About Cardiopulmonary Resuscitation

Overview

1. Necessity

The occurrence of cardiac arrest is difficult to predict, and 60–80% of unexpected cardiac arrests occur in places other than medical facilities, such as homes, workplaces, and streets. Therefore, the first witnesses of cardiac arrest are often ordinary people, such as family members, coworkers, and passersby.

If 4–5 minutes pass after cardiac arrest occurs, the brain suffers irreversible damage. Therefore, only when the person who witnesses the cardiac arrest starts cardiopulmonary resuscitation immediately can the person in cardiac arrest be restored to a normal state.

Basic life support refers to the initial steps of cardiopulmonary resuscitation: when an unconscious person suspected of cardiac arrest is found, call for help, perform chest compressions, and apply a defibrillator. The purpose of basic life support is to restore the patient’s heartbeat as quickly as possible by performing chest compressions and defibrillation until advanced resuscitation is carried out when the patient develops cardiac arrest.

2. Chain of Survival

Once cardiac arrest occurs, it is very difficult to restore the patient to normal. Therefore, high-risk patients who are likely to experience cardiac arrest should first receive medical care in advance and make efforts to prevent cardiac arrest. If cardiac arrest does occur, a witness should quickly recognize the condition and immediately report it to the emergency medical system.

After making the report, the witness should immediately begin cardiopulmonary resuscitation, and the emergency medical system, upon being notified of the cardiac arrest, should promptly arrive at the scene and perform advanced resuscitation, including defibrillation. After the return of spontaneous circulation in a cardiac arrest patient, correcting the cause of the cardiac arrest and providing integrated post-cardiac-arrest care can improve the patient’s survival rate.

These series of processes to resuscitate a cardiac arrest patient are connected like links in a chain, so if any one of these elements is not carried out properly, it is difficult to expect resuscitation of the cardiac arrest patient. This concept, in which the essential steps for the survival of a patient who has suffered cardiac arrest outside the hospital must be connected to one another, is called the "Chain of Survival."

1. Prevention and early detection of cardiac arrest

The first link in the Chain of Survival is a concept newly introduced in 2015: prevention and early detection of cardiac arrest. Once cardiac arrest occurs, the survival rate is very low even if appropriate cardiopulmonary resuscitation is performed, so prevention is most important. In children, cardiac arrest is more often caused by accidents or injuries than by disease, so it can be prevented by avoiding such events in advance. In adults as well, the occurrence of cardiac arrest can be prevented by reducing risk factors for heart and cerebrovascular diseases.

When cardiac arrest occurs, the witness should recognize it quickly to shorten the time needed to report it to the emergency medical system. To do this, ordinary people who are likely to witness cardiac arrest should be educated about the symptoms of cardiac arrest so that they can recognize it promptly.

2. Rapid reporting

The first link in the Chain of Survival is the series of steps in which a witness calls the emergency medical system to report the occurrence of cardiac arrest, and the emergency medical dispatcher who receives the call dispatches the 119 ambulance team to the area where the patient is found. To do this, a reporting system must be in place so emergency patients can be reported, and the emergency number for reporting cardiac arrest in Korea is 119.

3. Rapid cardiopulmonary resuscitation

After reporting to 119 and until the ambulance crew arrives, the best emergency care is cardiopulmonary resuscitation by a witness. When a witness performs cardiopulmonary resuscitation, the survival rate is 2–3 times higher than when it is not performed. Therefore, it is advisable for schools, the military, group residences, workplaces, and public institutions to provide regular cardiopulmonary resuscitation education.

4. Effective advanced resuscitation and post-cardiac-arrest care

To restore spontaneous circulation in a cardiac arrest patient who does not respond to defibrillation, advanced resuscitation such as securing access for medication administration, administering drugs such as vasoconstrictors or antiarrhythmic agents, and advanced airway management must be performed. This is carried out by ambulance crews or medical professionals. After spontaneous circulation is restored in a cardiac arrest patient, treatment must also be provided to maintain hemodynamic stability and identify the cause of the cardiac arrest to prevent recurrence. Integrated post-cardiac-arrest care should be provided to patients whose spontaneous circulation has been restored, and this includes general intensive care as well as targeted temperature management, coronary intervention for acute myocardial infarction, and the diagnosis and treatment of seizures. Therefore, it is advisable that patients resuscitated from cardiac arrest be transferred to a medical institution or facility that can professionally carry out these treatment processes for post-cardiac-arrest care.

So far, I have explained the overview of cardiopulmonary resuscitation.

In the next installment, we will look at how to use a defibrillator and the order of steps for performing it.

Source: Korea Centers for Disease Control and Prevention National Health Information Portal