A tweet (now deleted) by the railway minister Ashwini Vaishnaw, containing a video of a passenger receiving CPR has attracted criticism. The CPR could be seen being continued even after the patient regained consciousness. The X handle of the railway ministry also tweeted the same video, claiming that the train’s TTE providing CPR immediately saved a passenger’s life.
Several experts urged the minister to delete the tweet, citing the danger of continuing CPR even after the patient regains consciousness. The misleading tweet underscored the importance of following the correct procedure while performing CPR.
What is CPR and can it be used to save lives?
Cardiopulmonary resuscitation (CPR) is an emergency life-saving procedure performed on someone whose heart and breathing have stopped.
CPR is done to restart blood flow to organs, provide oxygen to the brain and remove any obstruction in the airways stopping the person from breathing freely.
CPR is used to externally restart the functioning of the heart by applying pressure on the chest at appropriate and continuous intervals. CPR can be done while people wait for an ambulance to arrive and transfer the patient to a medical facility at the earliest.
What is less followed is the number of times CPR has to be performed, and the impacts of underdoing and/or overdoing it. Besides the need for proper training to execute CPR, it is essential to stop CPR once the patient comes back to consciousness.
CPR is performed on all age groups and genders during the emergency, that is when the heartbeat and breathing have stopped, while the amount of pressure applied to children should be less.
Three steps in CPR
Since the timely application of CPR can sometimes restore breathing and heart functions, everyone is expected to know the importance and the procedure to perform CPR.
Dr Raghavendra Cheruku, senior interventional cardiologist at Gemcare Kamineni Hospitals, Hyderabad, explained the three important steps in CPR. “Compression, Airway and Breath (CAB) are the three important steps in CPR. Compression is required to ensure blood circulation since the heart pumps blood to all the organs.”
Chest compressions
Explaining the process of compression, Dr Raghavendra said, “We have to keep the heel of the left palm in the middle of the chest and place the other hand over it. Then push the chest roughly by 5 cm or 2 inches. This has to be done 100 to 120 times per minute.”
If CPR does not help in the revival of the patient, a defibrillator should be used while keeping an eye on the pulse.
Releasing the airway
The executor also has to ensure that the airway is unobstructed. “When the patient is lying down, push the head followed by lifting the chin. This will open the airway, giving a relief to the patient,” Dr Raghavendra said.
Giving breath
The next step is to breathe into the patient either through an Ambu bag – also known as a manual resuscitator or bag valve mask (BVM) – or by providing air mouth-to-mouth. The Ambu bag may not be available in some places and hence mouth-to-mouth breathing becomes the easy option.
“After taking a deep breath, seal the mouth completely and blow the air slowly for 10 times per minute. The blowing should be stopped when the chest is filled, which has to be noticed while performing this. For every 10 chest compressions, one mouth-to-mouth breathing should be provided,” Dr Raghavendra added.
Artificial breathing is essential to maintain vitals
Providing artificial breathing is crucial since oxygen is essential to maintain the vitals of the patient. Further, stoppage of oxygen to the brain for 4-8 minutes can lead to brain death even if other vitals are recovered.
“By blowing air, we are providing 21 per cent of oxygen to the patient, while in a medical facility, 100 per cent can be provided. This 21 per cent is highly essential to maintain all vital organs, including the supply of oxygen to the brain,” Dr Raghavendra said.
Danger of undergoing and overdoing CPR
The important aspect of performing CPR is how correctly it is done, without under or overdoing it. The position of the hands in providing compression is vital.
Dr Raghavendra added, “If the hands are placed above or below the centre of the chest during CPR, the ribs, lungs and other internal organs can be damaged due to excess pressure.”
If the number of chest compressions is less than 100 to 120 per minute, the compression is insufficient for the heart to restart, while a higher number does not provide the heart enough time to refill.
The execution of CPR can help bring back breathing and heartbeat in some patients if there is still a chance to do so. Earlier, only doctors were performing CPR, but common people were provided training by healthcare professionals. Some organisations in Hyderabad provide training for learning how to administer first aid and CPR.
