Cardiac arrest (sudden stopping of the pumping
function of the heart) is an important cause of sudden death. Cardiopulmonary resuscitation (CPR), which involves performing chest compressions and rescue breathing (see below), is a temporary procedure that can be used to maintain
some blood flow to the brain, heart, and other vital organs until trained
medical personnel are available to provide more advanced treatment. Studies
have found that CPR is most effective when started as soon as possible after
cardiac arrest (ie, within minutes of the arrest) and when trained medical
personnel arrive within 8 to 12 minutes of the arrest. Cardiopulmonary resuscitation
should be performed only by persons trained in the technique because specific
CPR recommendations vary depending on the patient's age and the cause of arrest.
If performed incorrectly, CPR may be ineffective or harmful. Because most
cardiac arrests occur outside the hospital, it is important for laypersons
to be trained in CPR. The January 19, 2005, issue of JAMA contains 2 articles evaluating CPR performed by trained personnel
in both in-hospital and out-of-hospital settings.
Activation of the local emergency
medical service (EMS) system. In most areas of the United States and
Canada this is done by dialing 9-1-1. Because CPR is only a temporary measure,
it is always important to know how to activate your local EMS and to do so
as soon as a cardiac arrest occurs.
Chest compressions are
performed by applying downward pressure to the chest wall with the hands positioned
in a specific way over the sternum (breast bone).
When performed correctly, these compressions cause blood to be pumped from
the heart to other vital organs.
Rescue breaths (mouth-to-mouth
breathing) provide oxygen to the lungs when the individual is not breathing.
Rescue breaths are alternated with chest compressions at a specific ratio,
depending on the patient's age.
The Heimlich maneuver is
used for patients who are unable to breathe as a result of choking, which
may lead to cardiac arrest. The Heimlich maneuver is therefore taught during
most CPR classes and, like CPR, this technique is performed differently depending
on the patient's age and size.
Automatic external defibrillators
(AEDs) are computerized devices that can be used to detect and treat ventricular fibrillation, an irregular heart rhythm that
is an important cause of sudden cardiac death. Automatic external defibrillators
provide both visual and voice instructions and are used by some EMS personnel
and by lay rescuers. These devices are now located in many public places,
including airports, and have been found to improve survival for patients with
ventricular fibrillation when used early. These devices can only be used on
patients older than 8 years. Most CPR classes now include instruction on the
proper use of AEDs.
Learn how to perform CPR. For information regarding classes in your
area, please contact the organizations below.
American Heart Association 877/AHA-4CPRhttp://www.americanheart.org
American Red Cross 202/303-4498 http://www.redcross.org
American College of Emergency Physicians 800/798-1822 http://www.acep.org
To find this and previous JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at http://www.jama.com. A Patient Page on CPR was published in the April 7, 1999, issue.
Sources: American Heart Association, American Red Cross
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical
diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals
to share with patients. Any other print or online reproduction is subject
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Ringold S, Glass TJ, Glass RM. Cardiopulmonary Resuscitation (CPR). JAMA. 2005;293(3):388. doi:10.1001/jama.293.3.388