Standard Operating Procedure: Cardiopulmonary Resuscitation (CPR)

Introduction

This Standard Operating Procedure (SOP) outlines the standardized clinical protocol for performing high-quality Cardiopulmonary Resuscitation (CPR) in accordance with the latest International Liaison Committee on Resuscitation (ILCOR) guidelines. The objective is to maintain adequate circulatory flow and oxygenation to vital organs during cardiac arrest. This procedure must be executed immediately upon identification of a patient who is unresponsive and not breathing (or only gasping). Time to intervention is the single most critical factor in patient survival.

Step-by-Step CPR Checklist

Phase 1: Scene Safety and Assessment

• Ensure Scene Safety: Verify the environment is safe for the rescuer and the patient.
• Check Responsiveness: Tap the patient’s shoulders firmly and shout, "Are you okay?"
• Assess Breathing and Pulse: Observe the chest for rise and fall; perform a carotid pulse check (limit to no more than 10 seconds).
• Activate Emergency Response: Call for help (or direct a specific bystander to call 911/Code Blue) and retrieve an Automated External Defibrillator (AED).

Phase 2: High-Quality Compressions

• Positioning: Place the patient 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), with the second hand interlaced on top.
• Compression Depth: Push hard at a depth of at least 2 inches (5 cm).
• Compression Rate: Maintain a rate of 100 to 120 compressions per minute.
• Chest Recoil: Allow full chest recoil after every compression; do not lean on the chest between strokes.

Phase 3: Airway and Ventilation

• Airway Opening: Perform a head-tilt, chin-lift maneuver (if no cervical spine injury is suspected).
• Ventilation Ratio: Provide 2 breaths after every 30 compressions (30:2 ratio).
• Delivery: Each breath should be given over 1 second, with enough volume to produce visible chest rise.
• Minimize Interruptions: Keep interruptions in chest compressions to less than 10 seconds.

Phase 4: AED Integration

• Power On: As soon as the AED arrives, press the power button and follow voice prompts.
• Electrode Placement: Attach pads to the patient’s bare skin as indicated by the diagrams.
• Analysis: Ensure no one is touching the patient during the heart rhythm analysis.
• Shock Delivery: If a shock is advised, ensure "All Clear," then press the shock button. Immediately resume CPR after the shock.

Pro Tips & Pitfalls

• Pitfall - Hyperventilation: Providing too many breaths or breaths that are too forceful can increase intrathoracic pressure, which decreases venous return to the heart and lowers cardiac output.
• Pitfall - Compression Fatigue: Compressions become ineffective after 2 minutes due to rescuer fatigue. Rotate compressors every 2 minutes (or 5 cycles) to maintain quality.
• Pro Tip - Metronome: Use a mobile app or mental beat (e.g., "Stayin' Alive" by the Bee Gees) to maintain the required 100-120 beats per minute.
• Pro Tip - The "Pit Crew" Approach: Assign specific roles (Leader, Compressor, Airway, AED/Monitor) immediately to ensure seamless transitions.

FAQ

1. How do I know if I am pressing hard enough? If you are performing CPR on a simulation manikin, you should hear a "clicker" sound indicating proper depth. On a human patient, monitor for a palpable carotid pulse generated by your compressions and look for signs of perfusion (e.g., improved skin color).

2. Should I perform CPR if the patient is gasping? Yes. Occasional, irregular gasping is known as "agonal breathing." It is a common sign of cardiac arrest and should be treated as the patient not breathing normally.

3. What if I am worried about legal liability? In most jurisdictions, "Good Samaritan" laws protect laypersons and trained rescuers who act in good faith to provide emergency care. Prioritize the patient’s life, as the risk of doing nothing far outweighs the risk of attempting to provide aid.