Resuscitation actions in case of cardiac arrest. Resuscitation measures. Examples of specific situations and algorithm for diagnosis and action

Resuscitation measures are the actions of a doctor in case of clinical death, aimed at maintaining the functions of blood circulation, breathing and revitalizing the body. There are two levels of resuscitation measures: basic And specialized resuscitation. The success of resuscitation measures depends on three factors:

Early recognition of clinical death;

Immediate initiation of basic resuscitation;

The rapid arrival of professionals and the start of specialized resuscitation.

Diagnosis of clinical death

Clinical death (sudden cardiac arrest) is characterized by the following signs:

Loss of consciousness;

Absence of pulse in the central arteries;

Stopping breathing;

Absence of heart sounds;

Pupil dilation;

Change in skin color.

However, it should be noted that to state clinical death and begin resuscitation measures, the first three signs are sufficient: lack of consciousness, pulse in the central arteries and breathing. After the diagnosis is made, basic cardiopulmonary resuscitation should begin as soon as possible and, if possible, call a team of professional resuscitators.

Basic cardiopulmonary resuscitation

Basic cardiopulmonary resuscitation is the first stage of care, the timeliness of which determines the likelihood of success. Conducted at the site of discovery of the patient by the first person possessing her skills. The main stages of basic cardiopulmonary resuscitation were formulated back in the 60s of the 20th century by P. Safar.

A - airway- ensuring free patency of the airways.

IN - breathing- Ventilator.

WITH - circulation- indirect cardiac massage.

Before starting these stages, it is necessary to place the patient on a hard surface and place him in a supine position with his legs elevated to increase blood flow to the heart (elevation angle 30-45? C).

Ensuring free airway patency

To ensure free patency of the airways, the following measures are taken:

1. If there are blood clots, saliva, foreign bodies, or vomit in the oral cavity, it should be mechanically cleaned (the head is turned to the side to prevent aspiration).

2. The main method of restoring airway patency (in case of tongue retraction, etc.) is the so-called triple technique of P. Safar (Fig. 8-9): straightening the head, moving the lower jaw forward, opening the mouth. In this case, you should avoid straightening your head if you suspect a cervical spine injury.

3. After completing the above measures, take a test breath of the “mouth to mouth” type.

Artificial ventilation

Mechanical ventilation begins immediately after the patency of the upper respiratory tract is restored, and is carried out according to the “mouth to mouth” and “mouth to nose” type (Fig. 8-10). The first method is preferable; the person resuscitating takes a deep breath, covers the victim’s mouth with his lips and exhales. In this case, you should pinch the victim’s nose with your fingers. In children, breathing into the mouth and nose is used at the same time. The use of air ducts greatly simplifies the procedure.

General rules of mechanical ventilation

1. The injection volume should be about 1 liter, the frequency should be approximately 12 times per minute. The blown air contains 15-17% oxygen and 2-4% CO 2, which is quite enough, taking into account the air in the dead space, which is close in composition to atmospheric air.

2. Exhalation should last at least 1.5-2 s. Increasing the duration of exhalation increases its effectiveness. In addition, the possibility of gastric dilation, which can lead to regurgitation and aspiration, is reduced.

3. During mechanical ventilation, airway patency should be constantly monitored.

4. To prevent infectious complications, the resuscitator can use a napkin, handkerchief, etc.

5. The main criterion for the effectiveness of mechanical ventilation: expansion of the chest when air is injected and its collapse during passive exhalation. Swelling of the epigastric region indicates a distended stomach. In this case, you should check the airway or change the position of the head.

6. Such mechanical ventilation is extremely tiring for the resuscitator, so as soon as possible it is advisable to switch to mechanical ventilation using simple “Ambu” type devices, which also increases the effectiveness of mechanical ventilation.

Rice. 8-9. Triple technique of P. Safar: a - retraction of the tongue; b - extension of the head; c - extension of the lower jaw; d - mouth opening

Rice. 8-10. Types of artificial respiration: a - mouth to mouth; b - mouth to nose; c - in the mouth and nose at the same time; g - using an air duct; d - position of the air duct and its types

Indirect (closed) cardiac massage

Indirect cardiac massage is also classified as basic cardiopulmonary resuscitation and is carried out in parallel with mechanical ventilation. Chest compression leads to restoration of blood circulation due to the following mechanisms.

1. Heart pump: compression of the heart between the sternum and the spine due to the presence of valves leads to mechanical squeezing of blood in the desired direction.

2. Chest pump: compression causes blood to be squeezed out of the lungs and sent to the heart, which greatly helps restore blood flow.

Choosing a point for chest compression

Pressure on the chest should be applied in the midline at the border of the lower and middle third of the sternum. Usually, moving the IV finger upward along the midline of the abdomen, the resuscitator feels the xiphoid process of the sternum, applies another II and III to the IV finger, thus finding the point of compression (Fig. 8-11).

Rice. 8-11. Selection of compression point and indirect massage technique: a - compression point; b - hand position; c - massage technique

Precordial stroke

In case of sudden cardiac arrest, a precordial shock may be an effective method. Using a fist from a height of 20 cm, strike the chest twice at the point of compression. If there is no effect, proceed to closed cardiac massage.

