CPR being performed on a medical-training manikin
Cardiopulmonary resuscitation (CPR) is an emergency procedure performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.
According to the International Liaison Committee on Resuscitation guidelines, CPR involves chest compressions at least 5 cm (2 in) deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart and thus the body. The rescuer may also provide breaths by either exhaling into the subject's mouth or nose or using a device that pushes air into the subject's lungs. This process of externally providing ventilation is termed artificial respiration. Current recommendations place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.
CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the patient has a return of spontaneous circulation (ROSC) or is declared dead.
- 1 Medical uses
- 2 Methods
- 3 Effectiveness
- 4 Pathophysiology
- 5 Complications
- 6 Adjunct devices
- 7 Prevalence
- 8 Society and culture
- 9 History
- 10 Administering CPR to animals
- 11 See also
- 12 References
- 13 External links
CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest.:S643 If a person still has a pulse but is not breathing (respiratory arrest) artificial respirations may be more appropriate, but, due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse. In those with cardiac arrest due to trauma CPR is considered futile but still recommended. Correcting the underlying cause such as a pneumothorax or pericardial tamponade may help.
In 2010, the American Heart Association and International Liaison Committee on Resuscitation updated their CPR guidelines.:S640 The importance of high quality CPR (sufficient rate and depth without excessively ventilating) was emphasized.:S640 The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB).:S642 An exception to this recommendation is for those believed to be in a respiratory arrest (drowning, etc.).:S642 The most important aspect of CPR are: few interruptions of chest compressions, a sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much.
A universal compression to ventilation ratio of 30:2 is recommended by the AHA.:8 With children, if at least 2 trained rescuers are present a ratio of 15:2 is preferred.:8 In newborns a rate of 3:1 is recommended unless a cardiac cause is known in which case a 15:2 ratio is reasonable.:S647 If an advanced airway such as an endotracheal tube or laryngeal mask airway is in place, artificial ventilation should occur without pauses in compressions at a rate of 8–10 per minute. The recommended order of interventions is chest compressions, airway, breathing or CAB in most situations,:S642 with a compression rate of at least 100 per minute in all groups.:8 Recommended compression depth in adults and children is at least 5 cm (2 inches) and in infants it is 4 centimetres (1.6 in).:8 As of 2010 the Resuscitation Council (UK) still recommends ABC for children. As it can be difficult to determine the presence or absence of a pulse, the pulse check has been removed for lay providers and should not be performed for more than 10 seconds by healthcare providers.:8 In adults, rescuers should use two hands for the chest compressions, while in children they should use one, and with infants two fingers (index and middle fingers).
Compression-only (hands-only or cardiocerebral resuscitation) CPR is a technique that involves chest compressions without artificial respiration.:S643 It is recommended as the method of choice for the untrained rescuer or those who are not proficient because it is easier to perform and instructions are easier to give over a phone.:S643:8 In adults with out-of-hospital cardiac arrest, compression-only CPR by the lay public has a higher success rate than standard CPR. The exceptions are cases of drownings, drug overdose and arrest in children. Children who receive compression-only CPR have the same outcomes as those having received no CPR.:S646 The method of delivering chest compressions remains the same, as does the rate (at least 100 per minute). It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR. As per the American Heart Association, the beat of the Bee Gees song "Stayin' Alive" provides an ideal rhythm in terms of beats per minute to use for hands-only CPR. One can also hum Queen's "Another One Bites The Dust", which is exactly 100 beats-per-minute and contains a memorable repeating drum pattern. For those with non cardiac arrest and people less than 20 years of age, standard CPR is superior to compression-only CPR.
Simultaneous maintenance of blood circulation and ventilation can be obtained by compressing the back if the victim is in prone position, by turning the head to the side and compressing the back. Due to the head's being turned, the risk of vomiting and complications caused by aspiration pneumonia is significantly reduced, and the method means the patient continues to get air into their lungs without the need for mouth-to-mouth respiration.
During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left; if this is not effective, either roll the woman 30° or healthcare professionals should consider emergency Caesarean section.
|Type of Arrest||ROSC||Survival||Source|
|Witnessed In-Hospital Cardiac Arrest||52%||19%|||
|Unwitnessed In-Hospital Cardiac Arrest||33%||8%|||
|Out-of-Hospital Cardiac Arrest Overall||59%||10%|||
|Unwitnessed Out-of-Hospital Cardiac Arrest||21%||4%|||
|Witnessed Out-of-Hospital Cardiac Arrest||41%||15%|||
|Witnessed and "Shockable" with Bystander CPR||53%||37%|||
|Bystander Compression-only Resuscitation||-||13%|||
|Bystander Conventional CPR||-||8%|||
CPR serves as the foundation of successful cardiopulmonary resuscitation, preserving the body for defibrillation and advanced life support. Even in the case of a "non-shockable" rhythm, such as Pulseless Electrical Activity (PEA) where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.
Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed "shockable" arrest. In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.
Compression-only CPR may be less effective in children than in adults, as cardiac arrest in children is more likely to have a non-cardiac cause. In a 2010 prospective study of cardiac arrest in children (age 1–17) for arrests with a non-cardiac cause, provision by bystanders of conventional CPR with rescue breathing yielded a favorable neurological outcome at one month more often than did compression-only CPR (OR 5.54; 95% confidence interval 2.52–16.99). For arrests with a cardiac cause in this cohort, there was no difference between the two techniques (OR 1.20; 95% confidence interval 0.55–2.66). This is consistent with American Heart Association guidelines for parents.
There is a higher proportion of patients who achieve spontaneous circulation (ROSC), where their heart starts beating on its own again, than ultimately survive to be discharged from hospital (see table above). This may be due to medical staff being ultimately unable to address the cause of the cardiac arrest, to other co-morbidities, or to the patient being gravely ill in more than one way. Ultimately, only 5–10% of patients in cardiac arrest will survive after an attempted resuscitation.
CPR is used on people in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. Typically if blood flow ceases for one to two hours, then body cells die. Therefore, in general CPR is effective only if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings, prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain stem death, and allows the heart to remain responsive to defibrillation attempts.
While CPR is a last resort intervention, without which a patient without a pulse will all but certainly die, the physical nature of how CPR is performed does lead to complications that may need to be rectified. Common complications due to CPR are rib fractures, sternal fractures, bleeding in the anterior mediastinum, heart contusion, hemopericardium, upper airway complications, damage to the abdominal viscus - lacerations of the liver and spleen, fat emboli, pulmonary complications - pneumothorax, hemothorax, lung contusions.
The most common injuries sustained from CPR are rib fractures, with literature suggesting an incidence between 13% and 97%, and sternal fractures, with an incidence between 1% to 43%. Whilst these iatrogenic injuries can require further intervention (assuming the patient survives the cardiac arrest), only 0.5% of them are life-threatening in their own right.
The type and frequency of injury can be affected by factors such as gender and age. For instance, women have a higher risk of sternal fractures than men, and risk for rib fractures increases significantly with age. Children and infants have a low risk of rib fractures during CPR, with an incidence less than 2%, although, when they do occur, they are usually anterior and multiple.
Where CPR is performed in error by a bystander, on a patient not in cardiac arrest, only around 2% suffer injury as a result (although 12% experienced discomfort).
While several adjunctive devices are available, none other than defibrillation, as of 2010, have consistently been found to be better than standard CPR for out-of-hospital cardiac arrest.:S644 These devices can be split into three broad groups: timing devices' those that assist the rescuer to achieve the correct technique,especially depth and speed of compressions; and those that take over the process completely.
Timing devices can feature a metronome (an item carried by many ambulance crews) in order to assist the rescuer in achieving the correct rate. Some units can also give timing reminders for performing compressions, ventilating and changing operators.
Manual assist devices
Mechanical devices have not been found to have greater benefit than harm and thus are not currently recommended for widespread use.
Audible and visual prompting may improve the quality of CPR and prevent the decrease of compression rate and depth that naturally occurs with fatigue, and to address this potential improvement, a number of devices have been developed to help improve CPR technique.
These items can be devices to placed on top of the chest, with the rescuer's hands going over the device, and a display or audio feedback giving information on depth, force or rate, or in a wearable format such as a glove. Several published evaluations show that these devices can improve the performance of chest compressions.
As well as its use during actual CPR on a cardiac arrest victim, which relies on the rescuer carrying the device with them, these devices can also be used as part of training programs to improve basic skills in performing correct chest compressions.
There are also some automated devices available that take over the chest compressions for the rescuer. These have several advantages: they allow rescuers to focus on performing other interventions; they do not fatigue and begin to perform less effective compressions, as humans do; and they are able to perform effective compressions in limited-space environments such as air ambulances, where manual compressions are difficult. These devices use either pneumatic (high-pressure gas) or electrical power sources to drive a compressing pad on to the chest of the patient. One such device, known as the LUCAS, was developed at the University Hospital of Lund, is powered by the compressed oxygen supplies already standard in ambulances and hospitals, and has undergone numerous clinical trials, showing a marked improvement in coronary perfusion pressure and return of spontaneous circulation.
In August 2013, a 41-year-old woman living in a town near Melbourne in Australia was treated with the LUCAS device for 53 minutes while a stent was placed in an artery near her heart, clearing a 100% blockage. She was considered to be clinically dead for 40 minutes. She was discharged from the hospital a week later.
