Cardiopulmonary Resuscitation (CPR) is an emergency life-saving procedure performed when the heart stops beating. The primary goal is to maintain minimal blood flow to the brain and heart until advanced medical help arrives. The process relies on the Chain of Survival, a sequence of coordinated actions that significantly improves survival rates from cardiac arrest.
Before touching a collapsed patient, the rescuer must ensure the environment is completely safe. Rushing into a hazardous scene creates multiple casualties. Once safety is established, check for responsiveness by tapping the patient's shoulders and shouting loudly. Look for normal breathing while simultaneously scanning for chest movement. Do not mistake occasional gasping, known as agonal breathing, for normal breathing; agonal gasps indicate cardiac arrest and require immediate action. If the patient is unresponsive and not breathing normally, activate the emergency response system and retrieve an automated external defibrillator immediately.
High-quality chest compressions are the cornerstone of effective resuscitation. Place the heel of one hand on the center of the patient's chest—the lower half of the sternum—and place your other hand on top, interlocking your fingers. Position your shoulders directly over your hands with your elbows locked straight.
Push hard and push fast. For an adult, compress the chest to a depth of at least 5 centimeters (2 inches) but not more than 6 centimeters, at a rate of 100 to 120 compressions per minute. Allow complete chest recoil between compressions to let the heart chambers refill with blood. Minimize interruptions in compressions; pauses should never exceed 10 seconds.
Opening the airway is vital because the tongue often falls back and blocks the pharynx in an unconscious person. Use the head-tilt, chin-lift maneuver to open the airway, unless a cervical spine injury is suspected, in which case the jaw-thrust maneuver is preferred.
Deliver rescue breaths using a barrier device, bag-valve-mask (BVM), or mouth-to-mask technique. Each breath should be delivered over one second, just enough to make the chest rise visibly. Avoid excessive ventilation, as too much air or high pressure can enter the stomach, causing gastric distension and subsequent aspiration.
An Automated External Defibrillator (AED) analyzes the heart rhythm and delivers an electric shock if a shockable rhythm like ventricular fibrillation or pulseless ventricular tachycardia is detected. As soon as the AED arrives, turn it on and follow the visual and voice prompts.
Apply the adhesive electrode pads to the bare chest according to the diagrams on the pads—typically one on the upper right chest and the other on the lower left side. Ensure no one is touching the patient while the AED analyzes the rhythm or delivers a shock. Immediately resume chest compressions after the shock is delivered.
Advanced Cardiac Life Support (ACLS) expands on basic life support by introducing invasive airway management, vascular access, and targeted pharmacology. Advanced providers insert endotracheal tubes or supraglottic airways to secure a definitive airway and allow continuous chest compressions without pausing for breaths.
Intravenous or intraosseous lines are established to administer emergency drugs. Vasopressors like epinephrine are given to constrict peripheral blood vessels and improve coronary and cerebral perfusion pressures. Antiarrhythmic medications such as amiodarone are utilized for refractory shockable rhythms.
When spontaneous circulation returns, post-resuscitation care begins. The immediate goals are to optimize ventilation and oxygenation, maintain hemodynamic stability, and identify the precipitating cause of the arrest. Targeted temperature management may be implemented to protect neurological function in comatose patients.
Common complications following prolonged CPR include fractured ribs, sternal bruising, pneumothorax, and aspiration pneumonia. Nurses must continuously monitor vital signs, urine output, and neurological status to detect early signs of deterioration.
Resuscitation efforts present complex ethical and legal dilemmas for healthcare professionals. A Do Not Resuscitate (DNR) order is a legally binding document instructing providers not to attempt CPR if breathing or heart function ceases. In the absence of a valid DNR, nurses have a legal and ethical duty to initiate life-saving measures.
Resuscitation should be withheld or stopped if there are obvious signs of irreversible death, such as rigor mortis, decapitation, or dependent lividity. Nurses must respect patient autonomy and advance directives while balancing the duty to preserve life.