All the information you will find on this page is for information only and is not meant as teaching. For those who are not experts we suggest contacting an organisation legally authorised to teach first aid procedures. Clearly, you use this information at your own risk.
CPR is a technique used in the event of cardiac arrest. In Italy it is estimated that every year cardiac arrest strikes one person in a thousand; this high number of cases gives an idea of how important it is to know the procedure in order to help the person affected.
The causes of cardiac arrest can be many; very often it comes on with acute symptoms caused by heart disease (for example coronary artery disease), which means that in most cases cardiac arrest (CA) occurs suddenly and without “warning signs”, because the disease had shown no symptoms.
In the vast majority of cases, CA is the culmination of cardiac arrhythmias such as “Ventricular Fibrillation” (VF) and “Ventricular Tachycardia” (VT): when it is gripped by these arrhythmias, the heart cannot do its job as a blood “pump”; this is followed by ischaemia which, if not treated promptly, inevitably leads to asystole (total absence of rhythm) and death within a few minutes.
How to perform cardiopulmonary resuscitation
First of all you need to know that CPR is a “cornerstone” of what is known in the jargon as BLS (Basic Life Support), a standardised first aid procedure used to secure the basic vital functions. It is essentially based on a sequence of four actions identified by the letters A, B, C and D:
A – Airway opening;
B – Breathing (check);
C – Circulation (chest compressions);
D – Defibrillation.
First of all you must call 112 as soon as you realise that the person is not responding and is not breathing normally, putting the phone on speaker: the operator can guide you step by step. Our job is to keep up a minimum of circulation with chest compressions until help arrives: every minute without resuscitation significantly reduces the chances of survival.
A) Airway opening
This is the first action to carry out; it makes it easier for air to get into the injured person's lungs. It consists of two manoeuvres:
a) Head tilt and chin lift: with the palm of one hand on the forehead you push, while with two fingers of the other hand you press on the bony part of the chin, pushing upwards.
b) Jaw thrust (subluxation of the jaw): when it is not possible to tilt the head back (head or spinal injuries) you proceed by first pushing the lower jaw down and then bringing it forward, so that the lower teeth are in front of the upper teeth.
B) Breathing
The GAS manoeuvre (Guardo-Ascolto-Sento, i.e. Look-Listen-Feel): for 10 seconds we place our cheek close to the injured person's mouth with our eyes turned towards the chest. Essentially it means looking (G) for any movement of the chest, listening (A) for any sounds and feeling (S) the air coming out of the mouth, to make sure there is breathing activity.
If the person is not breathing normally (even if there are only slow, noisy breaths, so-called gasping) they are considered to be in cardiac arrest: call 112 and start chest compressions straight away, without looking for a pulse.
Rescue breaths (mouth-to-mouth) are given only after the compressions, following the 30:2 pattern described below, and only if you are trained: keeping the head tilted back and pinching the nose, blow for about 1 second while watching the chest rise. Anyone who is not trained, or doesn't feel up to it, does compressions only.
C) Circulation
It is in this phase that we carry out heart massage. There is no need to look for a pulse: the absence of normal breathing is enough. We proceed like this:
We kneel level with the injured person's chest, arms and shoulders perpendicular to the point where we will apply the compressions, exactly on the breastbone, placing the palm of one hand on the bare surface of the chest and, with the other hand, interlocking the fingers of the hand on the chest and pulling them up so as not to touch other points. Now, using our body weight, we apply enough force to push the injured person's chest down by 5-6 cm; in this way a sort of blood circulation is produced, because the heart is squeezed between the breastbone and the thoracic vertebrae.
The rate of compressions must be 100-120 per minute, letting the chest come all the way back up after each compression (compression and release must last the same time). The international guidelines in force call for cycles of 30 compressions alternating with 2 rescue breaths, keeping pauses to a minimum.
D) Defibrillation
If there is a semi-automatic external defibrillator (AED) nearby, it should be fetched as soon as possible: in Italy anyone may use it, even without specific training. Just switch it on and follow the voice instructions, continuing the compressions until the device asks you not to touch the person.
It is extremely important not to stop CPR before help arrives; if there are two of you, it is best to take turns at the compressions about every 2 minutes, because tiredness quickly reduces the effectiveness of the massage.
Before every outing, also check your first aid kit.