Artificial ventilation can be achieved with multiple devices. While manual bag valve mask devices supply oxygen-enriched air through a facial mask (without maintaining an open airway), automatic devices utilize an oropharyngeal airway (e.g., Bergman or Guedel airways), which ensures airway patency. They also have a nozzle for the rescuer with a protective mask mode, preventing any mouth-to-mouth contact. Another system called the AutoPulse is electrically powered and uses a large band around the patient's chest that contracts rhythmically in order to deliver chest compressions. This is also backed by clinical studies showing increased rates of return of spontaneous circulation.
To support training and incident management mobile apps have been published on the largest app markets. An evaluation of 61 available apps has revealed that a large amount does not follow international guidelines for basic-life support and many apps are not designed in a user-friendly way.
Chance of receiving CPR
Various studies suggest that in out-of-home cardiac arrest, bystanders, lay persons or family members attempt CPR in between 14% and 45% of the time, with a median of 32%. This indicates that around a third of out-of-home arrests have a CPR attempt made on them. However, the effectiveness of this CPR is variable, and the studies suggest only around half of bystander CPR is performed correctly. A recent study has shown that members of the public having received CPR training in the past lack the skills and confidence needed to save lives. These experts believe that better training is needed to improve the willingness to respond to cardiac arrest.
There is a clear correlation between age and the chance of CPR being commenced. Younger people are far more likely to have CPR attempted on them before the arrival of emergency medical services. It was also found that bystanders more commonly administer CPR when in public than when at the patient's home, although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts. People with no connection to the victim are more likely to perform CPR than are a member of their family.
There is also a clear correlation between cause of arrest and the likelihood of a bystander initiating CPR. Lay persons are most likely to give CPR to younger cardiac arrest victims in a public place when it has a medical cause; victims in arrest from trauma, exsanguination or intoxication are less likely to receive CPR.
Finally, it has been claimed that there is a higher chance that CPR will performed if the bystander is told to perform only the chest compression element of the resuscitation.
Chance of receiving CPR in time
CPR is likely to be effective only if commenced within 6 minutes after the blood flow stops because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4–6 minutes in an oxygen deprived environment and, therefore, cannot survive the reintroduction of oxygen in a traditional resuscitation. Research using cardioplegic blood infusion resulted in a 79.4% survival rate with cardiac arrest intervals of 72±43 minutes, traditional methods achieve a 15% survival rate in this scenario, by comparison. New research is currently needed to determine what role CPR, electroshock, and new advanced gradual resuscitation techniques will have with this new knowledge.
A notable exception is cardiac arrest that occurs in conjunction with exposure to very cold temperatures. Hypothermia seems to protect by slowing down metabolic and physiologic processes, greatly decreasing the tissues' need for oxygen. There are cases where CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia.
Society and culture
CPR is often severely misrepresented in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation.
A 1996 study published in the New England Journal of Medicine showed that CPR success rates in television shows was 75% for immediate circulation, and 67% survival to discharge. This gives the general public an unrealistic expectation of a successful outcome. When educated on the actual survival rates, the proportion of patients over 60 years of age desiring CPR should they suffer a cardiac arrest drops from 41% to 22%.
Chest compressions are capable of causing significant local blunt trauma, including bruising or fracture of the sternum or ribs. Performing CPR on a healthy person may or may not disrupt normal heart rhythm, but regardless the technique should not be performed on a healthy person because of the risk of trauma.
The portrayal of CPR technique on television and film often is purposely incorrect. Actors simulating the performance of CPR may bend their elbows while appearing to compress, to prevent force from reaching the chest of the actor portraying the victim. Other techniques, such as substituting a mannequin torso for the "victim" in some shots, may also be used to avoid harming actors.
A form of "self-CPR" termed "cough CPR" was the subject of a hoax chain e-mail entitled "How to Survive a Heart Attack When Alone," which wrongly cited "ViaHealth Rochester General Hospital" as the source of the technique. Rochester General Hospital has denied any connection with the technique.
"Cough CPR" in the sense of resuscitating oneself is impossible because a prominent symptom of cardiac arrest is unconsciousness, in which case coughing is impossible, although myocardial infarction (heart attack) may occur to give rise to the cardiac arrest, so a patient may not be immediately unconscious. However, the vast majority of people suffering chest pain from a heart attack will not be in cardiac arrest and CPR is not needed to begin with. In these cases, attempting "cough CPR" will increase the workload on the heart and may be harmful.