Closed heart massage technique

The victim lies on a rigid base (to prevent the possibility of displacement of the entire body under the influence of the hands of the resuscitator) with raised lower limbs (increased venous return). The resuscitator is positioned on the side (right or left), puts one palm on top of the other and applies pressure to the chest with arms straightened at the elbows, touching the victim at the point of compression only with the proximal part of the palm located below. This increases the pressure effect and prevents damage to the ribs (see Fig. 8-11).

Intensity and frequency of compressions. Under the influence of the resuscitator’s hands, the sternum should shift by 4-5 cm, the frequency of compressions should be 80-100 per minute, the duration of pressure and pauses should be approximately equal to each other.

Active "compression-decompression". Active chest compression-decompression has been used for resuscitation since 1993, but has not yet found widespread use. It is carried out using the Cardiopamp apparatus, equipped with a special suction cup and providing active artificial systole and active diastole of the heart, facilitating mechanical ventilation.

Direct (open) heart massage

Direct cardiac massage is rarely used during resuscitation measures.

Indications

Cardiac arrest during intrathoracic or intraabdominal (transdiaphragmatic massage) operations.

Chest injury with suspected intrathoracic bleeding and lung damage.

Suspicion of cardiac tamponade, tension pneumothorax, pulmonary embolism.

Injury or deformation of the chest that prevents closed massage.

The ineffectiveness of a closed massage for several minutes (relative indication: used in young victims, with the so-called “unjustified death”, is a measure of despair).

Technique. A thoracotomy is performed in the fourth intercostal space on the left. The hand is inserted into the chest cavity, four fingers are placed under the lower surface of the heart, and the first finger is placed on its front surface and rhythmic compression of the heart is performed. During operations inside the chest cavity, when the latter is wide open, massage is performed with both hands.

Combination of mechanical ventilation and cardiac massage

The order of combining mechanical ventilation and cardiac massage depends on how many people are providing assistance to the victim.

Reanimating One

The resuscitator performs 2 breaths, followed by 15 chest compressions. This cycle is then repeated.

Two people resuscitating

One resuscitator performs mechanical ventilation, the other performs indirect cardiac massage. In this case, the ratio of breathing frequency and chest compressions should be 1:5. During inspiration, the second resuscitator should pause in compressions to prevent regurgitation from the stomach. However, when performing massage against the background of mechanical ventilation through an endotracheal tube, such pauses are not necessary. Moreover, compression during inspiration is useful, since more blood from the lungs enters the heart and artificial circulation becomes effective.

Effectiveness of resuscitation measures

A mandatory condition for carrying out resuscitation measures is constant monitoring of their effectiveness. Two concepts should be distinguished:

Effectiveness of resuscitation;

The effectiveness of artificial respiration and blood circulation.

Effectiveness of resuscitation

The effectiveness of resuscitation is understood as the positive result of reviving the patient. Resuscitation measures are considered effective when a sinus rhythm of heart contractions appears, blood circulation is restored with registration of systolic blood pressure of at least 70 mm Hg, pupil constriction and the appearance of a reaction to light, restoration of skin color and resumption of spontaneous breathing (the latter is not necessary).

Efficiency of artificial respiration and blood circulation

The effectiveness of artificial respiration and blood circulation is said when resuscitation measures have not yet led to the revival of the body (spontaneous blood circulation and breathing are absent), but the measures taken artificially support metabolic processes in tissues and thereby lengthen the duration of clinical death. The effectiveness of artificial respiration and blood circulation is assessed by the following indicators:

1. Constriction of the pupils.

2. The appearance of transmitting pulsation in the carotid (femoral) arteries (assessed by one resuscitator while another performs chest compressions).

3. Change in skin color (decreased cyanosis and pallor).

If artificial respiration and blood circulation are effective, resuscitation measures continue until a positive effect is achieved or until the indicated signs disappear permanently, after which resuscitation can be stopped after 30 minutes.

Drug therapy for basic resuscitation

In some cases, during basic resuscitation it is possible to use pharmacological drugs.

Routes of administration

During resuscitation, three methods of drug administration are used:

Intravenous injection (it is advisable to administer drugs through a catheter in the subclavian vein);

Intracardiac;

Endotracheal (with tracheal intubation).

Intracardiac injection technique

Puncture of the ventricular cavity is performed at a point located 1-2 cm to the left of the sternum in the fourth intercostal space. In this case, a needle 10-12 cm long is required. The needle is inserted perpendicular to the skin; A reliable sign that the needle is in the cavity of the heart is the appearance of blood in the syringe when the piston is pulled towards itself. Intracardiac administration of drugs is currently not used due to the threat of a number of complications (lung injury, etc.). This method is considered only from a historical perspective. The only exception is the intracardiac administration of epinephrine into the ventricular cavity during open cardiac massage using a conventional injection needle. In other cases, drugs are administered into the subclavian vein or endotracheally.

Drugs used in basic resuscitation

For several decades, the administration of epinephrine, atropine, calcium chloride, and sodium bicarbonate was considered necessary during basic cardiopulmonary resuscitation. Currently, the only universal drug used in cardiopulmonary resuscitation is epinephrine at a dose of 1 mg (endotracheal - 2 mg), it is administered as early as possible, subsequently repeating the infusion every 3-5 minutes. The main effect of epinephrine during cardiopulmonary resuscitation is the redistribution of blood flow from peripheral organs and tissues to the myocardium and brain due to its α-adrenomimetic effect. Epinephrine also stimulates β-adrenoreactive structures of the myocardium and coronary vessels, increases coronary blood flow and contractility of the heart muscle. During asystole, it tones the myocardium and helps to “start” the heart. In case of ventricular fibrillation, it promotes the transition of small-wave fibrillation to large-wave fibrillation, which increases the effectiveness of defibrillation.

