RESUSCITATION

The knowledge required to practice resuscitation need not only be the preserve of the skilled hospital emergency team. Anyone can learn the simple techniques that can save the life of a fellow human being.

During the course of the 1960s it became common place in hospitals for people who had not only stopped breathing, but who also had lost their heartbeat to be saved from death; the basic techniques of cardio-pulmonary resuscitation (CPR) were born. Nowhere was this more successful than for patients who had suffered a heart attack. Because so many of these patients lives could be saved, they tended to be gathered together in a special ward equipped with all the facilities for immediate CPR. These wards became known as coronary care units - now found in many hospitals.

HOW RESUSCITATION WORKS

There are only three basic principles to successful resuscitation, and these are the same whether they are being applied by the highly skilled team in a hospital or by a member of the public in the street.

· First, the patient’s airway must be unobstructed. This means that the air passages in the upper part of the throat and the mouth must be clear so that air can get down into the lungs-such things as vomit or false teeth must be removed from the mouth without delay.

· Second, air must be pumped into the lungs. The simple way of doing this is with the ‘kiss of life’. The basic technique is easy: the mouth is placed firmly over the mouth of the patient and the patient’s mouth is blown into about 10 times a minute. It is essential that the head of the patient is tipped backwards since this allows the airway to remain open.

· Third, the oxygen that is being supplied to the lungs must be carried to the rest of the body via circulation of the blood. This is done by using the non-beating heart as a sort of pump by means of cardiac message. It was really the development of this technique that led to the widespread use of CPR.

Before today’s techniques of external cardiac massage, people used to carry out an emergency operation to open the chest at the bedside and then squeeze the heart in their hands to circulate the blood. It was later realized that the same effect could be achieved without opening the chest at all. Pressure on the sternum (the breastbone), causes the heart to be emptied of blood that then flows to the rest of the body. When the pressure is removed, the heart fills up again with blood. So, regular applications of pressure produce an almost normal, regular pulse, sending blood to the vital organs.

The kiss of life with additional cardiac massage, if no pulse can be felt, can save lives without any other sort of additional help at all. In addition to this, these techniques can keep people alive long enough for them to be taken to hospital where more sophisticated equipment like defibrillators and mechanical ventilators (breathing machines) can be used.

CLEARING AIRWAYS

One of the problems associated with any sort of unconsciousness is that the normal swallowing mechanism is lost so that food, and particularly vomit can go down into the lungs instead of being directed into the gullet. In hospital this problem is avoided by placing a tube in the trachea (windpipe) which is then sealed with an inflatable cuff-this of course means that nothing can slip down into the lungs.

The trouble with tracheal tubes is that it is a very skilled job to put them in place. Although it is a basic skill for an anesthetist it would not be easy for someone to perform in the street.

In order to get over this difficulty there is an exciting new development called an oesophageal obturator airway. This too is a tube with a baloon-like cuff at the end of it, but instead of being put into the trachea, it is put into the oesophagus (gullet) where the tube naturally tends to go. Unlike the tracheal tube it has a blind end so that vomit cannot get past it up into the mouth and then down into the lungs of the patient.

Once the oesophagus is blocked off, any air pumped into the mouth has to go down into the lungs., so that with the aid of this device air can be pumped into the mouth and then into the lungs using a bag instead of having to give the kiss of life. With this sort of airway, a semi-skilled person can have almost the same advantages as the hospital anesthetist when it comes to resuscitation.

RESUSCITATION OUTSIDE HOSPITAL

In light of the successes of resuscitation in hospitals, people started to turn their attention to the possibility of bringing the techniques of CPR onto the streets in the hope of saving even more lives, again, particularly in those people who had just suffered, or were in the process of suffering a heart attack. Different ideas were tried in several cities around the world, and many of the schemes were and are very successful.

It is quite possible to save life by the simple and straightforward business of basic CPR. If you find someone who is not breathing, clear his or her airway and start the kiss of life. If you cannot feel a pulse get someone else to give heart massage, and if you are on your own at last try giving the chest a good hard thump, since this sometimes has the same effect as an electric shock in starting the heart off again. Remember you can’t do any harm - if someone’s heart has stopped and he isn’t breathing he is going to die anyway; but at least you can give him a chance of life. And don’t hand back - time is often of the essence and every minute counts.