Cardio-pulmonary resuscitation (CPR) is expired air resuscitation (EAR) used in conjunction with external cardiac compressions (ECC). It is the singularly most effective form of active resuscitation available, and is used universally by trained first aid providers and medical personnel. The technique is used to assist in resuscitation of casualties in cardiac arrest.

While expired air resuscitation is the method by which oxygen is provided to the casualty, external cardiac compressions, when applied correctly, duplicate the heart's mechanical function of pumping the oxygenated blood around the body. This combination of techniques is the basis of CPR. Effective CPR can sustain a casualty until more expert definitive medical treatment is available.  It is vital that CPR is initiated immediately on contact with the casualty.

A particularly important aspect of CPR is that the rescuer's hands are positioned correctly in relation to the casualty's heart.  There are two common methods used to locate the correct position of the heart; the Xiphoid Location , and the Calliper Method.

Xiphoid Location

Place two fingers of one hand over the casualty's xiphoid process, the small 'bump' at the base of the sternum. The other hand is then placed with the palm of the hand in the centre of the sternum, above the two fingers.  This position on the lower part of the sternum approximates the location of the heart.

Calliper Method

The middle finger of one hand is placed on the `sternal notch', the depression above the sternum below the throat. The middle finger of the other hand is placed at the base of the xiphoid process. Both hands are then moved together so that the thumbs meet in the middle of the sternum. The lower hand is then positioned palm down across the lower part of the sternum, close to the thumb of the upper hand. This approximates the location of the heart.

For adults and older children place one hand in position, the second hand is positioned over the first and the fingers entwined for stability. An alternative is for the second hand to grip the wrist of the first. The chest is then compressed approximately 1/3 the depth of the chest with pressure exerted through the heel of the bottom hand.

INDICATIONS FOR CPR:

 
• unconsciousness
 
• usually no respirations, although there may be brief irregular, 'gasping' breaths
• no pulse

PROCEDURE FOR ADULT AND OLDER CHILD ONE-PERSON CPR:

• check for DANGER
• check for response, gently shake and shout
• call for help
• roll casualty away from you
• check and clear airway
• look, listen and feel for breathing
• If not breathing place casualty on back on a firm flat surface
• open airway
• give two effective breaths
• assess the rise and fall of the chest
• check for carotid (neck) pulse (5 - 10 seconds)
• kneel beside casualty's chest
• locate correct hand position
• place hands centrally over heart, fingers entwined
• lean over casualty, arms straight, elbows locked
• commence 15 compressions, with even pressure approximately 1/3 the depth of the chest
• compressions - rate of 100 per minute
• give two effective breaths
• relocate correct hand position
• 15 compressions
• continue cycles and recheck pulse around every 1 minute

CPR is to be continued once begun until either the casualty is revived, the rescuer is relieved by expert medical aid, or until the rescuer is too exhausted to continue. Should the casualty regain his/her pulse and breathing, put him/her into the stable side position and observe closely, as often the casualty lapses back into cardiac arrest. If pulse only returns, continue with EAR.