The use of atropine (1 ml of 0.1% solution), sodium bicarbonate (4% solution at the rate of 3 ml/kg body weight), lidocaine, calcium chloride and other drugs is carried out according to indications depending on the type of circulatory arrest and the cause that caused it. In particular, lidocaine at a dose of 1.5 mg/kg body weight is the drug of choice for fibrillation and ventricular tachycardia.

Basic resuscitation algorithm

Taking into account the complex nature of the necessary actions in case of clinical death and their desired speed, a number of specific algorithms for the actions of the resuscitator have been developed. One of them (Yu.M. Mikhailov, 1996) is presented in the diagram (Fig. 8-12).

Rice. 8-12. Algorithm for basic cardiopulmonary resuscitation

The cessation of cardiac and respiratory activity leads to a state of clinical death. It defines a short, reversible period between life and death. First aid provided in case of cardiac arrest within seven minutes allows you to return a person to normal existence.

This is possible because irreversible phenomena in brain cells due to hypoxia have not yet occurred. The lost functions are taken over by the remaining undamaged neurons.

Clinical experience shows that the period of clinical death is individual and can last from two to 15 minutes. And if hypothermia is used (artificial cooling to 8–10 degrees), it extends to two hours.

If cardiac arrest is recorded in a hospital, then doctors certainly have enough skills and resuscitation equipment to take immediate action to save the patient. There is special honey for this. staff of intensive care and resuscitation departments.

However, the place of assistance in the event of sudden death can be a work office, apartment, street, or any uncrowded room. Here, a person’s life depends on events carried out by random passers-by and witnesses.

How to give first aid

Every adult should be able to provide emergency first aid. It must be remembered that you only have 7 minutes for all actions. This is a critical period for restoring cerebral circulation. If the victim can be saved later, he faces complete disability.

Those around us are faced with a difficult task:

provide, using indirect cardiac massage, an imitation of contractions to temporarily support the blood flow system;
restore spontaneous breathing.

The sequence of actions depends on the number of people taking part in providing assistance. Two will do it faster. In addition, someone should call an ambulance and note the time.

First you need to make sure that nothing in your mouth can interfere with breathing, clean the oral cavity with your finger, straighten your tongue;
put the victim on a hard surface (ground, floor), tilt his head back;
hit the sternum with a fist (a precordial blow can immediately “start” the heart);
Heart massage is done by jerky pressure on the sternum, keeping your arms straight and resting them on the patient’s chest;
At the same time, artificial respiration is carried out in the classical way “mouth to mouth” or “mouth to nose”; when breathing into the mouth, you need to pinch your nose with your fingers; it is important to hold the victim’s lower jaw with your hand, pushing it slightly forward (to prevent the tongue from retracting).

The massage continues until cardiac activity is restored and facial skin color returns to normal.

If the chest begins to rise on its own, it means that your own breathing has appeared. But if the pulse begins to be felt, and there are no respiratory movements, only artificial respiration should be continued.

The critical period for resuscitation is considered to be 20 minutes. After this, the biological stage of death is stated.

The arriving ambulance team will continue resuscitation measures.

What can emergency doctors do?

At the ambulance stage, first aid is provided in case of cardiac arrest.

Ventilation of the lungs is carried out through a mask using an Ambu bag. To achieve full contact with the trachea and press the tongue, intubation is performed or a special tube is inserted, connecting it to the bag. Compression achieves the supply of air mass into the lung tissue.

If special equipment is available, the heart is defibrillated with an electric current.

The effect of the discharge can be enhanced by the administration of Adrenaline and Atropine. These are drugs that sharply increase myocardial excitability. After their introduction intracardially, a second attempt at defibrillation is made.

In the absence of a defibrillator, indirect massage continues.

In a car with an ECG device, it is possible to take an electrocardiogram, at least a single lead. It can be used to judge the presence of asystole or fibrillation.

After delivering the patient to the hospital

If the heart rhythm is successfully restored, urgent measures are taken to stabilize contractions and eliminate the metabolic consequences of clinical death.

The patient is placed in the intensive care unit.

It is connected to a heart rate monitor. This is important because restored heart contractions are prone to changes in rhythm and various disturbances. Antiarrhythmic drugs help compensate for them.

An alkaline solution must be injected drip-wise to eliminate acidosis.

In the hospital, it is possible to conduct an examination and identify the cause of cardiac arrest.

In case of fluid compression and cardiac tamponade, pericardiocentesis is immediately performed with pumping out the exudate. If pneumothorax is detected, installing a drainage to expand the lung helps.

If spontaneous breathing is shallow and congestive wheezing is heard in the lower parts of the lungs, the patient is intubated and transferred to artificial mechanical ventilation with increased oxygen supply

Examples of specific situations and algorithm for diagnosis and action

To analyze the cases that medical workers and people far from medicine have to deal with, let’s look at examples of situations that allow you to think about your role in resuscitation.

Situation one

The young man fell in front of the employees, without even having time to let go of the briefcase with documents. A lot of people gathered around and they called an ambulance. While waiting for the doctors, everyone groans and remembers various cases of illness from their experience. The result was that the patient died, and the ambulance doctor could only note signs of biological death.

Unfortunately, a similar situation often arises anywhere. When people, instead of taking active pre-medical actions, panic, get lost, and miss time for resuscitation.