The American Heart Association (AHA) and other resuscitation bodies do not endorse "cough CPR", which it terms a misnomer as it is not a form of resuscitation. The AHA does recognize a limited legitimate use of the coughing technique: "This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital, particularly during cardiac catheterization. In such cases the patient's ECG is monitored continuously, and a physician is present." When coughing is used on trained and monitored patients in hospitals, it has been shown to be effective only for 90 seconds.
CPR learned from movies and television
In at least one case, it has been alleged that CPR learned from a movie was used to save a person's life. In April 2011, it was claimed that nine-year-old Tristin Saghin saved his sister's life by administering CPR on her after she fell into a swimming pool, using only the knowledge of CPR that he had gleaned from a motion picture, Black Hawk Down.
Hands-Only CPR portrayed as more palatable version
Less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location have CPR performed on them. Most bystanders are worried that they might do something wrong. On October 28, 2009 The American Heart Association and the Ad Council launched a Hands-Only CPR public service announcement and website as a means to address this issue. In July 2011, new content was added to the website including a digital app that helps a user learn how to perform Hands-Only CPR.
In the 19th century, Doctor H. R. Silvester described a method (The Silvester Method) of artificial respiration in which the patient is laid on their back, and their arms are raised above their head to aid inhalation and then pressed against their chest to aid exhalation. The procedure is repeated sixteen times per minute. This type of artificial respiration is occasionally seen in films made in the early 20th century.
A second technique, called the Holger Nielsen technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, was a form of artificial respiration where the person was laid face down, with their head to the side, resting on the palms of both hands. Upward pressure applied at the patient’s elbows raised the upper body while pressure on their back forced air into the lungs, in essence the Silvester Method with the patient flipped over. This form is seen well into the 1950s (it is used in an episode of Lassie during the mid-1950s), and was often used, sometimes for comedic effect, in theatrical cartoons of the time (see Tom and Jerry's "The Cat and the Mermouse" ). This method would continue to be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in 1979. The technique was later banned from first-aid manuals in the UK.
Similar techniques were described in early 20th century ju-jutsu and judo books, as being used as far back as early 17th century. A New York Times correspondent reported those techniques being used successfully in Japan in 1910. In ju-jutsu (and later on, judo) those techniques were called Kappo or Kutasu.
However, it was not until the middle of the 20th century that the wider medical community started to recognize and promote artificial respiration combined with chest compressions as a key part of resuscitation following cardiac arrest. The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude, Guy Knickerbocker and Peter Safar. Jude and Knickerbocker, along with William Kouwenhoven and Joseph S. Redding had recently discovered the method of external chest compressions, whereas Safar had worked with Redding and James Elam to prove the effectiveness of artificial respiration. It was at Johns Hopkins University where the technique of CPR was originally developed. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Perason. Soon afterward, the technique was used to save the life of a child. Their combined findings were presented at the annual Maryland Medical Society meeting on September 16, 1960 in Ocean City, and gained widespread acceptance over the following decade, helped by the video and speaking tour they undertook. Peter Safar wrote the book ABC of Resuscitation in 1957. In the U.S., it was first promoted as a technique for the public to learn in the 1970s.
Artificial respiration was combined with chest compressions based on the assumption that active ventilation is necessary to keep circulating blood oxygenated, and the combination was accepted without comparing its effectiveness with chest compressions alone. However, research over the past decade has shown that assumption to be in error, resulting in the AHA's acknowledgment of the effectiveness of chest compressions alone (see Compression only in this article).
CPR has continued to advance, with recent developments including an emphasis on constant, rapid heart stimulation, and a de-emphasis on the respiration aspect. Studies have shown that people who had rapid, constant heart-only chest compression are 22% more likely to survive than those receiving conventional CPR that included breathing. What's more, because people tend to be reluctant to do mouth-to-mouth, chest-only CPR nearly doubles the chances of survival overall, by increasing the odds of receiving CPR in the first place.
Administering CPR to animals
It is feasible to perform CPR on animals, including cats and dogs. The principles and practices are virtually identical to CPR for humans, except that resuscitation is usually done through the animal's nose, not the mouth. CPR should only be performed on unconscious animals to avoid the risk of being bitten; a conscious animal would not require chest compressions. Animals, depending on species, may have a lower bone density than humans and so CPR can cause bones to become weakened after it is performed.
- Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL (November 2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.
- (), "European Resuscitation Council (2005). "Part 2: Adult basic life support". Guidelines for resuscitation. "The following is a summary of the evidence-based recommendations for the performance of basic life support: Rescuers begin CPR if the victim is unconscious, not moving, and not breathing (ignoring occasional gasps).[...]"
- Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A (2010-11-02). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation 122 (18 Suppl 3): S829–61. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228.
- Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O'Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D (October 2010). "Part 1: executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation 122 (16 Suppl 2): S250–75. doi:10.1161/CIRCULATIONAHA.110.970897. PMID 20956249.
- Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, Abella BS, Kleinman ME, Edelson DP, Berg RA, Aufderheide TP, Menon V, Leary M (June 25, 2013). "CPR Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association". Circulation 128 (4): 417–35. doi:10.1161/CIR.0b013e31829d8654. PMID 23801105.
- "Highlights of the 2010 American Heart Association Guidelines for CPR and ECC" (PDF). American Heart Association.
- Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA (November 2010). "Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S685–705. doi:10.1161/CIRCULATIONAHA.110.970939. PMID 20956221.
- "Resuscitation Council UK Paediatric Advanced Life Support Guidelines" (PDF). Retrieved 2010-10-24.
- Mohun, Janet et al. First Aid Manual. St John Ambulance, St Andrews Ambulance and British Red Cross.
- Hüpfl M, Selig HF, Nagele P (October 2010). "Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis". Lancet 376 (9752): 1552–7. doi:10.1016/S0140-6736(10)61454-7. PMC 2987687. PMID 20951422.
- Ewy, Gordon A (June 2008). "Cardiocerebral Resuscitation: Could this new model of CPR hold promise for better rates of neurologically intact survival?". EMS Magazine (Cygnus) 37 (6): 41–49. Retrieved 2008-08-02.
- "Save a Life: Hands-Only CPR". Crowdrise.com. Archived from the original on June 21, 2011. Retrieved 2011-06-16.
- "From Queen, The Best Song For CPR — Except For The Lyrics". Archived from the original on May 29, 2012. Retrieved 2012-05-29.
- Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T (2011). "Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study". BMJ 342: c7106. doi:10.1136/bmj.c7106. PMID 21273279.
- Koenig KL (March 4, 2011). "Compression-Only CPR Is Less Effective Than Conventional CPR in Some Patients". JW Emerg Med 2011 (304): 1.
- Wei J, Tung D, Sue SH, Wu SV, Chuang YC, Chang CY (21 July 2005). "Cardiopulmonary resuscitation in prone position: a simplified method for outpatients" (PDF). Journal of the Chinese Medical Association (Elsevier, published May 2006) 69 (5): 202–206. doi:10.1016/S1726-4901(09)70219-9. PMID 16835981.
- Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF (November 2010). "Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S720–8. doi:10.1161/CIRCULATIONAHA.110.970970. PMC 3741663. PMID 20956223.
- Brady WJ, Gurka KK, Mehring B, Peberdy MA, O'Connor RE (2011). "In-hospital cardiac arrest: Impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge". Resuscitation 82 (7): 845–852. doi:10.1016/j.resuscitation.2011.02.028. PMID 21454008.
- "2012 National Utstein Report". CARES Cardiac Arrest Registry to Enhance Survival. Retrieved 2013-10-18.
- Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadeboncoeur TF, Clark LL, Gallagher JV, Stapczynski JS, LoVecchio F, Mullins TJ, Humble WO, Ewy GA (2010). "Chest Compression–Only CPR by Lay Rescuers and Survival from Out-of-Hospital Cardiac Arrest". JAMA 304 (13): 1447–1454. doi:10.1001/jama.2010.1392. PMID 20924010.
- Sarver Heart Center. "Frequently Asked Questions about Chest-Compression-Only CPR". Retrieved 2013-10-18.
- Public Health - Seattle & King County. "Heart attack survival rate continues to climb in King County". Retrieved 2013-10-18.
- Resuscitation Academy. "About". Retrieved 2013-10-18.
- Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM, Berg RA, Hiraide A (2010). "Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study". Lancet 375 (9723): 1347–54. doi:10.1016/S0140-6736(10)60064-5. PMID 20202679.
- "Checklist for Parents of Children with Arrhythmias". American Heart Association. 2009-01-16. Retrieved 2010-04-11.
- WebMD Medical News. "Real CPR isn't everything it seems to be". Retrieved 2007-06-13.
- Smith, Nathalie, MSN, RN. "Anoxic Brain Damage". Third Age.
- Tuhrim, Stanley. "Anoxic Brain Injury". Mount Sinai Medical Centre.
- Brass, Lawrence, MD. Heart Book. Chapter 18:Stroke (PDF). Yale University.
- Turkowski, Ken. "A pleas for VBAC education".
- "Hyperbaric Oxygen Therapy". Family Health News.
