Cardiopulmonary resuscitation is a means of restoring circulation to the body when the heart has ceased pumping on its own due to myocardial infraction (heart attack), massive hemorrhage (excessive blood loss), or other physiological reasons. It maintains the oxygen content of the blood and manually distributes it to the cells of the body where it is needed, especially the brain. Brain cells cannot endure more than about four minutes without oxygen or extreme and irreversible brain damage ensues. The following steps for cardiopulmonary resuscitation are not meant to be an absolute guide for performing this lifesaving procedure, but rather as a reminder for those who have forgotten their skills, or an introduction for those who are interested in taking an instructional class in the future.

A person is not legally insured to perform CPR unless he has passed a written and skills exam and been certified by an organization such as the American Red Cross. It is highly encouraged that everyone receive this basic training.

In order to perform CPR and obtain maximum efficiency per compression, the victim must be placed flat on his/her back on a hard surface. This may require that the patient be moved from a soft surface, such as a bed, to the floor. Unresponsiveness must be ascertained by shouting and shaking the patient at the shoulders. Loudly ask, “Are you okay?” If unresponsiveness continues, call 911 or local emergency medical system. If other people are in the vicinity, order one particular person to do this so that you may begin CPR immediately. Select one person so that he/she is personally responsible for activating the emergency medical system, and inform them of the status of the patient so they can pass the information on to the operator.

The first step of CPR is ensuring adequate airway in the patient. The position of the head is termed “head-tilt/chin-lift,” and is achieved by pressing down on the forehead with the heel of one hand and pushing up on the chin with the fingers of the other hand. This positions the airway so that there is minimal obstruction from tissue surrounding the trachea and the airway is open.

The second step is restoring breathing to the patient. With the first step completed, position your cheek directly above the victim’s nose and mouth so that any breath coming in or out of the patient’s nose or mouth will be felt warm on your cheek, and any breathing noises can be heard. Your eyes should be directed toward the victim’s chest to watch for rising and falling which indicate respiration. Your hand can also be placed lightly on the chest to feel for rising and falling of the chest as well. Perform this look, listen and feel method for 5-10 seconds. If the patient is breathing but unconscious, DO NOT perform CPR, just wait for the ambulance.

If the patient is not breathing, pinch his/her nose closed and give 2 full, slow breaths into the victim’s mouth using a microshield, if possible. It is up to the discretion of the rescuer whether to perform CPR if a microshield is unavailable. It is important that the breaths not be too shallow because the blood will not be adequately oxygenated. Furthermore, you should wait for the chest to rise and fall before delivering the second full breath. If the breath does not go in, reposition the head using head-tilt/chin-lift method and try again. If the breath still does not go in, then the airway is obstructed and the Heimlich maneuver should be performed using abdominal thrusts. If the breaths do go in, proceed to the next step.

The last step in CPR is circulation, which is evaluated by checking the carotid pulse at the side of the trachea in the neck. Feel for 5-10 seconds. If there IS a pulse, continue rescue breathing at a rate of 1 breath every 5 seconds (12 breaths per minute) and DO NOT perform compressions. If there is no pulse, chest compressions should be begun by placing the heel of one hand over the lower part of the sternum, approximately 2 fingers’ width above the very tip of the sternum. Place the other hand directly above the first hand with palms down, and interlock fingers. Depress the sternum 1.5 to 2 inches per compression. The mechanism of this compression actually compresses the heart between the sternum bone and the vertebrae, causing it to manually expel blood and naturally refill, distributing blood throughout the body without actually contracting the cardiac muscle. The rate of compression is 15 compressions to every 2 breaths (80-100 compressions per minute). Every minute, the presence of a pulse should be re-evaluated at the carotid artery.

This procedure should continue uninterrupted until advanced life support arrives. A brief summary of the procedure of CPR is the ABC’s: Airway, Breathing, and Circulation. When these are assessed and treated sequentially and CPR is properly performed, the life-sustaining effects of CPR can be attained.