And some even start talking about the “prohibition of approaching the corpse until the police arrive.” Who said that the victim is already a corpse? Has anyone even dared to check your pulse and pupils? Such a death remains on the conscience of the crowd.

Imagine that you or your loved ones might find yourself in a similar situation

Situation two

A woman was seen lying on the street with rare breathing movements, unconscious, and her pulse could not be determined. Passers-by called an ambulance. They started doing chest compressions and assisted breathing.

The result is that before the team arrived, it was possible to maintain blood circulation “manually,” which slowed down irreversible changes and reduced hypoxia.

Often people begin to doubt the need for chest compressions due to assumptions about fainting or a stroke. There is very little time left for doubt. When fainting, the pulse is preserved, the pupils react to light. With a stroke, facial asymmetry, changes in the tone of the limbs on one side, and pupils of different widths are possible. The pulsation is also preserved.

Situation three

Ambulance doctors received a call for the cardiology team because the caller correctly described the victim’s symptoms.

Having loaded the patient onto a gurney, she was wheeled into the car; the intensive care vehicle has technical equipment for all activities

The algorithm of actions has been worked out in practice:

the tongue is attached to the lower jaw with a special curved air duct tube, an Ambu bag for manual artificial respiration is attached to it;
Adrenaline solution was injected intracardially with a long needle;
in the absence of pulsation in the carotid and femoral arteries, if heart sounds cannot be heard, defibrillation is indicated;
indirect massage and artificial respiration last 20 minutes.

During this time, the car reaches the hospital and the question of the advisability of continuing resuscitation measures is decided.

Situation four

Cardiac arrest occurred during intestinal surgery. The anesthesiologist noticed a sudden drop in blood pressure in a patient under anesthesia, and cardiac activity stopped on the monitor. Surgeons note blanching of the internal organs and mesentery.

Algorithm of actions:

the surgical intervention is terminated;
Adrenaline solution is injected into the subclavian vein;
defibrillation is performed;
in the absence of restoration of heart contractions, the discharge is repeated;
between shocks, a soda solution is injected in a stream to prevent acidosis;
the surgeon opens the diaphragm, inserts his hand into the chest cavity and manually massages the heart, squeezing and unclenching it.

The technique is called direct cardiac massage, it is possible with an open chest or from the abdominal cavity

The success of the measures is judged by the resumption of the rhythm on the monitor and the increase in pressure.

Surgeons notice the beginning of bleeding in the wound. The operation ends with minimal mechanical damage after the break. The diaphragm is sutured.

Alternative resuscitation

The experience accumulated in different countries in resuscitation measures during cardiac arrest allows us to choose the most effective methods. Research in recent years has established the priority of cardiac mechanisms of clinical death (90% of cases) against the background of an intact respiratory system. Therefore, doubts arose about the need for emergency measures to restore breathing.

The state of Arizona uses the MICR methodology. She suggests doing several more intense cycles of chest compressions without mouth-to-mouth breathing.

The rules provide:

in the first 2 minutes of resuscitation, mandatory 100 chest compressions per minute (200 in total);
then pulse control, administration of Adrenaline and defibrillation;
repeat this way 2 more times;
only after this is tracheal intubation and artificial respiration performed.

The technique is used by paramedics and firefighters. Comparison of effectiveness in terms of patient survival occurred only in out-of-hospital cases of clinical death. As a result, the percentage of those resuscitated increased from 1.8 (using classical methods of massage and artificial respiration) to 5.4.

The UNIVERSAL algorithm (named after the first letters of the stages) has been published in Russia and is used by many. In it, artificial ventilation is placed in third place in the step-by-step actions after the precordial stroke and the beginning of chest compressions. For inpatient conditions, pacing is recommended by introducing an electrode into the heart cavity through a subclavian catheter.

How are the consequences of clinical death corrected?

If help is late, then it is not possible to fully restore body functions. The brain suffers the most. A person loses intelligence and memory. Failure is possible after forced hypoxia of the kidneys and liver. It's impossible to fix anything.

Is life necessary in exchange for intelligence? There is no solution to the problem yet

During early recovery, the patient receives long-term maintenance therapy with antiarrhythmic drugs and nootropic drugs for brain cells. He is periodically examined by doctors (a cardiologist and a neurologist) and carried out a follow-up examination. In the absence of complications, the patient can return to work subject to restrictions (physical activity, night shifts, stressful situations, hypothermia are contraindicated).

You should always remember the limited ability of internal organs to restore damaged functions, especially the brain and heart. Nature gave man the opportunity to use them once. Not everyone gets a second chance.

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Timely emergency first aid to restore the victim’s breathing and heartbeat helps save the patient’s life. What should be done in case of cardiac arrest? How effective are pre-medical measures? You will read about this and much more in our article.

First aid for cardiac and respiratory arrest

Quite often, the victim experiences a simultaneous absence of breathing and heartbeat. In this case, a combination of techniques for performing indirect cardiac massage and artificial respiration is recommended. Such procedures are carried out until the person is fully resuscitated or until the ambulance arrives.

