remember! The priority of action is first indirect cardiac massage, and only then, if possible, inhalation of artificial respiration. Moreover, if discharge from the mouth of a dying person poses a threat of infection or poisoning by poisonous gases, then you should limit yourself to performing chest compressions (a non-ventilated version of resuscitation). With each compression of the chest by 3-5 cm during chest compressions, the lungs are expelled up to 300-500 ml of air. After compression stops, the chest returns to its original position and the same volume of air is sucked into the lungs. Active exhalation and passive inhalation occur.

Remember! When performing chest compressions, your hands are not only the heart, but also the lungs of the victim.

Rule one If the victim is lying on the ground, you should definitely kneel in front of him. It doesn’t matter from which side you approach it. However, for right-handed people, it will be more convenient to deliver a precordial blow if the victim is on the side of their right hand.

Rule two For indirect cardiac massage to be effective, it must be performed on a flat, hard surface.

Rule three Place the base of the right palm above the xiphoid process so that the thumb is directed towards the chin or stomach of the victim. Place your left palm on the palm of your right hand.

Rule four: Move the center of gravity to the victim’s sternum and perform indirect cardiac massage with straight arms. This will allow you to maintain strength for as long as possible. Bend your elbows when performing chest compressions is equivalent to performing the physical exercise “push-ups”. If we take into account that with a rhythm of 60–100 pressures per minute, it is necessary to carry out resuscitation for at least 30 minutes even if it is ineffective (it is after this time that signs of biological death will clearly appear), then even an Olympic champion in gymnastics Remember! For children, indirect cardiac massage can be performed with one hand, and for a newborn - with two fingers.

Rule five: Push the chest at least 3-5 cm with a frequency of 60-100 times per minute, depending on the elasticity of the chest. Remember! Your palm should not leave the victim’s sternum.

Rule six You can begin applying pressure on the chest only after it has completely returned to its original position. If you do not wait until the sternum returns to its original position and take your hands off it, then the next push will turn into a monstrous blow. Remember! In cases of rib fractures, in no case should you stop indirect cardiac massage. You just need to reduce the frequency of pressing to allow the chest to return to its original position, but be sure to maintain the same depth of pressing.

Rule seven The optimal ratio of chest compressions and mechanical ventilation breaths is 30:2, regardless of the number of participants. With each pressure on the chest, an active exhalation occurs, and when it returns to its original position, a passive inhalation occurs. Thus, new portions of air enter the lungs, sufficient to saturate the blood with oxygen. Remember! When performing resuscitation, priority should be given to chest compressions rather than ventilator breaths.

Unacceptable! Stop chest compressions even if there are no signs of its effectiveness until signs of biological death appear.

The essence and algorithm of massage

External cardiac massage is a rhythmic compression of the heart by compression between the sternum and the spine. Experts note that the chest of a person with cardiac arrest becomes more pliable due to loss of muscle tone, making it easy to perform compressions. The person providing assistance, if the NMS technique is followed, can easily displace the chest by three to five centimeters. Compression of the heart leads to a decrease in its volume and an increase in intracardiac pressure.

Rhythmic pressure on the chest area results in a difference in pressure inside the heart cavities, the blood vessels that extend from the heart muscle. Blood from the left ventricle travels through the aorta to the brain, while from the right ventricle it flows to the lungs, where it is oxygenated.

After the pressure on the chest stops, the heart muscle straightens, intracardiac pressure decreases, and the chambers fill with blood. As a result, artificial circulation is recreated.

You can perform a closed massage of the heart muscle only on a hard surface. The person must be placed on the floor. After this, it is necessary to perform the so-called precordial punch. It should be directed to the middle third of the chest. The impact height should be thirty centimeters. However, according to recent data, the value of the precordial stroke is significantly reduced, and many experts do not recommend starting resuscitation measures with it. In order to conduct a closed cardiac massage, the person providing assistance places the palm of one hand on the other, after which he begins to carry out uniform pushes according to the established technique.

Rules for performing massage

For the emergency measures taken to be effective, it is extremely important to follow the cardiac massage technique. Only in this case, the efforts made to restore the victim’s cardiac activity can be justified.

When performing cardiac massage, the following rules should be observed:

1. The rescuer kneels in front of the victim lying on the ground or floor. It doesn't matter which side he is on. However, if the rescuer is right-handed, it will be more convenient for him to perform a precordial blow if he places his right hand towards the victim.
2. Place the base of your right palm slightly above the xiphoid process. The thumb should be directed either towards the chin or towards the victim’s abdomen.
3. The arms of the person performing chest compressions must be fully straightened. When the chest is displaced, the center of gravity must be moved to the chest of the person being assisted. As a result, the rescuer will be able to preserve his strength. If you bend your arms at the elbow joints, they will quickly get tired.
4. For resuscitation to be successful, first aid must arrive within half an hour. The frequency of pressure on the victim’s chest is sixty times per minute.
5. The depth to which chest compressions must be performed is three to five centimeters. In this case, the person providing assistance should not take their palms off the victim’s chest.
6. The next pressure on the chest should be done only after it returns to its original position.
7. During NMS, rib fractures are possible. This is not a reason to stop resuscitation measures. The only clarification is that pressure should be performed a little less often, but their depth should remain the same.
8. Simultaneously with NMS, artificial respiration is also performed. The ratio of chest compressions to ventilation should be 30:2. Compression on the victim's chest provokes exhalation, and the return of the chest to its original position is a passive inhalation. As a result, the lungs are saturated with oxygen.
9. During resuscitation measures, more attention should be paid to closed cardiac massage rather than artificial respiration.

