Standard Operating Procedure: Cardiopulmonary Resuscitation (CPR)

Overview

This Standard Operating Procedure (SOP) outlines the critical, time-sensitive steps required to perform high-quality Cardiopulmonary Resuscitation (CPR) on an unresponsive adult in cardiac arrest. The primary objective is to maintain hemodynamic stability and oxygenate vital organs—specifically the brain and heart—until Advanced Life Support (ALS) personnel arrive or the patient achieves Return of Spontaneous Circulation (ROSC). This procedure follows current American Heart Association (AHA) guidelines emphasizing the "Push Hard, Push Fast" protocol.

Phase 1: Scene Safety and Assessment

• Ensure Scene Safety: Before approaching, scan the environment for hazards (traffic, electrical wires, fire, chemical spills).
• Assess Responsiveness: Tap the patient firmly on the shoulders and shout, "Are you okay?"
• Activate Emergency Response: If the patient is unresponsive, call for professional help immediately or designate a specific bystander to call 911 and retrieve an Automated External Defibrillator (AED).
• Check for Breathing and Pulse: Simultaneously check for normal breathing and a carotid pulse for no more than 10 seconds. If absent, initiate CPR immediately.

Phase 2: High-Quality Chest Compressions

• Positioning: Place the patient on their back on a firm, flat surface. Kneel beside the patient’s chest.
• Hand Placement: Place the heel of one hand in the center of the chest (lower half of the sternum). Place the other hand on top and interlock fingers.
• Compression Depth: Compress at least 2 inches (5 cm) but no more than 2.4 inches (6 cm).
• Compression Rate: Maintain a speed of 100 to 120 compressions per minute.
• Chest Recoil: Allow the chest to fully recoil after each compression; do not lean on the chest between strokes.

Phase 3: Airway and Ventilation

• Airway Management: Use the head-tilt/chin-lift maneuver to open the airway. If trauma is suspected, use the jaw-thrust maneuver.
• Ratio: Perform 30 compressions followed by 2 rescue breaths.
• Breath Delivery: Deliver each breath over 1 second, ensuring the chest visibly rises.
• Minimize Interruptions: Keep interruptions in chest compressions to less than 10 seconds. Switch compressors every 2 minutes to prevent fatigue-related degradation in quality.

Phase 4: AED Integration

• Power On: As soon as the AED arrives, open the case and press the power button.
• Apply Pads: Attach pads to the patient’s bare chest as indicated by the diagrams on the pads.
• Clear for Analysis: Command all personnel to step away from the patient during rhythm analysis.
• Shock Delivery: If a shock is advised, ensure no one is touching the patient and press the "Shock" button. Resume compressions immediately after the shock.

Pro Tips & Pitfalls

• Pro Tip: Use a metronome app or hum the beat of "Stayin' Alive" by the Bee Gees to maintain the correct compression tempo of 100-120 BPM.
• Pitfall (Leaning): Leaning on the chest between compressions prevents the heart from refilling with blood, significantly reducing cardiac output.
• Pitfall (Hyperventilation): Avoid excessive ventilation. Providing too much air increases intrathoracic pressure, which decreases venous return to the heart.
• Pro Tip: If the patient begins to move, cough, or breathe normally, stop CPR but keep the AED attached and continue to monitor responsiveness until EMS takes over.

Frequently Asked Questions

1. Should I perform CPR if I am not trained? Yes. Hands-only CPR (compressions only) is highly effective for untrained bystanders. Push hard and fast in the center of the chest until professional help arrives.

2. What if I break the patient’s ribs during compressions? Rib fractures are a known complication of effective CPR. Do not stop; the risk of death from cardiac arrest outweighs the damage to the ribs. Continue high-quality compressions regardless of auditory or tactile feedback.

3. When should I stop CPR? Continue until:

• Professional medical personnel take over.
• The patient shows obvious signs of life.
• An AED becomes available and indicates a shock or analysis is required.
• The scene becomes unsafe for the rescuer.
• You are too physically exhausted to continue.