Indirect cardiac massage

First aid for cardiac arrest includes:

Preliminary preparation of resuscitation actions. The victim is moved to a horizontal position, face up. The rescuer chooses the optimal position for carrying out activities from the left or right side of the person;
The initial attempt to start cardiac activity. A one-time fast and fairly sharp blow of medium strength is applied to the area of the projection of the heart. In a number of situations, this allows you to immediately start the work of the organ. If there is no effect, proceed to standard resuscitation actions;
Performing indirect cardiac massage. The rescuer folds his arms, straightened at the elbows, palm on palm, and places them in the area of the lower half of the sternum so that the phalanges of his fingers are perpendicular to this area. The main emphasis is on the palm, the rescuer's fingers do not touch the victim's body. Next, quick jerking movements are performed, using the entire body weight of the person providing assistance, with pressure from 100 to 110 manipulations per minute, in series of 5-6 pushes with a pause of 1-2 seconds. In this case, the victim’s sternum bends no deeper than 4-5 centimeters;

Repeat the procedure and combine with artificial respiration. Indirect massage of the organ as part of first aid is performed until the heartbeat appears. Quite often the method is combined with artificial respiration. If the rescuer resuscitates the victim independently, then it is recommended to perform 10 “pumps” of the heart and 2 inhalations/exhalations as part of forced manual ventilation.

Artificial respiration

Basic measures for providing emergency assistance in case of respiratory arrest include the following:

Preliminary preparation. The victim lies on his back, his head tilted back. Any foreign objects (chewing gum, braces, other objects) are removed from the oral cavity, after which, using a napkin wrapped around a finger, the mucous membranes, teeth and internal space are cleaned of remnants of vomit, saliva, and so on;
Direct artificial respiration. The victim’s nose is pinched by the phalanges of the fingers of the rescuer’s left hand, while the right hand is located on the chin and fixes it. The person providing assistance takes a deep breath, then presses his lips tightly to the patient’s lips and exhales forcefully. During ventilation, the victim’s chest should rise and then slowly fall within 2 seconds;

Cyclic repetition and a combination with indirect cardiac massage. As part of manual resuscitation, artificial respiration is combined with chest compressions. The optimal formula is 2 full inhalations/exhalations at intervals of 2 seconds + 10 “pumps” of the heart. Attempts to restore breathing and heartbeat are made until stable vital signs appear or an ambulance arrives.

Emergency medical care

Primary resuscitation measures in case of cardiac and respiratory arrest as part of first aid are carried out by the ambulance team arriving at the scene. Regardless of the circumstances, the main goal of the procedure is to restore a person’s basic vital signs.

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To provide emergency assistance in case of cardiac and respiratory arrest in the absence of the necessary equipment, manual cardiopulmonary resuscitation is performed, identical to standard emergency pre-hospital therapy. Emergency care for cardiac and respiratory arrest:

Effectiveness of resuscitation measures

The effectiveness of resuscitation of a person in case of cardiac and respiratory arrest as part of first aid can be monitored by a number of signs:

Constriction of the pupils;
The appearance of basic transmission pulsation in large arteries;
Change in skin tone with a decrease in pallor and cyanosis;
Formation of sinus rhythm of heart contractions;
Registration of blood pressure (from 70 mm Hg);
Restoration of independent blood circulation and breathing.

In general, modern medicine establishes a general time frame for the rationality of resuscitation measures - the interval ranges from 15 to 40 minutes after the disappearance of basic vital signs.

Causes of cardiac arrest

Direct causes of cardiac arrest are:

Ventricular fibrillation;
Electromechanical dissociations;
Ventricular asystole;
Ventricular paroxysmal tachycardia;

Provoking circumstances:

Any types of shock;
Myocardial infarction or coronary heart disease;
Long-term arterial hypertension;
Pulmonary embolism;
Cardiac tamponade;
Severe asphyxia;
Overdose of adrenergic blockers, barbiturates, drugs, cardiac glycosides, and other drugs;
Prolonged systemic hypothermia of the entire body;
Pneumothorax.

Signs of a pathological process

If symptoms of cardiac arrest appear, first aid should be immediately provided to the victim by performing manual cardiopulmonary resuscitation.

The main signs of cardiac arrest include:

Rapid loss of consciousness;
Noisy agonal and very rare breathing with regular stops;
Absence of pulsation of large arteries;
Rapid bluish discoloration of the skin;
Formation of convulsions, dilation of pupils with partial or complete loss of reaction to light.

Possible consequences

Against the background of this pathological process, in the medium term, even with the effectiveness of emergency therapy, the development of ischemic brain damage, systemic kidney diseases, complex disorders of the liver and other organs is possible.

In a significant proportion of cases, cardiac arrest in the absence of immediate qualified first aid to the victim leads to death.

Regardless of the circumstances, a person must be hospitalized in a hospital, where he is provided with complex therapy, including both the main treatment of the cause of the development of the pathology and appropriate restorative measures as part of rehabilitation.

Rehabilitation activities

The main actions during the post-rehabilitation period include preventive measures to prevent recurrent cases of cardiac arrest. Basic activities:

Strict adherence to drug therapy prescribed by a doctor;
Correction of diet adapting it to the recommendations of a nutritionist;
Regular performance of physical therapy exercises within the framework of strictly dosed loads;
Redistribution of circadian rhythms with sufficient time for rest;
Timely completion of preventive examinations by specialized specialists;
Other actions as necessary.

From this article you will learn: when it is necessary to perform cardiopulmonary resuscitation, what activities include assisting a person who is in a state of clinical death. An algorithm of actions in case of cardiac and respiratory arrest is described.

