Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is the emergency procedure that combines chest compressions with rescue ventilation to maintain a minimum of circulation and oxygen delivery during cardiac arrest. By generating artificial blood flow to the heart and brain until a normal rhythm can be restored, CPR is the central response to the failure of circulation in the ABC framework.

Definition

Cardiopulmonary resuscitation is the combination of external chest compressions and assisted ventilation used during cardiac arrest to sustain circulation and oxygenation until spontaneous circulation is restored or resuscitation is ended.

Scope

The topic covers the rationale and components of CPR, the chain of survival, the emphasis on high-quality chest compressions, the role of defibrillation, and the distinction between basic and advanced life support. The nurse's role in recognition, team-based resuscitation, and post-arrest care is framed as reference knowledge rather than as resuscitation instructions.

Core questions

• How is cardiac arrest recognized and the resuscitation response triggered?
• What makes chest compressions 'high-quality'?
• How do defibrillation and CPR work together?
• How do basic and advanced life support differ?

Key concepts

• Cardiac arrest and the chain of survival
• High-quality chest compressions
• Compression-to-ventilation relationship
• Defibrillation and shockable rhythms
• Basic versus advanced life support
• Minimizing interruptions
• Return of spontaneous circulation
• Post-cardiac-arrest care

Mechanisms

In cardiac arrest the heart no longer pumps, so external chest compressions manually generate forward blood flow by compressing the heart and raising intrathoracic pressure, perfusing the coronary and cerebral circulations. Outcomes depend on compression quality — adequate rate and depth, full recoil, and minimal interruptions — because perfusion pressure builds up over a sequence of compressions and falls rapidly when they stop. For shockable rhythms such as ventricular fibrillation, defibrillation can restore an organized rhythm, and early defibrillation combined with high-quality CPR is the strongest determinant of survival. Advanced life support adds airway management, vascular access, and medications to this foundation.

Clinical relevance

CPR is a core competency across clinical settings and underpins rapid-response and code-team systems, with nurses often first to recognize arrest and initiate resuscitation. This entry describes the concepts and evidence as reference material and is not a substitute for accredited life-support training or for guidance on resuscitating a specific patient.

Epidemiology

Cardiac arrest, both in and out of hospital, is a major cause of death, and survival is strongly time-dependent: each minute of delay in effective CPR and defibrillation reduces the chance of survival, which is why the chain of survival emphasizes early recognition and response.

History

Modern CPR was consolidated around 1960 when Kouwenhoven, Jude, and Knickerbocker described closed-chest cardiac massage, which was then combined with mouth-to-mouth ventilation pioneered in resuscitation research into the integrated technique. Professional bodies subsequently standardized CPR through periodically updated guidelines that have progressively emphasized high-quality compressions and early defibrillation.

Key figures

• William Kouwenhoven
• James Jude
• Peter Safar

Seminal works

• kouwenhoven-1960
• panchal-2020

Frequently asked questions

Why is minimizing interruptions in chest compressions emphasized?

Perfusion pressure to the heart and brain builds up over successive compressions and falls quickly when compressions pause, so frequent or prolonged interruptions reduce the blood flow that CPR is meant to generate.

How do CPR and defibrillation relate?

CPR maintains circulation and keeps the heart viable, while defibrillation can terminate a shockable rhythm; the two are complementary, and early defibrillation combined with high-quality CPR most strongly predicts survival.