CPR

CPR
Name	CPR
Specialty	Emergency medicine
Synonyms	cardiopulmonary resuscitation

CPR is an emergency lifesaving procedure performed to restore and maintain circulation and ventilation in persons who have experienced cardiac arrest. It combines chest compressions, ventilations, and, when indicated, defibrillation to preserve organ perfusion until advanced care is available. CPR is central to resuscitation protocols developed and propagated by major institutions and has shaped emergency response systems worldwide.

History

Cardiac resuscitation efforts trace through episodes and figures in modern medical history including innovations following the Battle of Solferino-era humanitarian movements and later advances influenced by military medicine in World War II and Korean War. Early mouth-to-mouth descriptions appeared in 18th-century texts and were later refined by clinicians and organizations such as the American Heart Association, the British Heart Foundation, and the Red Cross during the 20th century. The introduction of closed-chest cardiac massage by researchers after World War II and the development of portable defibrillators by engineers associated with institutions like Massachusetts Institute of Technology and General Electric transformed outcomes. International consensus statements and guideline cycles convened by entities including the International Liaison Committee on Resuscitation and national bodies produced standardized algorithms adopted in emergency medical services in countries such as United States, United Kingdom, and Japan.

Indications and Contraindications

Indications for initiation are derived from clinical scenarios frequently encountered in settings with links to emergency response systems like the Emergency Medical Services frameworks of New York City, London Ambulance Service, and Tokyo Fire Department, including witnessed sudden collapse, apnea, and pulselessness during events such as acute myocardial infarction presentations seen in tertiary centers like Cleveland Clinic and Mayo Clinic. Contraindications are uncommon but include irreversible death criteria codified in legal and institutional policies exemplified by statutes in jurisdictions such as California and protocols from hospitals like St Thomas' Hospital; do-not-resuscitate orders issued by competent patients or legally recognized healthcare proxies at institutions like Johns Hopkins Hospital are honored. Ethical and legal frameworks influenced by cases in courts such as the Supreme Court of the United States and policy documents from agencies like the World Health Organization inform decision-making.

Techniques and Guidelines

Contemporary techniques follow algorithmic approaches promulgated by the American Heart Association, the European Resuscitation Council, and the International Liaison Committee on Resuscitation with emphasis on high-quality compressions, appropriate ventilation, and early defibrillation using automated external defibrillators supplied by manufacturers like ZOLL Medical Corporation and Philips. Bystander protocols promoted by community programs in cities such as Osaka and Stockholm recommend hands-only compressions for untrained rescuers, while advanced cardiac life support sequences taught in courses by organizations like the Resuscitation Council (UK) include airway management techniques used in tertiary centers such as Guy's Hospital and medication algorithms used in intensive care units at Charité – Universitätsmedizin Berlin. Use of mechanical chest compression devices developed by companies like LUCAS and extracorporeal membrane oxygenation strategies implemented at specialized centers such as Karolinska University Hospital represent adjuncts under specific guidelines.

Physiology and Mechanism

The physiologic rationale derives from studies in cardiovascular physiology from laboratories at institutions like Harvard Medical School and University of Cambridge, showing that chest compressions generate intermittent cardiac output and coronary perfusion pressure similar to afterload modulation observed in investigations at Johns Hopkins University. Ventilatory components aim to reestablish alveolar gas exchange as characterized by pulmonary research from National Institutes of Health and gas-exchange models used at Imperial College London. Defibrillation terminates malignant ventricular arrhythmias as demonstrated in electrophysiology work from centers such as Mayo Clinic and Cleveland Clinic and informed by early experiments at Massachusetts General Hospital.

Training and Certification

Training programs and certification pathways are offered by organizations including the American Heart Association, the Red Cross, the Royal College of Physicians, and regional providers affiliated with medical schools like University of Toronto and Monash University. Courses range from community-focused initiatives supported by municipal authorities in places like San Francisco and Melbourne to professional courses such as Basic Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support required by hospitals such as Mount Sinai Hospital and Toronto General Hospital. Credentialing and recertification intervals are governed by policies from professional societies including the American College of Emergency Physicians and hospital credentialing committees at centers like UCSF Medical Center.

Outcomes and Epidemiology

Epidemiologic data collected by registries such as the Resuscitation Outcomes Consortium and national databases in Sweden, United States, and Japan show variable survival rates influenced by witnessed arrest, bystander intervention rates, initial rhythm, and time to defibrillation. Community programs in cities like Copenhagen and Seattle that increased bystander CPR and automated external defibrillator availability reported improved survival to hospital discharge in observational studies published by investigators at institutions like Duke University and Stanford University. Ongoing public health initiatives and randomized trials coordinated by centers such as University College London and University of Pennsylvania continue to refine strategies to improve neurologically intact survival.

Category:Lifesaving procedures