The fundamentals of emergency resuscitation

Abstract

INTRODUCTION Resuscitation is the process by which an individual is brought ‘back to life’ or consciousness. Cardiorespiratory resuscitation is the process by which an individual's respiration and circulation may be temporarily supported to keep them alive long enough for the cause of the arrest to be treated, if this is possible. Ideally, all clinical personnel, both medical and non-medical, should be familiar with the principles and practice of cardiopulmonary resuscitation. In the United Kingdom, the Resuscitation Council (UK) runs an excellent Advanced Life Support Provider course, which covers the principles and practice of life support in detail. This chapter provides an overview of the subject of resuscitation. RECOGNITION AND ASSESSMENT The importance of the recognition and assessment of the suspected cardiorespiratory arrest cannot be overstated. Failure to recognize and respond to the arrest wastes valuable time and reduces the chance of a successful outcome. A respiratory arrest occurs when an individual stops breathing and becomes apnoeic. A cardiac arrest is when the heart fails to pump enough blood to maintain a pulse or blood pressure. If untreated, one always rapidly follows the other because, if breathing ceases, no oxygen enters the blood and the heart, brain and other vital organs are starved of oxygen. This hypoxia leads to the development of organ failure. Initially, because the brain has the greatest need for oxygen, it rapidly stops functioning properly and the patient loses consciousness. The brainstem is also affected and, shortly after, the heart ceases to beat effectively and the circulation fails, i.e. the blood pressure and pulse will be unrecordable. Without a circulation and the subsequent loss of tissue perfusion, damage to other vital organs will ensue. If, on the other hand, the patient has a cardiac arrest the circulation fails first and the brain then becomes starved of oxygen-rich blood. Cerebral function is compromised and the patient rapidly becomes unconscious. Because the brain also contains the respiratory centre, which controls breathing, the breathing will become erratic and eventually stop. In this case, the respiratory arrest is secondary to a cardiac arrest. Of all the vital organs which suffer injury following a cardiorespiratory arrest, the brain is the most vulnerable. Irreversible brain damage begins 3-4 min following a cardiorespiratory arrest. Not all parts of the brain, however, are damaged at the same rate.