- Newsweek 2007-05-07
- Myocardial contusion injury: redefining the diagnostic algorithm, M K Bansal, S Maraj, D Chewaproug, A Amanullah. Emerg Med J 2005;22:465-469 doi:10.1136/emj.2004.015339 ; http://emj.bmj.com/content/22/7/465.full
- Implicatii medico-legale in resuscitarea cardio-respiratorie, Aurel Mogoseanu. http://www.atitimisoara.ro/_files/documents/files/2007/Conferinte%20ATI/Implicatii%20medico-legale%20in%20resuscitarea%20cardio-respiratorie.pdf
- AHA, The Textbook of Emergency Cardiovascular Care and CPR, page 541
- Forensic Pathology: Principles And Practice, David Dolinak,Evan W. Matshes,Emma O. Lew, page 322
- AHA, Part 3: Adult Basic Life Support, http://circ.ahajournals.org/content/102/suppl_1/I-22.full ; Circulation. 2000; 102: I-22-I-59 doi:10.1161/01.CIR.102.suppl_1.I-22
- Krischer JP, Fine EG, Davis JH, Nagel EL (1987). "Complications of cardiac resuscitation". Chest 92 (2): 287–91. doi:10.1378/chest.92.2.287. PMID 3608599.
- Hoke RS, Chamberlain D (December 2004). "Skeletal chest injuries secondary to cardiopulmonary resuscitation". Resuscitation 63 (3): 327–338. doi:10.1016/j.resuscitation.2004.05.019. PMID 15582769.
- Baubin M, Rabl W, Pfeiffer KP, Benzer A, Gilly H (December 1999). "Chest injuries after active compression-decompression cardiopulmonary resucitation (ACD-CPR) in cadavers". Resuscitation 43 (1): 9–15. doi:10.1016/S0300-9572(99)00110-0. PMID 10636312.
- Maguire S, Mann M, John N, Ellaway B, Sibert JR, Kemp AM (2006). "Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review". Child Abuse Negl 30 (7): 739–51. doi:10.1016/j.chiabu.2005.12.007. PMID 16857258.
- Dolinak D (June 2007). "Rib fractures in Infants due to Cardiopulmonary Resuscitation". American Journal of Forensic Medicine and Pathology 28 (2): 107–110. doi:10.1097/01.paf.0000257392.36528.b8. PMID 17525558.
- White L, Rogers J, Bloomingdale M, Fahrenbruch C, Culley L, Subido C, Eisenberg M, Rea T (2010). "Dispatcher-Assisted Cardiopulmonary Resuscitation: Risks for Patients not in cardiac arrest". Resuscitation Science 121 (1): 91–97. doi:10.1161/CIRCULATIONAHA.109.872366. PMID 20026780.
- "Silicon Chip Article".
- Brooks SC, Bigham BL, Morrison LJ (2011). "Mechanical versus manual chest compressions for cardiac arrest". In Brooks, Steven C. Cochrane Database Syst Rev 1 (1): CD007260. doi:10.1002/14651858.CD007260.pub2. PMID 21249689.
- Hightower D, Thomas SH, Stone CK, Dunn K, March JA (September 1995). "Decay in quality of closed-chest compressions over time". Ann Emerg Med 26 (3): 300–3. doi:10.1016/S0196-0644(95)70076-5. PMID 7661418.
- Chiang WC, Chen WJ, Chen SY, Ko PC, Lin CH, Tsai MS, Chang WT, Chen SC, Tsan CY, Ma MH (March 2005). "Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts". Resuscitation 64 (3): 297–301. doi:10.1016/j.resuscitation.2004.09.010. PMID 15733757.
- Berg RA, Sanders AB, Milander M, Tellez D, Liu P, Beyda D (1994). "Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children". Acad Emerg Med 1 (1): 35–40. PMID 7621151.
- Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA (August 1995). "Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance". Acad Emerg Med 2 (8): 708–13. doi:10.1111/j.1553-2712.1995.tb03622.x. PMID 7584749.
- Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, O'Hearn N, Hoek TL, Becker LB (April 2007). "CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system". Resuscitation 73 (1): 54–61. doi:10.1016/j.resuscitation.2006.10.027. PMID 17258853.
- Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L, Sørebø H, Steen PA (December 2006). "Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study". Resuscitation 71 (3): 283–92. doi:10.1016/j.resuscitation.2006.05.011. PMID 17070980.
- "CPREzy". Retrieved 2007-08-18.
- "CPR Glove Website". Retrieved 2009-01-05.
- Perkins GD, Augré C, Rogers H, Allan M, Thickett DR (23 August 2004). "CPREzy: an evaluation during simulated cardiac arrest on a hospital bed" (PDF). Resuscitation 64 (2005): 103–8. doi:10.1016/j.resuscitation.2004.08.011. PMID 15629562.
- Boyle, Andrew J; Wilson, Andrew M; Connelly, Kim; McGuigan, Louisa; Wilson, Jenny; Whitbourn, Robert (March 2002). "CPREzy:an evaluation during simulated cardiac arrest on a hospital bed". Resuscitation 54 (2002).
