Cardiopulmonary resuscitation (CPR) is indicated for any patient that is unresponsive or apnoeic or if a pulse cannot be identified in the patient. The success rate of CPR to return of spontaneous circulation (ROSC) is between 30-45%, however discharge from hospital is <5%.
A full cycle of Basic Life Support is 2 minutes long and focuses on ABC: Airway, breathing and circulation.
Airway: visualize airway and place endotracheal tube.
Breathing: ventilate with oxygen at 10 breaths per minute. Ventilation can be achieved with an anaesthetic circuit although an ambu bag is preferred.
Circulation: with patient in lateral recumbency, begin cardiac compressions at 100-120 compressions per minute. There are two techniques for chest compressions, usually depending on the size of the patient:
There are certain indications where it might be more appropriate or beneficial to enter the thoracic cavity to directly compress the heart (internal chest compressions).
Charts for emergency drugs and dosages should be accessible with the emergency drugs and emergency trolley if available. It is preferable to gain intravenous access, if this cannot be achieved then drugs can be administered via a (dog urinary) catheter which is longer than the endotracheal tube. The drugs should be diluted in saline and given at a higher dose x2. Epinephrine /adrenaline, atropine, vasopression, naloxone, and lidocaine can be given via this route.
Defibrillate as soon as possible - precordial thump could be considered if defibrillation not available.
Check blood glucose and electrolytes if possible and correct where necessary (DEFG - Don’t Ever Forget Glucose).
No clear guidelines exist as to when to stop basic life support (BLS). However, with prolonged resuscitation the chance of a successful neurological outcome is poor. 20-40 minutes can be considered depending on the patient and the suspected cause of the arrest, eg longer for a patient that has had an overdose or waiting for drugs to be reversed.
It is essential that BLS should be practiced and rehearsed to improve changes of return to spontaneous circulation (ROSC). Algorithms and drug charts can be downloaded from: http://www.acvecc-recover.org/