Article publication date: 07/01/2017

Article updated date: 06/02/2019

Cardiopulmonary resuscitation (abbreviated as CPR) is a set of emergency measures for breathing and breathing, with the help of which they try to artificially support the vital activity of the brain until spontaneous circulation and breathing are restored. The composition of these activities directly depends on the skills of the person providing assistance, the conditions under which they are carried out and the availability of certain equipment.

Ideally, resuscitation performed by a person who does not have a medical education consists of closed heart massage, artificial respiration, and the use of an automatic external defibrillator. In reality, such a complex is almost never performed, since people do not know how to properly carry out resuscitation measures, and external external defibrillators are simply not available.

Determination of vital signs

In 2012, the results of a huge Japanese study were published that included more than 400,000 people with cardiac arrest occurring outside a hospital setting. In approximately 18% of those victims who underwent resuscitation measures, spontaneous circulation was restored. But only 5% of patients remained alive after a month, and with preserved functioning of the central nervous system - about 2%.

It should be borne in mind that without CPR, these 2% of patients with a good neurological prognosis would have no chance of life. 2% of 400,000 victims means 8,000 lives saved. But even in countries with frequent resuscitation training, cardiac arrest is treated outside the hospital in less than half of cases.

It is believed that resuscitation measures, correctly carried out by a person located close to the victim, increase his chances of revival by 2-3 times.

Physicians of any specialty, including nurses and doctors, must be able to perform resuscitation. It is desirable that people without medical education can do it. Anesthesiologists and resuscitators are considered the greatest professionals in restoring spontaneous circulation.

Indications

Resuscitation should be started immediately after identifying a victim who is in a state of clinical death.

Clinical death is a period of time that lasts from cardiac and respiratory arrest to the occurrence of irreversible disorders in the body. The main signs of this condition include absence of pulse, breathing and consciousness.

It must be recognized that not all people without medical education (and even those with it) can quickly and correctly determine the presence of these signs. This can lead to an unjustified delay in the start of resuscitation measures, which greatly worsens the prognosis. Therefore, modern European and American recommendations for CPR take into account only the absence of consciousness and breathing.

Resuscitation techniques

Before starting resuscitation, check the following:

Is the environment safe for you and the victim?
Is the victim conscious or unconscious?
If you think the patient is unconscious, touch him and ask loudly, “Are you okay?”
If the victim does not respond, and there is someone else besides you, one of you should call an ambulance, and the second should begin resuscitation. If you are alone and have a mobile phone, call an ambulance before starting resuscitation.

To remember the procedure and technique for performing cardiopulmonary resuscitation, you need to learn the abbreviation “CAB”, in which:

C (compressions) – closed cardiac massage (CCM).
A (airway) – opening of the airways (OP).
B (breathing) – artificial respiration (AR).

1. Closed heart massage

Carrying out ZMS allows you to ensure blood supply to the brain and heart at a minimal - but critically important - level, which supports the vital activity of their cells until spontaneous circulation is restored. Compression changes the volume of the chest, resulting in minimal gas exchange in the lungs even in the absence of artificial respiration.

The brain is the organ most sensitive to reduced blood supply. Irreversible damage to its tissues develops within 5 minutes after the blood flow stops. The second most sensitive organ is the myocardium. Therefore, successful resuscitation with a good neurological prognosis and restoration of spontaneous circulation directly depends on the high-quality performance of VMS.

The victim with cardiac arrest should be placed in a supine position on a hard surface, with the person providing assistance placed at his side.

Place the palm of your dominant hand (depending on whether you are left- or right-handed) in the center of your chest, between your nipples. The base of the palm should be placed exactly on the sternum, its position should correspond to the longitudinal axis of the body. This focuses the compression force on the sternum and reduces the risk of rib fracture.

Place your second palm on top of the first and interlace their fingers. Make sure that no part of your palms touches your ribs to minimize pressure on them.

To transfer mechanical force as efficiently as possible, keep your arms straight at the elbows. Your body position should be such that your shoulders are vertical over the victim's sternum.

The blood flow created by closed cardiac massage depends on the frequency of compressions and the effectiveness of each of them. Scientific evidence has demonstrated the existence of a relationship between the frequency of compressions, the duration of pauses in the performance of VMS and the restoration of spontaneous circulation. Therefore, any interruptions in compression should be minimized. It is possible to stop VMS only at the time of performing artificial respiration (if it is carried out), assessing the recovery of cardiac activity and for defibrillation. The required frequency of compressions is 100–120 times per minute. To get an approximate idea of the pace at which CMS is performed, you can listen to the rhythm in the song by the British pop group BeeGees “Stayin' Alive.” It is noteworthy that the name of the song itself corresponds to the goal of emergency resuscitation - “Staying Alive.”

The depth of the chest deflection during VMS should be 5–6 cm in adults. After each pressing, the chest should be allowed to fully straighten, since incomplete restoration of its shape worsens blood flow. However, you should not remove your palms from the sternum, as this can lead to a decrease in the frequency and depth of compressions.

The quality of the CMS performed sharply decreases over time, which is associated with the fatigue of the person providing assistance. If resuscitation is carried out by two people, they should change every 2 minutes. More frequent shifts may result in unnecessary interruptions in the health service.

2. Opening the airways

In a state of clinical death, all a person’s muscles are in a relaxed state, which is why, in a supine position, the victim’s airways can be blocked by the tongue moving towards the larynx.