Algorithm for performing indirect cardiac massage

Closed cardiac massage will be effective only if it is performed in accordance with the algorithm. You must proceed as follows:

1. First of all, determine the place where the compression will be carried out. There is a common belief that a person's heart is on the left. This is not entirely true. In fact, you should not press on the left side, but on the center of the chest. This is extremely important, because if you apply compression to the wrong place, you can not only fail to achieve the desired effect, but also cause harm. The point that we need is located in the center of the chest, at a distance of two fingers from the center of the sternum (where the ribs touch).
2. Place the heel of your palm at this point so that your thumb “looks” either at the victim’s stomach or chin, depending on which side of him you are on. Place your second palm crosswise on top of the first. Please note that only the base of the palm should be in contact with the body of the person you are helping. Fingers should remain hanging.
3. Don't bend your elbows. It is necessary to apply pressure using your own weight, and not the strength of your arm muscles, because otherwise you will quickly get tired, and the force of pressure at each point will be different.
4. With each pressure, the victim's chest should drop to a depth of five centimeters. In other words, the compression must be strong, because this is the only way you will be able to properly disperse the blood throughout the body so that it delivers oxygen to the brain.
5. Artificial ventilation is performed between compressions. Its cyclicity is two breaths for every fifteen shocks.

Signs that resuscitation was successful are the appearance of a pulse in the area of ​​the carotid artery, as well as the reaction of the person’s pupils to light.

Conducting a closed heart massage for a child

Unfortunately, sometimes there are situations when, for one reason or another, a child’s heart stops. In this case, the reaction of people nearby should be immediate - the baby must immediately begin closed heart massage, since every second of lost time brings a tragic outcome closer.

In infants, clinical death can be caused not only by sudden death syndrome, but also by neurological diseases, sepsis, drowning, airway obstruction, acute bronchospasm, pneumonia, severe trauma or serious burns and other diseases.

Indications for chest compressions for infants and older children are: sudden deterioration in the child’s condition, fainting, absence of heartbeat when palpating the carotid artery, cessation of respiratory activity, lack of pupillary response to light.

Features of the procedure for children

Carrying out resuscitation of children has a number of features.

First of all, chest compressions should begin in babies immediately after signs of clinical death have been detected. At the same time, artificial respiration is carried out, before starting which it is necessary to ensure the free passage of air through the respiratory tract.

Indirect cardiac massage in newborns is performed with little effort. Infants are placed on their backs, with their shoulders facing them. The thumbs should touch the front of the chest, and their base will be on the lower third of the chest.

In addition, a closed massage of the heart muscle of a newborn can be performed by placing it on your forearm, and holding its head slightly tilted back in the palm of your hand.

When performing NMS, children under one year of age should use only two fingers for pressure - the second and third. The frequency of compressions should be from eighty to one hundred per minute.

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Heart massage for children aged one to seven is done while standing to the side of them, using the heel of the palm.

When resuscitating children over eight years old, massage is done with both hands. The main thing when performing NMS for a child is to carefully calculate the strength. Excessively strong pressure can lead to damage to the chest, which, in turn, can lead to injuries to internal organs and the development of hemo- and pneumothorax.

Step-by-step instructions for massage, recommendations, warnings

The sequence of actions that make up the technique of indirect cardiac massage includes:

1. Determine whether the patient has a pulse and heartbeat:

• Feel the anterolateral surfaces of the neck with your fingers in the projection of the location of the carotid arteries. The absence of pulsation indicates cardiac arrest.
• Listen with your ear or phonendoscope to the left half of the chest.

2. If you doubt the absence of heartbeats, before performing chest compressions, determine other signs of clinical death:

• complete lack of consciousness and any reactions to your actions;
• wide pupils that do not respond to light;
• no breathing.


Signs of clinical death

3. If these signs occur, feel free to begin chest compressions, following the technique:

• Place the patient on his back, but only on a hard surface.
• Open the patient's mouth, if there is mucus, vomit, blood or any foreign bodies in it, clean the oral cavity with your fingers.
• Tilt the victim's head back well. This will prevent the tongue from retracting. It is advisable to fix it in this position by placing any cushion under the neck.
• Stand to the patient's right at chest level.
• Place the hands of both hands on the sternum at a point that is located two fingers above the lower end of the sternum (the border between the middle and lower third).
• The hands should lie in this way: the fulcrum of one hand is the soft part of the palm in the area of ​​​​the eminence of the thumb and little finger just below the wrist. Place the second hand on the one located on the chest and interlace their fingers into a lock. Fingers should not rest on the ribs, as they can cause fractures during the massage.
• Bend over the victim so that with your correctly positioned hands you seem to be resting on the sternum. Arms should be straight (elbows bent).

Click on the photo to enlarge
The technique for performing chest compressions should be as follows:

1. At least 100 times per minute.
2. So that it is pressed in 3–5 cm.
3. Apply compression not by bending and straightening your arms at the elbows, but by applying pressure throughout your entire body. Your hands should be a kind of transmission lever. This way you won’t get tired and will be able to massage as much as you need. This procedure requires a lot of strength and energy.

Click on photo to enlarge

Indirect cardiac massage can last about 20 minutes. After every minute, assess whether a pulse appears in the carotid arteries. If after this time the heartbeat has recovered, further massage is not advisable.

It is not necessary to perform artificial respiration simultaneously with cardiac massage, but it is possible. The correct technique in this case: after 30 pressures, take 2 breaths.