Cardiopulmonary resuscitation : state of the art in 2011

Abstract

Failure to recognise the signs of sudden cardiac arrest or impending cardiac arrest will lead to delayed intervention. Cardiopulmonary resuscitation (CPR) must be initiated without delay, irrespective of the level of skill of the caregiver. The 2010 CPR guidelines emphasise the importance of chest compressions, which have now become the first step in the CPR sequence [compressions, airway, breathing or circulation, airway, breathing (CAB), instead of airway, breathing, compressions, or airway, breathing, circulation (ABC)]. Hands-only CPR should be encouraged where untrained caregivers are involved. Although ventilation may be an important step in some cases of arrest, e.g. primary asphyxia, excessive and inappropriate ventilation is detrimental. Rapid defibrillation is an essential life-saving step for specific arrest rhythms. Always consider reversible causes of cardiac arrest, and “find it, flag it, fix it and follow up!” Ideally, and especially during an inhospital cardiac arrest, skilled providers should strive to work as a team. Team performance must be reviewed regularly to improve CPR efforts and ultimately outcome. Resuscitation and CPR during the perioperative period is unique, and therefore should be tailored individually to each specific clinical situation. A detailed knowledge of the most up-to-date resuscitation algorithms is essential. These are available from any resuscitation council.