To open the airway:

Place the palm of your hand on the victim's forehead.
Tilt his head back, straightening it at the cervical spine (this technique should not be done if there is a suspicion of spinal damage).
Place the fingers of your other hand under your chin and push your lower jaw up.

3. Artificial respiration

Modern recommendations for CPR allow people who have not undergone special training not to perform ID, since they do not know how to do this and only waste precious time, which is better to devote entirely to closed cardiac massage.

People who have undergone special training and are confident in their ability to perform high-quality ID are recommended to carry out resuscitation measures in the ratio of “30 compressions - 2 breaths.”

Rules for conducting ID:

Open the victim's airway.
Pinch the patient's nostrils with the fingers of your hand on his forehead.
Press your mouth firmly against the victim's mouth and exhale as usual. Make 2 such artificial breaths, watching the rise of the chest.
After 2 breaths, immediately begin ZMS.
Repeat the cycles of “30 compressions - 2 breaths” until the end of resuscitation measures.

Algorithm for basic resuscitation in adults

Basic resuscitation measures (BRM) are a set of actions that can be carried out by a person providing assistance without the use of drugs or special medical equipment.

The cardiopulmonary resuscitation algorithm depends on the skills and knowledge of the person providing assistance. It consists of the following sequence of actions:

Make sure there is no danger in the area of care.
Determine whether the victim is conscious. To do this, touch him and ask loudly if he is okay.
If the patient reacts in any way to the call, call an ambulance.
If the patient is unconscious, turn him onto his back, open his airway, and assess for normal breathing.
In the absence of normal breathing (do not confuse it with rare agonal sighs), begin CMS with a frequency of 100–120 compressions per minute.
If you know how to do ID, carry out resuscitation measures in a combination of “30 compressions - 2 breaths”.

Features of resuscitation measures in children

The sequence of this resuscitation in children has slight differences, which are explained by the peculiarities of the causes of cardiac arrest in this age group.

Unlike adults, in whom sudden cardiac arrest is most often associated with cardiac pathology, in children the most common causes of clinical death are breathing problems.

The main differences between pediatric intensive care and adult intensive care:

After identifying a child with signs of clinical death (unconscious, not breathing, no pulse in the carotid arteries), resuscitation measures should begin with 5 artificial breaths.
The ratio of compressions to artificial breaths during resuscitation in children is 15 to 2.
If assistance is provided by 1 person, an ambulance should be called after performing resuscitation measures for 1 minute.

Using an automatic external defibrillator

An automated external defibrillator (AED) is a small, portable device that delivers an electrical shock (defibrillation) to the heart through the chest.

Automatic external defibrillator

This shock has the potential to restore normal cardiac activity and restore spontaneous circulation. Since not all cardiac arrests require defibrillation, the AED has the ability to assess the victim's heart rhythm and determine whether a shock is needed.

Most modern devices are capable of reproducing voice commands that give instructions to people providing assistance.

AEDs are very easy to use and were specifically designed to be used by people without medical training. In many countries, AEDs are placed in crowded areas such as stadiums, train stations, airports, universities and schools.

Sequence of actions for using an AED:

Turn on the power to the device, which then begins to give voice instructions.
Expose your chest. If the skin is damp, dry the skin. The AED has sticky electrodes that need to be attached to your chest as shown on the device. Attach one electrode above the nipple, to the right of the sternum, the second - below and to the left of the second nipple.
Make sure the electrodes are firmly attached to the skin. Connect the wires from them to the device.
Make sure no one is touching the victim and click the "Analyze" button.
After the AED analyzes your heart rhythm, it will give you instructions on what to do next. If the device decides that defibrillation is needed, it will alert you. No one should touch the victim while the shock is being applied. Some devices perform defibrillation on their own, while others require you to press the “Shock” button.
Resume resuscitation immediately after delivering the shock.

Termination of resuscitation

CPR should be stopped in the following situations:

An ambulance arrived and its personnel continued to provide assistance.
The victim showed signs of resumption of spontaneous circulation (he began to breathe, cough, move, or regained consciousness).
You are completely exhausted physically.

Unexpected cardiac arrest is a life-threatening condition with a high rate of death. The primary sources of the pathological process are presumably insufficient oxygen supply, ischemic lesions, hemorrhagic or anaphylactic shock conditions, and general hypothermia.

Provocateurs for stopping the contraction of the heart muscle are considered to be accidents, acute poisoning, lightning or electric shock, acute myocardial infarction, insufficient functionality of the cardiovascular department, and traumatic brain injury.

First aid for cardiac arrest should be provided in the first five minutes from the start of the process - lack of oxygen negatively affects the tissue of the brain.

Requirements for pre-medical auxiliary measures

If a loved one or a passer-by experiences cardiac arrest, he or she must be provided with emergency assistance. The algorithm includes a certain sequence of actions, the basics of which should be known to every person, regardless of education.

Pulse measurement– produced in the cervical region, on the carotid arteries. An additional measurement area is the groin area. Checking is carried out with two (or three) fingers. A pulsation should be felt under the pads.

Breath test– you should pay attention to whether there is movement of the chest. If not, you should apply a small mirror to the mouth area - if the surface becomes foggy, then the victim breathes on his own.

If there are obvious signs of cardiac arrest, additional methods in the form of blood pressure measurements are pointless - they will not be obtained, and precious time will be irretrievably lost. It must be remembered that delay is a gradual destruction of the patient’s body tissues and a gradual transition to death.

The first priority is to call emergency help - if the information is correct, a cardiology team with the necessary equipment will arrive to the victim. After calling the medical service, you should proceed directly to help.

