Cardiorespiratory arrest

What is cardiorespiratory arrest?

Cardiorespiratory arrest (CPA) is a sudden event and consists of the sudden interruption or failure of cardiac and respiratory functions. As a result, the person:

• Becomes unconscious
• Doesn't respond
• does not breathe or does not breathe normally

What are the causes of cardiorespiratory arrest?

The causes of cardiorespiratory arrest can be diverse, but the most frequent are related to the heart, for example:

• severe heart rhythm changes
• acute myocardial infarction, also known as a heart attack

But there are others:

• choking or airway obstruction due to a foreign body
• drowning

What should I do to a victim of cardiorespiratory arrest?

In the event of a victim of cardiorespiratory arrest, you should:

• Call 112 immediately for help
• initiate Basic Life Support maneuvers
  • if there are two resuscitators, while one calls 112 and calls for help, the other must immediately start Basic Life Support maneuvers
• If you have access to an automated external defibrillator, you can use it safely

Basic Life Support consists of two actions: chest compressions (cardiac massage) to circulate blood and ventilations to give oxygen to the lungs.

How to do Basic Life Support?

Basic Life Support (BLS) includes the following steps:

• Lay the victim on their back on a hard surface (e.g., floor)
• Place your overlapping hands with fingers interlaced in the middle of the victim's chest
• With your arms straight and perpendicular to the victim's body, press on the chest and relieve: repeat 30 times this compression and decompression movement
• At the end of the 30 compressions, perform two ventilations through the victim's mouth: fill the lungs with air and exhale into the victim's mouth, covering the victim's nose with your fingers and isolating those of the victim with your lips, so that there is no escape of air. In cases where it is not possible to do ventilations, do only compressions
• After ventilating, resume compressions and always follow the sequence of 30 chest compressions with 2 ventilations. Maintain maneuvers until help arrives or the victim recovers

What is acute myocardial infarction?

The Acute Myocardial Infarction (AME), also known as a heart attack, occurs due to an interruption of blood circulation in a region of the heart. It can be a sudden event or preceded by warning symptoms and progressive worsening.

What are the symptoms of acute myocardial infarction?

The main symptoms of acute myocardial infarction are:

• persistent chest pain, often occurring as a tightness/pressure/crushing sensation of the chest that may extend to the arms, neck, chin, or back
• general malaise
• feeling short of breath or difficulty breathing
• nausea or vomiting
• pale, grayish, clammy, or sweaty skin

What to do to a victim of acute myocardial infarction?

If you see someone with symptoms of acute myocardial infarction, call 112 immediately, as this is a medical emergency and needs quick intervention.

What is a choke?

Choking, or airway obstruction by a foreign body (OVACE), consists of the existence of object(s) or food(s) in the airway (mouth, oropharynx, larynx, trachea or bronchi) that hinders or prevents breathing.

How can I identify a choking victim?

This situation can be easily identified when the victim tries to cough to try to expel the foreign body, often putting their hand around their neck while coughing.

If the obstruction is not resolved, the victim may become unconscious.

What should I do if the choking victim is conscious?

The goal is for the victim to be able to expel the foreign body to resolve the obstruction.

If the victim is conscious:

• Ask for help
• If the victim is able to cough (effective coughing), verbally encourage them to cough

Do not interfere with the victim's attempts to expel the foreign body, but remain by their side and monitor their situation

• If it resolves, evaluate the need to go to a health service
• If it doesn't, call 112

• If the victim is unable to cough, call 112 and perform clearance maneuvers such as back knocks or abdominal thrusts

Intersperse five blows to the back with up to five abdominal thrusts until the situation resolves or the victim is knocked unconscious

How should I perform the back slam maneuver?

To perform the back slam manoeuvre:

1. Place yourself next to and behind the victim
2. Slip an arm under the victim's armpit and support it at chest level with one hand, keeping it tilted forward, in such a position that if any object is displaced by the blows it can come out freely through the mouth
3. Apply up to 5 strokes with the base of the other hand, on the upper back, between the shoulder blades

How should I perform the abdominal compression maneuver?

To perform the abdominal compression maneuver (Heimlich maneuver):

1. Stand behind the victim and circle the victim's abdomen with your arms
2. Close the fist of one hand and position it above the navel, with your thumb facing the victim's abdomen
3. Overlap the second hand on top of the other and apply a quick compression inwards and upwards
4. Repeat this process up to five times

What precautions should I take with the victim after clearance maneuvers?

Any victim who has been subjected to this type of maneuver should be referred to the hospital to prevent any type of associated injury.

If the victim becomes unconscious, what should I do?

If the victim becomes unconscious, he or she should:

• Place it carefully on the floor or hard surface
• Immediately call 112
• start Basic Life Support by performing continuous chest compressions

What is a drowning?

When a liquid medium, usually water, enters the airway that prevents breathing, it is said that we have drowned. It can occur by submersion (if the person is completely under the liquid) or by immersion (if only part of the body, including the airway, is in contact with the liquid).

What to do in case of drowning?

If the victim is experiencing a drowning episode, he/she should:

With the victim still in the water, if conscious:

• throw some floating object at the victim so that he can grab onto it and stay on the surface of the water
• Call 112 and ask for help

With the victim still in the water, if unconscious:

• Call 112

With the victim out of the water, if conscious:

• Talk to the victim and look for injuries
• Call 112

With the victim out of the water, if unconscious:

• call 112, or if a second resuscitator is available, ask him to call 112
• 5 Inflations/Vents
• then start Basic Life Support with 30 chest compressions followed by 2 insufflations/ventilations

Source: Sociedade Portuguesa de Cardiologia (SPC)