How to Perform Resuscitation (CPR) on an Unconscious Person

If a person isn’t breathing and/or has no pulse, it’s important to provide high quality CPR (resuscitation) in order to deliver Oxygen (O2) to the brain. Learning how to provide high quality CPR and providing it quickly to a person who isn’t breathing, or does not have a pulse, can make all the difference in the world!

If fact the American Heart Association reports that 70% of Americans haven’t had a CPR class, and don’t know how what to do if a person is experiencing cardiac arrest or a cardiac emergency. Since almost 90% of cardiac arrests occur at home, where the person needs immediate Cardiopulmonary resuscitation, probably provided by an immediate family member, it makes it even more important to learn how to perform high quality CPR that can save the life of a loved one or family member.

Why CPR works!

So, let’s learn how CPR works and why it can provide lifesaving Oxygen (O2) to the brain. If a person has a normal healthy heart beat, each contraction of the heart produces what is called “stroke volume”, which leads to “Cardiac Output” which then leads to “Perfusion” of Oxygen (O2) to the brain. Stroke volume is the amount of blood per beat that is moved to the brain and throughout the body. Cardiac Output is simply the amount of blood per minute being delivered to the brain, and perfusion simply means the delivery a fluid, (in this case oxygenated blood) to saturate the brain with lifesaving Oxygen (O2). But if a person has no pulse, stroke volume drops to zero, cardiac output drops to zero and Oxygen perfusion in the brain starts to run out and usually the person has about 4-5 minutes before brain damage occurs and is followed by death.

High quality CPR can double or triple an adult’s chance of survival. However, as I mentioned above, time is of the essence and you need to act quickly. At 4-5 minutes without oxygen, the patient will suffer from permanent brain damage. At 8-10 minutes in most cases, the person can die. Almost 90% of cardiac arrest patients die because no one performed CPR at the scene.

Before You Start CPR

First of all, you want to make sure the environment around you is safe and there are no threats to your safety. Then you want to check if the patient can respond by tapping them on the shoulder and shouting “Are you okay?” If they don’t respond, activate the EMS by asking someone to call 911 and bring back an AED. If you’re alone and you have a cell phone, do it yourself and put the phone on “speaker”.

Performing CPR

In the next step (assuming you have no formal medical training), you look for breathing for 5 to 10 seconds. If they have no breathing, you need to locate the center of the chest and begin chest compressions. Compressions are the most important part of high quality CPR because they restore blood circulation. When rescuers deliver CPR to cardiac arrest victims, they essentially create an artificial heartbeat that creates “stroke volume”, which leads to “Cardiac Output” which then leads to “Perfusion” of Oxygen (O2) to the brain. The chest compressions manually squeeze or compress blood out of the heart and push it throughout the body, delivering some oxygen-rich blood to the victim’s brain and organs. But the organ that really counts is the brain, which is vulnerable to less Oxygen. Basically, the rescuer “becomes” the victim’s heartbeat and extends or “re-sets” the victims 4-5 minute clock.

You need to provide compressions that are deep enough and that are fast enough, for an adult, that’s a 2” compression followed by a 2” chest recoil. You also need to allow the chest to return or spring back to its normal position after every compression, (this allows the heart to refill after every compression) and make sure not to interrupt the compressions for more than 10 seconds. High quality CPR has two important components, 1) providing compressions and 2) giving breaths. But if you are a lay provider, (someone as I mentioned before who has no formal medical training), then you can provide “hands only” CPR that does not include the breaths. If you choose to give breaths, it is best to use “Personal Protective Equipment” or what is called a CPR mask or Barrier Device that can protect you from viral or bacterial micro-organisms that you don’t want on or in you. It is good practice to prevent a disease pathway from the victim to you. Giving breaths can be done mouth-to-mouth or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

According to the American Heart Association, if you are the untrained lay provider I described above or if you have not had an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED), then provide hands-only CPR. That means continuous (no need to stop for the breaths) chest compressions of 100 to 120 a minute until 911 and the EMT’s and paramedics arrive. You don't need to try rescue breathing for the reasons I outlined above.
But if have had an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED), then check to see if there is a pulse and breathing. If there is no breathing or a pulse within 10 seconds, begin chest compressions. Start CPR with 30 chest compressions before giving two rescue breaths (a ratio of 30 to 2 compressions to breaths).

Giving Breaths
As I said above, rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. If you decide to do breaths, you need to use the head-tilt, chin-lift maneuver which opens the airway. Then pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. But if you have the “Personal Protective Equipment” or what is called a CPR mask or Barrier Device, use it for every breath. Give the first rescue breath lasting one second, and watch to see if the chest rises, (chest rise is the only confirmation that the breath was successful). If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. The 30 to 2 compressions to breaths is considered one cycle of CPR. After two breaths resume chest compressions to restore circulation and Oxygen to the brain.

The AED

As soon as an automated external defibrillator (AED) is available, turn it on. The most important thing to remember about using the AED is to turn it on. It is very easy to use. Once it is on, you simply follow the prompts. When the AED tells you to administer one shock, then resume CPR immediately, starting with chest compressions. If you're not trained to use an AED, the 911 or dispatch operator may be able to guide you in its use. Continue CPR until there are signs of movement or emergency medical personnel take over.