The Cardiopulmonary Resuscitation (CR) — the term which exists relatively recently, approximately from 50th years of the last century. Nevertheless, in view of special importance of this direction, it develops constantly and improved. One of the most significant steps was creation of national councils on resuscitation — the organizations designed to supplement, develop and support in current state of the recommendation about holding resuscitation actions.
One of the largest associations which are engaged in development of relevant recommendations about SLR is the European Council on resuscitation (ERC). A long time the recommendations published by ERC in 2000 were standard, however in 2005 cardinal revision of the sequence of resuscitation actions was made that made a certain revolution in this area. It was caused by results of the researches which showed that the actions directed to blood circulation restoration are priority when carrying out SLR at adults.
The sudden cardiac standstill represents one of the leading causes of death of people. Frequency of occurrence of this state in Europe averages 55–113 on 100,000 inhabitants a year, or 350,000-700,000 cases a year. At most of patients, victims of a sudden cardiac standstill, it happens on the mechanism of development of fibrillation of ventricles, or hemodynamically inefficient ventricular tachycardia to the subsequent transition to an asystolia.
The earlier resuscitation actions are begun and actions for restoration of a rhythm are carried out, the survival probability is higher. Also chance to save the patient above at the beginning of cardiopulmonary resuscitation at a stage fibrillation of ventricles; successful resuscitation actions are less probable if the rhythm already passed into an asystolia.
The concept of a so-called "chain of survival" — the sequences of actions when which performing (in the specified sequence) the best results when carrying out SLR are achieved was developed. This chain includes the following actions:
● Early recognition and call of the help
● Early SLR
● Early defibrillation
● Postresuscitatic therapy
Cardiopulmonary resuscitation: modern aspects
The huge role for the timely beginning of holding resuscitation actions is played by early recognition of a cardiac standstill. Check of pulse on carotid or other arteries is considered an inexact method for definition of a condition of blood circulation now. The patient can have some time agonal breath after the termination of effective warm activity. Therefore it is considered that it is necessary to suspect a cardiac standstill of all cases when the patient is unconscious and has pathological breath (or its stop). Also the cardiac standstill should be suspected at patients with spasms as they can be manifestation of a stop of blood circulation.
Resuscitation actions are divided into the basic SLR (BLS) which is carried out by nonprofessional rescuers and expanded SLR (ALS) which is carried out by specially prepared personnel. Basic SLR includes basic maintenance of life and use of the automatic external defibrillator (AED). Expanded SLR includes exact diagnostics of a type of a cardiac standstill and carrying out according to a type of a stop of treatment and also ensuring passability of the upper airways and other specialized help.
When carrying out basic SLR it is necessary to remember that after a blood circulation stop blood in lungs and arteries remains oxygenic within several minutes therefore now recommend to begin SLR with thorax compressions, but not with ventilation. It cardinally distinguishes the recommendations about SLR which appeared in 2005 and later from all previous.
The immediate beginning of SLR can increase considerably survival after a cardiac standstill. If nonprofessional rescuers (passersby) who appeared near the victim are trained in carrying out SLR, then they have to carry out compressions of a thorax and artificial respiration. If helping SLR are not trained, then the dispatcher of health service has to instruct them to carry out only an indirect cardiac massage waiting for the professional help.
The early defibrillation (within 3–5 minutes after a cardiac standstill) can increase the frequency of survival of victims considerably. It can be reached by public access to automatic external defibrillators which are safe and effective even for rescuers without experience of use of a defibrillator.
At unsuccessfulness of initial attempts of resuscitation expanded resuscitation which is carried out by the prepared medical personnel with use of the corresponding medicines and the equipment has to be begun as soon as possible.