Indian Academy of Pediatrics

National CPR Day

21st July
(Spreading CPR Awareness from 17th July t0 24th July)
Among India’s populations, less than 2% are aware of CPR

About 4,280 people per 1 lakh population are getting

cardiac arrest per year in the country

Every minute 112 people are succumbing to cardiac arrest

Both of them did not receive timely CPR
 Significance of 21 July
st

Birthday of
Dr Anand Shandilya
(21/7/1962 – 1/1/2019)

Past National Convener

IAP ALS BLS
Teacher to many
Friend of many more
Human being par excellence
What is CPR/BLS?
• CPR - Cardiopulmonary resuscitation
• BLS - Basic life support

• BLS = sequence of steps to perform CPR. This term is

promoted by the American Heart Association (AHA).
Who needs CPR?
• Any victim of sudden cardiac arrest (SCA) would require
CPR.
• Cardiac arrest may occur in a variety of situations, both in-
and out-of-hospital circumstances.
SCA in adults
SCA in children
is often due to cardiac causes
major cause of cardiac arrest
including rhythm
in children is due to
abnormalities like ventricular
respiratory failure and/or
fibrillation or pulseless
shock.
ventricular tachycardia.
SCA is not Always “Heart attack” or “Myocardial Infarction”
A victim of cardiac arrest has the best chance of recovery, if the CPR
is administered by the person standing next to the victim
immediately on recognition of the condition

Majority of cardiac arrest occurs at home and is witnessed in 85%

95% of those who experience SCA die because of not receiving

timely intervention

CPR has to be initiated immediately upon recognition of SCA

(within 4-6 mins). Every minute delay in initiation of CPR increases
the chances of mortality by 17%
How to recognize CA?
A victim is in cardiac arrest if he/she suddenly becomes:
• Unconscious and unresponsive
• Stops breathing or is gasping with ineffective breaths and
• Does not have a pulse.
How to recognize CA in a child?
A child is labeled as “in cardiac arrest”
• Cessation of Circulation due to absent or ineffective
mechanical Cardiac Activity
• Clinically The child will be “unresponsiveness” and “not
breathing or may be having Agonal Gasps”

AHA PALS Guidelines

Steps of CPR
Adult CPR
1. Verify scene safety and check for
responsiveness
• Assess whether scene is safe to help the victim, lest you
yourself become the victim of circumstances
• Look for any evidence of etiology e.g drugs, poisonings or
other
• Assess the victim for a response
Verify The Scene Safety, Your own
safety is a Priority
 1. Check for response
Firmly tap the victim on
shoulder and ask a question
loudly in a language he/she
would understand like -
Are you okay? or
How are you? or
Do you need some help?
 2. Activate the emergency
response system & get AED
• You can use mobile device – Call 112 or 108 as applicable

• Or ask someone to get AED or Defibrillator & Emergency

equipment
 3. Breathing & Pulse Check
• Look for normal breathing and
carotid pulse simultaneously
• Breathing & pulse check should
not take more than 10 secs
 4. Determine next action
1. If breathing is • Monitor victim till help arrives or victim is
normal & pulse present taken to hospital. Keep in recovery position

2. If no breathing, but • Provide rescue breathing

pulse present

3. If no breathing and • Start high quality CPR

no pulse
 5. Begin High Quality CPR
1. Position yourself at victim’s side
2. Place the victim on a flat firm surface;
kneel down on your knees beside the
victim
3. Place the heel of your dominant hand
over the lower half of the sternum of
the victim. Place your other hand on
your first hand, grasping the fingers
of first hand by second hand
4. Straighten your arms and position
your shoulders directly over your
hands
 5. Begin High Quality CPR
4. Cycles of compressions and
breaths (30:2) starting with
chest compressions (C-A-B)
5. Push hard - upto 5-6 cms
6. Push fast - @ 100- 120 /min
7. Deliver compressions in a
smooth fashion
8. Allow complete chest recoil
 5. Begin High Quality CPR
9. Minimize interruptions
10. Count while delivering
compressions
11. Open airway to deliver two
breaths after 30 compressions
12. Use AED as soon as it is available
13. Deliver shock if prompted
(shockable rhythm)
Automated External
14. Resume high quality CPR Defibrillator
Opening airway by head tilt and chin lift
Must Avoid
Child CPR
Children
• From the age of 1 year to puberty
• Puberty = Chest or underarm hair on males and any breast
development in females
 Key differences
1. When to activate ERS (Emergency Response System)?
Shock is • If the arrest is not witnessed and you are alone – provide 2
a mins of CPR, before leaving the child to activate ERS and get
priority AED/ Defibrillator
• If arrest is sudden and witnessed by you and you are alone –
leave child to activate ERS and get an AED and then return to
the child
2. Pulse check – Is done either in carotids, femorals
depending on size of the child
Key differences
3. Compression : Ventilation ratio –
• Single rescuer – 30:2
• 2 rescuers – 15:2
4. Compression technique: Either 1 hand or 2 hand
technique is used
5. Compression depth – at least one third of the antero
posterior diameter of the chest (about 2’ or 5 cms)
Infant CPR
 Infant = age below 12 mo excluding
newly born infants in delivery room
• When to activate ERS (Emergency Response System)? – same
as for child
• Pulse check – Brachial pulse
• Technique of compressions –
• Single rescuer – 2 finger technique
• 2 rescuers – 2 thumb encircling technique
• Compression depth – at least 1/3 AP diameter of chest (~ 1.5’ / 4
cms)
• C:V ratio : 30:2 (2 rescuers) & 15:2 (2 rescuers)
Brachial artery pulse check
• Place 2-3 fingers on the
inside of the upper arm
between the infant’s
elbow and shoulder
Compression technique in infants

Single rescuer – 2 rescuers –

2 finger technique 2 thumb encircling technique
There is no greater joy than bringing back life into lives and Smile
on the faces
Thank you