- Public Health Initiative Uses PocketCPR to Help Improve Cardiac Arrest Survival Rates, October 20, 2008.
- Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T (2002). "Evaluation of LUCAS, a new device for automated mechanical compression and active decompression". Resuscitation 55 (3): 285–99. doi:10.1016/S0300-9572(02)00271-X. PMID 12458066.
- Rubertsson et al. (2006). "Increased restoration of spontaneous circulation after cardiac arrest with the LUCAS device compared to manual chest compressions". Resuscitation 69.
- Automatic CPR device saves life of woman who was clinically dead for over 40 minutes, ABC News Online, 19 August 2013
- Casner M, Andersen D, Isaacs SM (January–March 2005). "The impact of a new CPR assist device on the rate of return of spontaneous circulation in out-of-hospital cardiac arrest". Prehospital Emergency Care 9 (1): 61–7. doi:10.1080/10903120590891714. PMID 16036830.
- Hallstrom, Al; Rea, Thomas; Sayre, Michael; Christenson, James; Anton, Andy; Mosesso, Vince; Ottingham, Lois; Olsufka, Michele; Pennington, Sarah; White, Lynn; Yahn, Stephen; Husar, James; Morris, Mary; Cob, Leonard. "Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest" (PDF). Journal of the American Medical Association 295 (22).
- Kalz M, Lenssen N, Felzen M, Rossaint R, Tabuenca B, Specht M, Skorning M (March 2014). "Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study". Journal of Medical Internet Research 16 (3): e89. doi:10.2196/jmir.2951. PMID 24647361.
- Swor RA, Jackson RE, Cynar M, Sadler E, Basse E, Boji B, Rivera-Rivera EJ, Maher A, Grubb W, Jacobson R (June 1995). "Bystander CPR, ventricular fibrillation and survival in witnessed, unmonitored out-of-hospital cardiac arrest". Annals of Emergency Medicine 25 (6): 780–4. doi:10.1016/S0196-0644(95)70207-5. PMID 7755200.
- Wik L, Steen PA, Bircher NG (December 1994). "Quality of bystander cardiopulmonary resuscitation influence outcome after prehospital cardiac arrest". Resuscitation 28 (4): 195–203. doi:10.1016/0300-9572(94)90064-7. PMID 7740189.
- "Members of the public lack skills, confidence necessary to save lives with CPR, research shows". November 12, 2011. Retrieved November 12, 2011.
- Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, Delooz H (August 1993). "Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group". Resuscitation 26 (1): 47–52. doi:10.1016/0300-9572(93)90162-J. PMID 8210731.
- Gallagher EJ, Lombardi G, Gennis P (December 1995). "Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest". JAMA 274 (24): 1922–5. doi:10.1001/jama.274.24.1922. PMID 8568985.
- Jackson RE, Swor RA (June 1997). "Who gets bystander cardiopulmonary resuscitation in a witnessed arrest?". Academic Emergency Medicine 4 (6): 560–4. doi:10.1111/j.1553-2712.1997.tb03574.x. PMID 9189184.
- Bossaert L, Van Hoeyweghen R (1989). "Bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. The Cerebral Resuscitation study group". Resuscitation 17 (Suppl S55–69): S55–69; discussion S199–206. doi:10.1016/0300-9572(89)90091-9. PMID 2551021.
- Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE (March 1985). "Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation". American Journal of Emergency Medicine 3 (2): 114–9. doi:10.1016/0735-6757(85)90032-4. PMID 3970766.
- Athanasuleas CL, Buckberg GD, Allen BS, Beyersdorf F, Kirsh MM (2006). "Sudden cardiac death: directing the scope of resuscitation towards the heart and brain" (PDF). Resuscitation 70 (1): 44–51. doi:10.1016/j.resuscitation.2005.11.017. ISSN 0300-9572. PMID 16759784. Retrieved 2007-05-02.
- Kondratiev TV, Flemming K, Myhre ES, Sovershaev MA, Tveita T (July 2006). "Is oxygen supply a limiting factor for survival during rewarming from profound hypothermia?". Am. J. Physiol. Heart Circ. Physiol. 291 (1): H441–50. doi:10.1152/ajpheart.01229.2005. PMID 16461371. [Heart has enough oxygen to survive hypothermia Lay summary] – EurekAlert! (18 July 2006).
- Eich C, Bräuer A, Kettler D (2005). "Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation" (PDF). Resuscitation 67 (1): 145–8. doi:10.1016/j.resuscitation.2005.05.002. ISSN 0300-9572. PMID 16129537. Retrieved 2007-01-29.