Resuscitation measures in case of cardiac arrest are carried out sequentially:

It is necessary to place the patient on a flat horizontal surface (on his back) - with free access to the upper half of the body.
Remove all foreign objects from the oral cavity - dentures, teeth that have fallen out as a result of a fall, dentures, food debris, foreign bodies and vomit.
Throw your head back at an angle of 45 degrees, with your chin raised up - this position ensures free access of air through the respiratory tract.
Move the lower jaw forward to prevent accidental retraction of the tongue and spontaneous blockage of the airways.
Begin cardiopulmonary resuscitation measures - artificial ventilation of the lungs using the mouth-to-mouth technique requires blocking the nasal passages with two fingers. The assistant takes a deep breath and exhales as much air as possible into the victim’s mouth. The procedure is repeated twice. Too large volumes of air can cause rapid fatigue in the person helping – you should correctly calculate your strength.
When performing the mouth-to-nose technique, the patient's oral cavity is closed. The patient's lower jaw is raised slightly upward to prevent the tongue from sinking. Air is introduced into both nostrils simultaneously.
Actions for indirect massage of the heart muscle require a change in the position of the resuscitator’s body - he must kneel next to the patient (if he is on the ground), place his left hand on the middle part of the chest, the right one is placed on the left (in a cross). Pressure is applied with the upper limbs straight and not bent at the elbows at the same time. After fifteen vigorous pushes, air is inhaled twice (artificial ventilation), then repeated - another 15 presses.

After completing a block of actions, it is necessary to check cardiac and respiratory activity. If the required result is not achieved, all resuscitation measures are repeated. For young children, indirect massage of the heart muscle is performed with two fingers - the index and middle. If the victim is a teenager, then the technique involves using one palm.

Checking the correctness of the activity shows a spontaneous rise and fall of the chest at the time of shocks. With its immobility, the question arises of blockage of the airways in inaccessible places (without a surgical instrument).

Manipulations are carried out until cardiac and respiratory activity is completely restored. If one or the other is missing, the following is required:

if the patient breathes on his own, but the pulse is not palpable, measures for indirect massage of the heart muscle continue;
If a thread-like pulse appears, but there is no breathing, it is necessary to continue the artificial ventilation technique.

Even if resuscitation measures were successful, you should wait for emergency assistance to arrive and then hand over the victim to them. The patient's condition should be monitored - secondary arrest can occur at any minute.

Indirect massage of the heart muscle is always combined with artificial ventilation - without oxygen supply, any resuscitation measures are pointless. The lack of oxygen circulation in the bloodstream threatens tissue death, primarily the brain.

Self-transport of a person with cardiac arrest is prohibited - he is transported by an ambulance. In it, you can carry out further manipulations to restore basic vital signs.

How to do artificial respiration correctly

After moving the victim's head back and creating a free passage of the airways, the resuscitator slightly moves the patient's jaw forward.

Grasping the chin with his left hand and squeezing the nasal passages with the other, the assistant takes a deep breath and then exhales into the patient’s mouth. At the moment of exit, the victim’s chest should rise - this fact serves as an indicator of the correct implementation of artificial ventilation.

Lack of chest movement indicates an obstruction in the airway.

Rules for indirect effects on the heart

The victim is in a horizontal position, on his back, the resuscitator is on his side.
The end of the sternum is felt with your fingers (it is located in the epigastric zone).
The distance of two fingers is measured - transversely located towards the midline of the chest.
The left palm is placed on the previously determined area - the widest part, the right one is placed on top. The hands, when positioned correctly, form a cross. Palms straighten.
Pressure is carried out with straight (without bending at the elbows) hands. The depth of the push is about five centimeters. After the pressure, a short pause is maintained, and the movement is repeated. During all the manipulations, the palms do not come off or move, they are located at the original point.

When carrying out the technique, a certain mode is established - the speed of shocks is about 60 units per minute. With less frequent exposure, there is no effect on the circulatory system.

When resuscitating an adult, the technique uses both arm strength and body weight—broken ribs can be a complication of high blood pressure. With the help of children after five years of age, an indirect effect on the heart muscle is made with one palm, for younger children - with the index and middle finger. The childhood period requires an increase in the frequency of shocks - up to 110 units per minute.

The effectiveness of the treatment is assessed by the restoration of spontaneous breathing, the appearance of heart contractions and the gradual return of the skin color to normal - without a bluish tint.

All manipulations continue until complete recovery and the patient regains consciousness or the arrival of an emergency team. Lack of effectiveness within half an hour indicates the development of death. Restoring brain activity is impossible - irreversible changes have occurred.

Direct cardiac massage

Performed in an inpatient setting, in the intensive care unit of a cardiology clinic. The procedure requires compliance with conditions of absolute sterility, compliance with the rules of septic tanks and antiseptics.

The manipulation involves direct contact with the heart muscle - after opening the chest, the whole process is carried out. During this period, the patient is connected to the ventilator system. At the same time, pulse and cardiogram data are taken.

In what cases is heart massage not performed?

Emergency aid techniques are prohibited for certain pathological processes:

malignant tumors with numerous metastases;
traumatization of the cranium with disruption of the integrity of the brain;
certain diseases for which resuscitation measures do not make sense.

Experts determine the need for restorative manipulations - in some cases they are meaningless. In the absence of brain activity, auxiliary techniques are not performed.