Using chest compressions and rescue breaths with a view of
sustaining supply of oxygenated blood to vital organs, in particular brain, is
what constitutes cardiopulmonary recovery (CPR); the ultimate aim being to
prevent death or everlasting damage to brain tissue due to lack of oxygen.
Paramedics tend to use stipulations such as CPR, basic life
support (BLS) or fully developed basic life carry more often while
‘mouth-to-mouth respiration’ is more of a layman’s term.
CPR and endurance Rates in Cardiac Arrest Patients
According to a study accepted out by the University of
Amsterdam, the outcomes of out-of-hospital cardiac arrests can be altered
favourably by timely administration of CPR1. While studying the effects of CPR
on continued existence rates of cardiac arrest patients, Fergusson found that
not only does CPR positively influence survival rates but it may be the single
most effective conduct to buy time until ‘expert help’ arrives2. Furthermore,
research has shown that the probability of survival more than double if CPR is administer
during the overriding period before hospitalization3.
With more than three-quarters of cardiac arrests occurring
out-of-hospital3 and the proven
effectiveness of CPR in growing chances of
survival, CPR does indeed appear to be the proverbial ‘kiss of life’.
Importance of CPR in Sports
Cases of cardiac arrest important to death in athletes,
either due to cardiovascular causes (sudden death) or a blunt trauma to the
chest (commotio cordis), have always intrigued sport medicine researchers.
Increased adrenergic drive combined with altered anatomical and physiological
variables in high power sports can cause abnormal rhythm of the heart4. These
cardiac arrhythmias render the heart inefficient (as a pump); passage and
oxygenation of brain suffers ensuing in death.
Sudden death in sports is not a rare observable fact by any
stretch of imagination. An Italian study spanning 2 decades had reported an frequency
of 1 in 100,000 population per year and definitely identified the involvement
of sports with cardiac arrest5 (incidence of 2.3 per 100,000 in athletes as
compared to 0.9 per 100,000 in non-athletes6).
A more current study carried out in France reports an
incidence of 4.6 per million populations per year; 6% of these living being in ready
for action athletes7.
In a exposition study of the causes of death and types of
injuries in crevasse accidents, Hohlrieder et. al. reported that trauma and
asphyxia were mainly responsible for deaths. Of the survivors, the ones who
suffered cardiac arrests and were administer CPR continuously during migration
responded favourably and had a much better chance of survival then those who suffer
other life bullying injuries like critical multisystem disturbance and
hypothermia8.
apart the benefits of spectator sport and physical activity,
close relation of sudden death with these has tempt Corado et. al. to call
physical activity a ‘double-edged sword’9.
Aims of Delivering CPR
As avowed earlier, the immediate goals of delivering CPR is
to maintain patent airways and normal blood circulation without the use of (or
with barest minimum) utensils until such a time that expert help arrives or the
victim is relocate to the hospital.
The above are achieved by delivering ‘chest compressions’
and ‘rescue breaths’.
The purpose of the whole do exercises is twofold:
1. To ensure appropriate oxygenation of blood as it passes all
the way through the lungs
2. To preserve pumping of the heart so that oxygenated blood
is supplied to the brain (interruption of blood supply to the brain for as
little as 10 seconds can cause irretrievable damage)
CPR Procedure: The progression of Events
The acronym ‘DR-ABC’ or ‘Doctors’ ABC’ can be used to
remember the steps in delivering CPR.
1. Danger: assess immediate danger to the patient, other players
and self. For example, before running on to the field to attend to an sportsperson
who has ‘gone down’, it should first be confirmed that the referee has stopped
the game.
2. Response: check if the athlete is cognizant; gentle
tapping on the shoulder or asking if he/she is OK can do the trick.
If there is retort, put the athlete in recovery position
(provided there are no injuries) and check regularly.
If there is no response, call emergency (911/999) and
initiate CPR.
3. Airway: tilt head backwards and lift the chin so as to
open the mouth; obstructions if any are to be removed gently.
4. Breathing: ‘look, listen and feel’ for respiration: look
for chest movements, listen to breath sounds by bringing your ear close to the
athlete’s nose and feel the warmth of the athlete’s breath on your cheek.
If breathing, put the athlete in lateral recovery position
and dial urgent situation services; keep checking the athlete’s condition sporadically.
If not breathing, call urgent situation and start CPR.
5. Circulation: can be assess by feeling the carotid pulse
by the side of the neck. This be supposed to be done for not more than 10
seconds.
If pulse is in attendance, put the patient into recuperation
position and monitor.
If pulse is absent (or when in doubt), initiate chest density
followed by set free breaths. Send your colleague to get help. If you are
alone, get help first and then revisit to initiate CPR.
There are exceptions to these wide-ranging rules: in cases
of drown or in children, CPR should be imparted for a minute before departure
for help.
Although the succession of events, ‘DR ABC’ in CPR has been
followed for years, the new American Heart Association guidelines of 2010
suggest chest compressions to be initiated without assassination valuable time
in assessing airway and breathing. Thus, ‘ABC’ is now ‘CAB’.
Chest Compressions and Rescue breath: How To?
Chest Compressions:
1. place your hands on top of each other and interlock
fingers
2. place the heel of the bottom hand in the focus of the
chest at the level of the sternum (breast bone)
3. take care that your arms are perpendicular to the ground
so that you can deliver chest compressions efficiently; this will also ensure
that you conserve energy and avert fatigue
4. chest should be compacted a minimum of 4 to 5 cm; a full
recoil should be allowed before commencing the next compression
5. rate of chest compressions should be 100 per minute (a
total of 30 compressions should be given before delivering 2 breaths and then
carrying on with compressions)
Rescue breaths:
1. Titling the head backwards, pinch the patient’s nose and
make a seal over the patient’s mouth with yours. If a CPR kit is available, you
can make use of a CPR representative.
2. If you have concern over giving a ‘mouth-to-mouth’, bear
on giving chest compressions till such a time that lend a hand arrives.
Please note that:
1. CPR involves giving alternating chest compressions and
breaths: the ratio being 30:210
2. During trunk compressions, do not worry if ‘crack a few
ribs’; a few broken ribs won’t do much harm
3. Breaths should be forceful enough to make the chest rise
up; do not go for the second breath till you see the chest deflate finally
4. If concerned about benevolent breaths, carry on with
chest compression
5. After every link of minutes, check for recovery; if
patient is still not mouthful of air, continue with CPR
6. keep on with the cycle of alternate compressions and
breaths till such a time that uncomplaining recovers, expert help arrives or
you become done in.
To conclude, there is a very real risk of a cardiac arrest
and sudden death in competitive as well as spare time sports. In spite of the
proven effectiveness of CPR in growing survival chances in pulse-less and
non-breathing athletes and the fact these events are witness by a number of
individuals, very few of the victims are administer CPR7.
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