- Diem SJ, Lantos JD, Tulsky JA (1996-06-13). "Cardiopulmonary Resuscitation on Television - Miracles and Misinformation". New England Journal of Medicine 334 (24): 1578–1582. doi:10.1056/NEJM199606133342406. PMID 8628340. Retrieved 2009-02-01.
- "CPR statistics". American Heart Association. Retrieved 2007-06-13.
- Jones GK, Brewer KL, Garrison HG (2000). "Public expectations of survival following cardiopulmonary resuscitation". Academic Emergency Medicine 7 (1): 48–53. doi:10.1111/j.1553-2712.2000.tb01891.x. PMID 10894242.
- "Chicago CPR Classes". Chicago CPR Classes.
- "ViaHealth Rochester General Hospital statement on 'Cough CPR' email". Retrieved 2007-06-13.
- "Snopes Urban Legends Reference - Cough CPR". Retrieved 2007-06-13.
- "Cough CPR" (PDF). Newsletter (Australian Resuscitation Council) 27 (3): 2. 2003.
- "Cough CPR" (PDF). Newsletter (Australian Resuscitation Council) 29 (3): 2. 2005.
- "Cough CPR". American Heart Association. Retrieved 2007-06-13.
- "Arizona 9-year-old boy, Tristin Saghin, Saved Sister With CPR, Congratulated by Movie Producer Jerry Bruckheimer". ABC News. Retrieved 2011-04-24.
- American Heart Association
- American Heart Association, Ad Council launch Hands-Only CPR campaign
- Americans can learn Hands-Only CPR with a new digital application
- "Silvester's method". University College London. Retrieved 2007-06-12.
- Special Correspondence THE NEW YORK TIMES. (1910-09-04). "REVIVED BY JIU-JITSU. - A Strange Story from Japan - Apparently Dead Man Resuscitated. - View Article - NYTimes.com". New York Times. Retrieved 2013-05-28.
- Cornwall, J. W. (1935). "Jiu-Jitsu Methods of Resuscitation". BMJ 2 (3893): 318. doi:10.1136/bmj.2.3893.318-a. PMC 2461172."Corrections". BMJ 2 (5653): 394. 1969. doi:10.1136/bmj.2.5653.394.
- Kim Taylor. "JCS: Japanese Fighting: Self-Defence By Sleight Of Body". Ejmas.com. Retrieved 2013-05-28.
- Neil Ohlenkamp (2005-01-01). "Judo Chokes (shimewaza) - choking techniques". Judoinfo.com. Retrieved 2013-05-28.
- "Arrhythmias". Johns Hopkins Medicine. Retrieved 2008-09-06.
- See, e.g., "Award of the Heart", TIME magazine, November 28, 1973, retrieved on 05-28-2008 from time.com
- Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD (April 2008). "Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest". Circulation 117 (16): 2162–2167. doi:10.1161/CIRCULATIONAHA.107.189380. PMID 18378619. Retrieved 2008-04-02. On June 4th 2011 Jeremiah Kliesing "coded" at the Michael DeBakey VA hospital in Houston, Tx. Jeremiah underwent 5 1/2 hours of CPR by 20 doctors and nurses before being stabilized and transferred to St. Luke's Episcopal Hospital, where he's the second patient to receive the SYNCARDIA artificial heart. One of the Dr.s who preformed CPR was Dr. Donald Lazarus. Source= http://www.syncardia.com/2011-Press-Releases/total-artificial-heart-recipient-heads-home-for-the-holidays-with-new-donor-heart-a-kidney.html
- USA Today
American Heart Association revises CPR guidelines
An analysis of 3,700 cardiac arrests published Friday in the journal Lancet found that hands-only CPR saved 22% more lives than the conventional method. All told, the switch could save up to 3,000 additional lives a year in the USA and 5,000 to 10,000 in North America and Europe, says lead author Peter Nagele of Washington University in St. Louis. A landmark study published Oct. 6 in The Journal of the American Medical Associationfound that bystanders who applied hands-only CPR were able to boost survival to 34% from 18% for those who got conventional CPR or none at all. In addition, the percentage of people willing to provide CPR rose from 28% in 2005 to 40% in 2009.
- "CPR for Cats & Dogs". University of Washington School of Medicine.
|The Wikibook First Aid has a page on the topic of: Primary Assessment & Basic Life Support|
- 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
- ERC European Resuscitation Council
- CPR: NHS Choices
- How to resuscitate a child: NHS Choices
- Sarver Heart Center's Continuous Chest Compression CPR on YouTube
- A Video of Rescue Breathing for Laryngectomees and Neck Breathers*
- Comparison of CPR Training offered by AHA and Red Cross America*