Cardiopulmonary resuscitation (CPR) is a vital emergency procedure, capable of sustaining life when a person’s heart stops. It involves chest compressions, and sometimes rescue breaths, to maintain blood flow to the brain and other essential organs. Understanding its proper application, especially anatomical considerations, can enhance effectiveness.
Standard Hand Placement for CPR
Effective chest compressions require precise hand placement. For adults, the universal standard involves placing the heel of one hand on the lower half of the sternum, or breastbone, in the center of the chest. Place the other hand directly on top, interlocking fingers and lifting them to ensure only the heel of the bottom hand contacts the chest.
This position ensures compressions are delivered directly over the heart, facilitating blood circulation. Placing hands between the nipples serves as a reference point to locate the center of the chest. Maintaining straight arms and positioning shoulders directly over the hands allows the rescuer to use their upper body weight for compressions, promoting the necessary depth of at least 2 inches (5 centimeters) at a rate of 100 to 120 compressions per minute.
Navigating Anatomical Differences in Women
While the target location for chest compressions remains the sternum for all adults, regardless of gender, breast tissue can sometimes present a visual challenge. The goal is to compress the bone itself, not the breast tissue. Rescuers should place their hands firmly on the center of the chest, on the lower half of the sternum, even if it means compressing through or displacing breast tissue.
The presence or size of breast tissue does not alter the correct anatomical landmark. The technique is identical to that used for men, focusing on the bony structure beneath. Displacing breast tissue, if necessary, ensures effective compressions to the sternum.
Performing CPR on a Pregnant Woman
When providing CPR to a visibly pregnant woman, additional considerations support both the mother and fetus. Beyond the standard chest compressions on the sternum, a critical modification involves manually displacing the uterus to the left side of the body. This maneuver helps alleviate pressure on the major blood vessels, specifically the inferior vena cava and aorta, which can become compressed by the enlarging uterus, especially after 20 weeks of gestation.
Relieving this aortocaval compression improves blood return to the heart, enhancing cardiac output. While some older guidelines suggested tilting the mother to a 15-30 degree angle, current recommendations emphasize manual uterine displacement to the left while keeping the patient supine, as tilting can reduce the effectiveness of chest compressions. Chest compressions are still performed on the sternum with the same depth and rate as for other adults.
Prioritizing Immediate Action
Hesitation during cardiac arrest has severe consequences, as survival rates decrease significantly without intervention. Recognizing cardiac arrest and initiating chest compressions without delay is the most important step. The immediate goal of CPR is to maintain blood flow to the brain and other vital organs until professional medical help arrives.
Any attempt at CPR is more beneficial than no attempt. Even if a rescuer feels uncertain about perfect hand placement or other specific details, beginning compressions can make a substantial difference in outcomes. Bystander CPR can double or even triple the chances of survival for someone experiencing cardiac arrest outside of a hospital setting.