Cardiopulmonary Resuscitation
Definition
Cardiopulmonary resuscitation (CPR) is the organised response to cardiac arrest: chest compressions and ventilation to sustain circulation and oxygenation, rhythm analysis and defibrillation when the rhythm is shockable, and — in advanced life support — drugs, airway management and correction of the reversible cause. Survival is determined less by any single drug than by the fraction of arrest time spent compressing the chest and by how quickly a shockable rhythm is shocked.
Key Concepts
Basic life support
- Compressions: rate 100–120/min, depth 5–6 cm, ratio 30 compressions to 2 breaths.
- Check breathing and pulse for no more than 10 seconds. No normal breathing but a pulse present → rescue breathing at 1 breath every 6 seconds. No breathing and no pulse → start CPR.
- Shockable rhythm (VF or pulseless VT): deliver one shock — biphasic at the manufacturer's recommendation, or the maximum available (e.g. 200 J) if unknown; monophasic 360 J. Resume compressions immediately afterwards rather than pausing to reassess the rhythm or the pulse.
- Non-shockable rhythm: continue CPR and move to the advanced algorithm. (sources/Handbook-HA-2024, rating: high)
Advanced life support
- Airway: intubate only if skilled, otherwise continue bag-mask ventilation and call for help. Confirm tube position by five-point auscultation and a confirmation device. Continuous waveform capnography is recommended in addition to physical examination.
- Once an advanced airway is in place the 30:2 cycle ends — give 1 breath every 6 seconds with continuous compressions.
- Rhythm splits the drug path: shockable → defibrillate, adrenaline, then an antiarrhythmic; non-shockable → CPR, adrenaline, and a systematic hunt for the cause.
Drugs used in resuscitation
| Drug | Dose | Indication |
|---|---|---|
| Adrenaline | 1 mg (10 mL of 1:10,000) IV, every 3–5 min | All arrest rhythms |
| Amiodarone | 300 mg IV bolus, then a further 150 mg if required | Refractory VF / pulseless VT |
| Lignocaine | 1 mg/kg, then 0.5–0.75 mg/kg at 5–10 min (max 3 mg/kg), then 1–4 mg/min infusion | Refractory VF / pulseless VT |
| Magnesium sulfate | 1–2 g in 10 mL D5 IV | Torsades de pointes |
(Table: sources/Handbook-HA-2024)
- Intravenous or intraosseous access is preferred over the endotracheal route. If only the tube is available, doses are doubled, diluted in 10 mL of saline or water, delivered beyond the tube tip, and followed by several quick insufflations with compressions briefly withheld.
- The endotracheal drug set is remembered as L-E-A-N — lignocaine, epinephrine (adrenaline), atropine, naloxone.
Reversible causes
The 5Hs and 5Ts: hypovolaemia, hypoxia, hydrogen ion (acidosis), hyper/hypokalaemia, hypothermia; tension pneumothorax, tamponade, toxins, pulmonary thrombosis, coronary thrombosis. In asystole and PEA this list is the algorithm — there is no drug that fixes an untreated cause. See concepts/Cardiac-Tamponade, entities/Pulmonary-Embolism and entities/Acute-Coronary-Syndrome.
Post-resuscitation care
- Titrate oxygen to a saturation of 92–98%; do not hyperventilate.
- Treat hypotension with volume expansion or a vasopressor.
- Initiate targeted temperature management in patients who remain comatose.
- Treat seizures with diazepam or phenytoin.
- Consider an advanced airway with waveform capnography, and treat the precipitant. (sources/Handbook-HA-2024)
Contradictions / Open Questions
- The protocol accepts compression pauses that current practice tries to eliminate. The handbook's endotracheal drug route requires holding compressions during insufflation, and its 30:2 cycle stops compressions for every breath. Both cost coronary perfusion pressure, and neither is presented as a compromise forced by resource limits — which is what the endotracheal route is. (sources/Handbook-HA-2024, rating: high)
- Adrenaline is given without qualification, and the wiki holds no source weighing its outcomes. The handbook states the dose and interval but no effect size; no ingested source here addresses the return-of-spontaneous-circulation versus neurological-outcome trade-off, so the wiki cannot answer whether the drug improves survival with good function.
- No temperature target is given. "Initiate targeted temperature management" appears without a target, a duration or a cooling method, and no ingested source supplies them.
- Mechanical CPR and extracorporeal CPR are absent. Neither prehospital compression devices nor ECPR appear anywhere in the handbook's algorithm, so the wiki has no record of where either sits — a gap in the source, not a judgement about them.
- The 5H/5T list is presented as diagnostic but is not operationalised. No investigation or bedside test is attached to each cause, so recognising "coronary thrombosis" in an arrest still depends on information the algorithm does not tell you to gather.
Connections
- Related to entities/Heart-Failure — arrest is frequently the terminal event of a decompensated HF trajectory
- Related to concepts/Cardiogenic-Shock — the post-arrest state overlaps phenotypically with shock and shares its vasopressor and perfusion logic
- Related to concepts/Atrioventricular-Block — bradyasystolic arrest, and the pacing indications that prevent it
- Related to concepts/Cardiac-Tamponade, entities/Pulmonary-Embolism and concepts/Acute-Aortic-Syndrome — reversible causes that are treatable only if recognised
- Related to entities/Acute-Coronary-Syndrome — coronary thrombosis as a 5T, and the reason for early angiography after ROSC