Chapter 12: Respiratory care, CPR and blood transfusion
Skip chapter table of contents and go to main content
Evidence‐based approaches
Sudden death as a result of cardiac arrest is responsible for 60% of ischaemic heart disease deaths across Europe (RCUK [232]). The British Heart Foundation ([32]) also reports that of the 545 people who attend hospital within the UK each day with heart‐attack‐like symptoms, 180 people die.
Changes to adult basic life support (BLS) guidelines have been made to reflect the importance of performing high‐quality chest compressions. The rescuer should minimize the number and duration of pauses during chest compressions (RCUK [232]). The duration of collapse is frequently difficult to estimate accurately, so CPR should be given before attempting defibrillation outside hospital, unless the arrest is witnessed by a healthcare professional or an automated external defibrillator is being used (RCUK [232]). Audit and reports of cardiac arrest demonstrate that 70% of in‐hospital cardiac arrests are found to be in asystole and PEA; however, only 8–10% of those cardiac arrests are followed by survival to hospital discharge (Nolan et al. [200]).
Rationale
Changes to Resuscitation Council UK guidelines suggest that the BLS rescuer should make a rapid, simple assessment of the patient to determine they are in cardiorespiratory arrest and commence BLS immediately. The rescuer should not stop to check the patient or discontinue CPR unless the person starts to show signs of life, such as regaining consciousness, coughing, opening eyes, speaking or moving purposefully, and starts to breathe normally (RCUK [232]).
Indications
BLS is indicated if the patient is unconscious, has absent or agonal (gasping) respirations, and has no pulse.
Contraindications
BLS is contraindicated:
- if a valid Do Not Attempt Cardiopulmonary Resuscitation (DNaCPR) order is in place
- if the environment would place the rescuer at risk (in which case, do not attempt resuscitation until the environment is made safe).
