Cardiopulmonary Resuscitation (CPR) is a critical emergency technique used to save patients experiencing cardiac arrest. When a patient’s heartbeat or breathing stops, CPR temporarily maintains blood circulation and oxygen supply through chest compressions and artificial respiration, buying time for subsequent medical interventions. This technique is applicable in both in-hospital and out-of-hospital emergencies, such as heart attacks, drowning, or severe trauma-induced respiratory and circulatory failure.
The primary goal of CPR is to immediately restore blood flow to the brain and vital organs, reducing permanent damage caused by hypoxia. Modern CPR standards emphasize the priority of chest compressions, especially when performed by lay rescuers, who may focus on compressions without mandatory mouth-to-mouth breaths to increase willingness to intervene.
CPR mainly consists of two components: "Chest Compressions" and "Rescue Breaths." Chest compressions involve rhythmically pressing the sternum at least 5 centimeters deep to mimic the heart’s pumping function, maintaining blood flow to the brain and body. Rescue breaths are delivered via mouth-to-mouth or face mask to provide necessary oxygen to the lungs.
In medical settings, CPR may be combined with defibrillation to form "CPR-Defibrillation Cycles." The physiological mechanism involves: chest compressions generating blood flow to sustain core organ metabolism, while artificial respiration replenishes oxygen in the blood. The combination can delay cellular death and bridge the time until professional rescue arrives.
Applicable to all patients with ineffective breathing due to cardiac arrest. Common scenarios include ventricular fibrillation, asystole (cardiac arrest), pulselessness caused by severe hypotension, or respiratory and circulatory failure due to trauma. This technique is also suitable for children and infants, with adjustments in compression depth and ratio.
Not suitable for patients who still have spontaneous breathing or a pulse. If the patient exhibits rapid breathing but maintains a pulse, priority should be given to airway obstruction management or oxygen therapy rather than CPR. Rescuers must confirm unresponsiveness and absence of normal breathing before initiating CPR.
Non-professionals should primarily perform chest compressions: interlock both hands on the lower half of the sternum, pressing vertically at a rate of 100-120 compressions per minute. For adults, the depth should be 5-6 centimeters; for children, about 5 centimeters; for infants, 2-3 centimeters. If safe, incorporate cycles of 30 compressions followed by 2 rescue breaths.
Medical professionals must strictly adhere to the "30:2" compression-to-breath ratio, rotating rescuers every 2 minutes to maintain compression quality. Upon AED arrival, immediately coordinate defibrillation with CPR. Continue until the patient regains spontaneous circulation, professional rescue arrives, or the environment becomes unsafe.
CPR can immediately restore partial blood flow to the brain and heart, significantly increasing the success rate of subsequent treatments such as defibrillation. Statistics show that immediate CPR can increase survival rates for cardiac arrest patients by 2-3 times. Its advantages include high accessibility, and trained rescuers can initiate life-saving procedures promptly.
This technique requires no special equipment; chest compression-only CPR reduces operational barriers. Starting CPR within the golden 4 minutes of cardiac arrest effectively delays brain cell death and gains critical time for further medical intervention.
Potential complications include rib fractures, sternum fractures, lung injuries, or internal bleeding. Excessive chest compressions may cause rib fractures in 10-30% of cases, but this risk is secondary to the need to save lives. In infants and children, due to more fragile bones, pressure should be carefully controlled.
Important Notice: Incorrect execution may cause airway damage or delay proper treatment. If the patient is unresponsive due to causes other than cardiac issues (e.g., hypoglycemic coma), CPR may not improve the condition and other emergency measures should be employed.
Contraindications include severe thoracic deformities, known irreversible death (e.g., end-stage cancer), or explicit do-not-resuscitate (DNR) orders. Before performing, ensure the environment is safe to avoid performing CPR in moving vehicles or unstable locations.
Contraindications also include sternum fractures, severe thoracic abnormalities, or known irreversible brain injury. For overweight patients or those with a history of thoracic surgery, inform rescuers to assess risks. During CPR, continuously monitor the patient’s pulse and breathing, avoiding prolonging ineffective resuscitation.
CPR should be combined with Automated External Defibrillators (AED) to form the "CPR + AED" golden combination. If used with medications (e.g., adrenaline), administer quickly during compressions to ensure circulation of the drug throughout the body. When used with airway management techniques like intubation, coordinate the timing of compressions and ventilation.
Interactions to avoid include excessive compressions before confirming cardiac rhythm, which may interfere with rhythm interpretation. In cases of respiratory depression caused by certain analgesics (e.g., excessive sedatives), CPR remains the only effective emergency measure and should be prioritized.
Studies show that immediate CPR increases the 30-day survival rate of cardiac arrest patients from 6% to 20-30%. The American Heart Association reports that each minute of delay in starting CPR decreases survival by 7-10%. Compression-only CPR has been proven to have comparable survival rates to traditional CPR but is easier for the public to learn.
Large clinical trials confirm that correctly performed CPR maintains coronary artery blood flow and keeps cerebral oxygenation within 30-40% of normal levels. Bystander CPR in out-of-hospital cardiac arrest cases can increase survival to hospital by 2-3 times.
In medical facilities, mechanical CPR devices or extracorporeal circulation systems may be used, but these cannot replace immediate on-site CPR. If the cause is reversible (e.g., electrolyte imbalance), treat the primary condition concurrently. For infants, two-finger compressions may replace adult techniques.
Currently, no complete substitute exists; all cardiac arrest cases require CPR as the first-line intervention. Other supportive measures such as intubation or vasoactive drugs should be performed concurrently with CPR to be effective.
Before performing CPR, ensure the location is well-ventilated and spacious enough to move freely. Remove hard objects (such as keys or belts) from the patient to prevent injury. Quickly expose the patient’s chest by removing clothing, and confirm that someone has called emergency services and prepared an AED. In public places, designate personnel to direct and evacuate bystanders to maintain airflow.
How should I handle a patient who develops rib fractures after CPR?Overly forceful CPR may cause rib fractures. If the patient experiences chest pain or difficulty breathing, stop compressions immediately and notify medical personnel. Use sandbags to stabilize the chest during initial aid to reduce movement, and follow up with X-ray or CT scans to assess injury severity. Doctors may prescribe pain relief or recommend short-term bed rest; severe cases may require orthopedic consultation for potential surgery.
What lifestyle adjustments are recommended during recovery after CPR?During recovery, patients should avoid lifting heavy objects for at least four weeks and follow cardiologist advice to gradually resume exercise. If the cardiac arrest was due to heart problems, medications to control blood pressure and cholesterol should be taken, and smoking and alcohol consumption should be avoided. Light aerobic activities like walking are recommended, but strenuous activities that may trigger palpitations should be avoided.
What are the key differences in the sequence of using CPR and AED?When a patient is unresponsive with no breathing and no pulse, start chest compressions (CPR) rather than immediately searching for an AED. If an AED is found within 2 minutes, use it immediately; if not, continue CPR until professional rescue arrives. AEDs should be used in shifts to avoid delays, and do not wait for the device to arrive before starting rescue efforts, as the golden rescue window is within 4-6 minutes.
What complications might occur if an untrained bystander performs CPR?Untrained rescuers may cause rib or sternum fractures due to uneven force application, or compress the liver or spleen if hand placement is incorrect. It is recommended that the general public attend CPR training courses to learn proper techniques, such as the "interlocked hands" method and maintaining a rate of 100-120 compressions per minute. Legally, Taiwan’s "Good Samaritan Law" protects rescuers, but improper technique may increase the risk of complications for the patient.
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