Guidelines for Using Cardiopulmonary Resuscitation (CPR) and AED in Resuscitation

Key takeaways:

• Cardiopulmonary resuscitation, known as CPR, is a lifesaving medical procedure initiated when the heart stops beating. It typically consists of serial chest compressions and mouth-to-mouth breathing.
• CPR is a fundamental part of the BLS (Basic Life Support) protocol, an emergency medical response component that both medical and non-medical practitioners can carry out.
• The automated external defibrillator (AED) is a medical device that delivers an electrical current to the body to normalize an otherwise abnormal heart rhythm.
• The combined use of CPR and an automated external defibrillator could potentially double, or even triple, the survival rates of people who experience a cardiac arrest.

Cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators are fundamental aspects of the rapid emergency response when a person has a heart condition emergency, such as a sudden cardiac arrest.

CPR is an interventional procedure that involves several chest compressions and rescue breathing in adults at a ratio of 30 compressions to 2 rescue breaths. In other words, the victim’s chest is compressed 30 times, followed by two rescue breaths, and then the cycle is repeated.

The rescue breaths may be given mouth-to-mouth (standard), mouth-to-nose, or through devices.

The timely and effective initiation of CPR and appropriate use of the AED is believed to significantly increase the survival rates of people who experience cardiac arrest. Yet, many people lack adequate CPR training and skills, with the majority having very little knowledge of the AED medical device.

What is an automated external defibrillator (AED)?

An automated external defibrillator or AED is a medical device that is used in the management of heart condition-related emergencies such as sudden cardiac arrest.

The heart beats in a regular, steady, and coordinated pattern to ensure blood circulates the body and back. The pacemaker, the sinoatrial node, a cluster of specialized cells in the heart, maintains this rhythm.

The heart's pumping action is affected when its rhythm becomes abnormal, such as in medical cases like cardiac arrest, ventricular fibrillation, and supraventricular tachycardia.

The AED helps assess the heart’s rhythm, detect abnormalities, and restore normal or sinus rhythm. It delivers an electrical current through the body's surface at specific locations, allowing it to travel directly to the heart. 

AEDs are designed to be portable, lightweight, and user-friendly, making them simple enough for laypersons to use. They can be found in airports, train stations, sporting arenas, bus terminals, health facilities, workplaces, and hotels, among other places. 

Can AEDs be used during CPR?

Yes, AEDs can be used during CPR. The BLS (Basic Life Support) protocol is a set of interventions individuals are trained to give in response to medical emergencies. This protocol includes CPR and the use of an AED when needed.

An AED can be used during CPR if the victim has a “shockable” rhythm. A shockable rhythm is an abnormal heart rhythm that can be reversed using a defibrillator. The AED can detect such rhythms and will notify the user when it is appropriate to shock.

Examples of shockable rhythms include ventricular fibrillation (a type of irregular beating of the heart), also called v-fib, and pulseless ventricular tachycardia (when the heart’s lower chambers beat too fast that they can’t fill up with blood and with no detectable pulse). 

Non-shockable rhythms, such as asystole and pulseless electrical activity, cannot be reversed with AEDs and may require additional CPR or medication administration.

7 steps of CPR for adults

Here is a step-by-step guide to performing CPR on adults:

1. Begin by assessing the carotid pulse on the side of the neck. Feel the pulse by placing your first and middle fingers on the side of the neck along the windpipe for no longer than 10 seconds. 
2. If you are unsure or do not feel a pulse at all, begin your first cycle of CPR. Start to give 30 chest compressions, followed by two breaths.
3. To give the compressions, place the heel of your dominant hand on the lower part of the sternum in the middle of the chest. Place your other hand above the first hand.
4. Straighten your arms and ensure they do not bend at the elbows. Press into the person’s chest at 100-120 compressions per minute. The depth of your compressions should be 5 to 6 cm. Do not exceed this, as there is a fracture risk. Do not go less than this, either, or the compressions will be inadequate. 
5. Ensure that you completely stop pressing on the chest after each chest compression to allow blood flow to return and fill the heart and for the heart to maintain its normal architecture.
6. After 30 compressions, stop compressions and open the airway. This is done by tilting the head backward and lifting the chin. Place your hand on the person’s forehead and tilt their head back. Lift the person’s jaw by placing your index and middle finger on the lower jaw, then lift.
7. Pinch your nose and breathe through your mouth, watching your chest rise. Repeat. Then, resume the cycle with thirty chest compressions.

How to use an Automated External Defibrillator (AED)

Before using the AED, certain key considerations and criteria must be met. These exist to ensure safe and effective usage of the device.

Here are the key considerations:

1. Ensure oxygen does not flow through the individual when the shock is delivered.
2. Ensure no one is touching the patient when delivering the shock.
3. Ensure the individual is dry and away from water.
4. When assessing the rhythm, do not stop chest compressions for more than 10 seconds.

Criteria to be met before applying AED

Do not use the AED if:

• The carotid pulse can be detected.
• The individual is breathing or breathing ineffectively.
• The individual responds to calls, shouts, or shaking of shoulders.

Step-by-step of using the AED

1. Power on the AED.
2. Choose between adult or pediatric pads, depending on whether you will be using it on an adult or a child.
3. Inspect the chest wall and note any medication patches present. If they have any, remove them to prevent accidental thermal burns when delivering the shock.
4. Attach the AED pads to the bare chest, ensuring the cables are connected.
5. Place one chest pad at the upper right side of the chest and the other a few inches below the left armpit.
6. Clear the area to allow AED to read the rhythm. This may take up to 15 seconds.
7. If the AED shows “no shock advised,” restart CPR.
8. If the AED shows that shock is needed, clear the individual (i., ensure no one is in contact with them) and remove oxygen if present. Ensure they are visually cleared and shout “CLEAR.”
9. Press the “Shock” button.
10. Aftershock, immediately resume CPR, starting with chest compressions.
11. After two minutes of CPR, the AED will analyze the rhythm again.
12. Continue to follow the AED prompts.

Why you should learn how to perform CPR and how to Use AED

Every minute spent without initiating CPR and rapid defibrillation during a cardiac emergency decreases a person’s chance of survival by 7-10 percent.

AEDs used in the first minute of a cardiac arrest can increase survival rates to as high as ninety percent. This underscores the importance of CPR and AEDs as lifesaving, resuscitative measures.

Adequate CPR training better equips us to respond to medical emergencies outside a healthcare facility, such as in the workplace, schools, recreational venues, etc.

Where to learn about CPR and AED use

Learning how to perform CPR and use an AED should be encouraged. This invaluable skill helps save lives and keeps our communities safer. Several local organizations provide structured, in-person training programs that follow international standards for interested individuals.

Some organizations, such as the American Heart Association and Red Cross, offer in-person CPR training with certification, including using an AED. Additionally, several organizations offer online BLS courses and certifications that teach CPR and the appropriate use of an AED.

Wrap up

Every individual should prioritize safeguarding our communities. Anyone can learn to perform CPR—a medical degree is not needed.

If interested, consider visiting health organizations or paramedics' websites online or inquiring from a healthcare facility close to you about how or where to learn more about CPR and possibly get certifications, if needed.