Evidence-Based Analysis of a Cardiopulmonary Resuscitation Scenario

This report provides a critical analysis of a video scenario depicting cardiopulmonary resuscitation (CPR), evaluating the strengths and weaknesses of the techniques used against the Australian Resuscitation Council (ARC) guidelines. The analysis begins with the initial response, highlighting the prompt call for Code Blue but also noting the omission of airway and breathing assessment before chest compressions. The report then delves into the specifics of chest compression techniques, identifying both positive aspects such as patient positioning and hand posture, and negative aspects such as interruptions during the procedure. The use of defibrillation, epinephrine, amiodarone, and saline solutions are also discussed in relation to the evidence. The report emphasizes the importance of minimizing interruptions, maintaining the correct compression-to-ventilation ratio, and adhering to established protocols to maximize the chances of survival in cardiac arrest situations.

Running head: EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
Evidences based on Cardiopulmonary Resuscitation
Name of the Student:
Name of the University:
Author Note:

1EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
The prediction of cardiac arrest in patients who are admitted in hospital is poor and
quick medical attention is required for increasing their chances of survival. Mortality due to
cardiac arrests is a major problem each year and it occurs due to insufficient resuscitation or
delay in resuscitation process. The responsiveness of the code team and their immediate
action plays a role in increasing the chances of survival (Clarke et al., 2016). The
effectiveness of their action depends on the sequence of interventions they are performing.
The rate of survival is dependent on the early attendance and response from the emergency
code team, prompt cardio pulmonary resuscitation, quick fibrillation and advanced basic life
support. With this context, the main purpose of the essay is to critically analyze a video
scenario related to cardiac arrest scenario and review strength and weakness of skills related
to resuscitation. The analysis of the video is done on the basis of ARC guideline (Australian
Resuscitation Council). The strength and positive and negative points have been identified
and discusses with support from research evidence.
After reviewing the video by Saskatchewan Health Authority (2013), many positive
and negative skills were identified. For example, after identifying that the person is
irresponsive, the nurse immediately called for Code Blue. To indicate that a patient is having
a cardiopulmonary arrest, medical institution use the term Code blue (Ferreira et al., 2015). It
is an indication that a patient requires resuscitation and is in need of immediate medical
attention. In case of the video, her decision to immediately call for Code Blue was a good
decision as the patient was unresponsive. Her action was in relevance with the ARC guideline
8 which states DRS ABCD as the initial steps of resuscitation. The DRS ABCD involved
seven steps starting from checking for danger (D), checking for responsiveness (R), sending
for help (R), opening the airway (A), checking breathing (B), starting CPR (C) and then
defibrillation (D) (Australian Resuscitation Council: Guideline 8, 2018). She checked for
danger and responsiveness and sent for help (by calling Code Blue) after she recognized that

2EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
the patient was unresponsive. According to Avis et al. (2016), During unresponsiveness and
breathing problem observed in a patient, the emergency member of blue code team should
attend the patient to increase his or her survival rate. Their instant response during this
emergency is the most important step to handle severe condition. A clear communication and
a prompt action is always required to stimulate a fast response (Knight et al., 2014). The only
negative non-technical action taken by the rescuer was that she called verbally instead of
pressing the emergency button. Jung et al., (2016) explains that rescuers should avoid calling
helper verbally. Rather they can use any alarm call for addressing their needs. This can
prevent delay in arrival of the Code Blue Team.
Another negative point observed in the video was that after calling for Code Blue
team, the nurse engaged in doing chest compression without doing assessment of breathing
and airways. According to the ARC guideline 4, the assessment of airway and breathing takes
precedence over other injuries (Australian Resuscitation Council: Guideline 4, 2018).
Although the nurse accurately followed DRS steps, however she skipped the step of airway
and breathing before commencing CPR. In case of cardiac arrest, that absence of respiratory
movement is one of the major criteria that should be observed by the members of emergency
team (Dalal et al., 2018). According to Debaty et al. (2017), better assessment in case of
resuscitation is to check the abnormal breathing pattern or absence of breathing. Gasping and
abnormal breathing pattern is generally observed during cardiac arrest that subsides down
with time. The recognition of this gasping and hypoxia by the bystanders and emergency
medical dispatchers is vital for the proper diagnosis of the arrest (Adams, 2018). According
to the ARC guideline 5, rescuers should look for absence or abnormal breathing rate to
identify the need for resuscitation (Australian Resuscitation Council: Guideline 5, 2018).
However, the rescuer in the video did not looked for movement of the upper abdomen or

3EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
lower chest, did not assessed escape of air from the nose and felt for movement of air at the
mouth and nose.
The next vital step according to the DRS ABCD steps mentioned in the ARC
guideline 8 (2018) is conducting chest compressions. According to Rajab et al. (2011),
responder should initiate chest compression after activating emergency response system.
Chest compression is a crucial activity for successful resuscitation as it increases the chances
of survival by generating small but critical amount of blood flow to the heart and brain.
Compression of chest restores the blood flow and oxygen perfusion to the brain and other
organs (Russo et al., 2017). It is a highly standardized technique where proper patient
positioning, hand posture, compression rate, compression depth and rotation determine the
success of the method. Throughout the video, many negative and positive points related to
techniques used for chest compression has been identified. The positive point was that the
rescuer started chest compression immediately after calling for Code Blue. The rescuer’s
action was in accordance with the ARC guideline 8. The benefit of this action was it
minimizes any chances of delay in compressions. Li et al. (2013) states that delay in starting
compression lead to grave consequences for patient. Hence, initiating chest compression as
early as possible is effective in reducing to increase survival chance of cardiac arrest patient.
In this section, negative and positive points related to the techniques uses for chest
compression in the video have been highlighted. The first vital technique for successful CPR
is appropriate patient positioning and posture while performing the procedure. In the video,
the positive skills observed were that the rescuer maintained supine position of patient after
observing that the patient was irresponsive. She lowered the height of bed, places the patient
in supine position and stood beside patient’s bed while conducting CPR. A backboard was
also placed below the patient during the early phase of CPR. This was a good step taken by
staffs because placement of patients on a hard surface before resuscitation favored optimal

4EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
transfer of energy during the chest compression process. Rajab et al. (2011) explains such
step minimizes waste of compressive force because of the soft surface of the hospital bed.
The compression should be done after tilting patient’s head backward that results in the
opening up of the airway (Idris et al., 2015).
Another positive aspect found in the video was that for appropriate hand posture and
hand position was maintained by the staff. She placed the dominant hand over the center of
the patient’s chest and it was aligned with the long axis of the sternum. This was a positive
skills demonstrated during CPR because it minimizes chances of rib fractures by placing
compressive forces on the sternum. While performing CPR, it is necessary to overlap both
hand and maintain a parallel position. The same position was maintained by the rescuer too.
The arms were straight and elbows fully extended. The advantage of this technique was that it
helped in getting maximum mechanical advantage. Evidence also supports the fact that for an
effective compression to happen the depth of compression should be 5 cm and the hands of
the compressor should be extended while giving compression (Stiell et al., 2014).
The quality of chest compression is also dependent on minimum interruptions during
the procedure and maintenance of 30:2 compression: ventilation ratio. The ARC guideline 8
(2018) set high priority on minimizing interruptions rate during the chest compression and
balancing 30 compressions with 2 effective breaths between cycle of chest compression. The
guidelines also mention that continuous chest compression should be done within a two
minute time frame. At 8: 58, the statement of code captain indicated that the two minute time
frame was followed. Kwak et al., (2016) also supports the fact that 30:2 compression:
ventilation ratio has been recommended by international guideline to minimize
hyperventilation and minimize interruptions. Although recent evident suggest increasing C: V
rations, however it may decrease quality of CPR due to rescuer fatigue. The two breaths
cycles between cycle of chest compression was maintained, however Another weakness

5EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
observed in the video was that there were several instances of interruptions during the
procedure. The chest compression was stopped for a few seconds during defribillation
process and then checking for pulse and blood pressure in between. This deteriorates the
quality of chest compression. Less interruptions to CPR during cardiac arrest is required for
better outcome of the result. Checking of pulse often take 10 seconds and may delay and
interrupt the process, so, this should be avoided. Interruptions can be limited by charging the
manual defibrillator during chest compression (Gough & Nolan 2017).
The quality of chest compression may deteriorate with time due to rescuer fatigue.
Hence, to address rescuer fatigue, it is necessary that compressor is rotated every two
minutes. Another member should take over the responsibility of compression if the first
compressor done compression for two minutes and more (Yang et al., 20154). The same
technique was followed by compressors in the video too. The process was done for 12
minutes and the two staffs alternatively took the chest compression responsibility to minimize
fatigue and maintain quality of CPR. This action is in accordance with the ACR guideline 8
(2018) as it emphasized on having multiple rescuers and continuing resuscitation until the
person becomes exhausted. Chung, (2017) explains that the change in duty should be done
with negligible interruptions since any delay in this process may deteriorate the survival
chances of the patient. Hence, the strength of chest compression process as demonstrated in
the video was maintenance of desired C: V ratio, optimal position and rescuer fatigue.
However, the negative aspects of the chest compression process were brief period of
interruptions during the procedure. As per ARC guideline 8 (2018), attaching an automated
external defribrillator (AED) is also necessary to after CPR. After arrival of the Code Blue
team, AED was applied to patient. Chest compression was paused during defribillation
attempt. This was done for rhythm analysis. Deakin and Koster (2016) suggest that this can

6EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
be prevented by resuming chest compression during defribillator charging or eliminating
pulse checks.
Epinephrine is used in cardiac arrest and it is the primary drug to be administered
during CPR that reverses cardiac arrest (Lin et al., 2015). The drug was administered to
patient in the video too. The drug acts by increasing coronary perfusion and arterial blood
pressure during CPR through alpha-1- adreno receptor (Callaway, 2013). However many
evidences suggest that adrenalin administered during hypothermic cardiac arrest are
responsible for increasing overall cerebral oxygen extraction regardless of an increase in
cerebral perfusion pressure (Putzer et al., 2016). It is also associated with poor outcome since
it is responsible for the increase in demand of oxygen in heart muscle. Further evidences
suggested that epinephrine administration within 2 minutes of first commencement of
defibrillation decrease the rate of survival. It is thus recommended to administer epinephrine
afterwards (Andersen et al., 2016).
Amiodarone was also administered to patient in the video. Amiodarone is also
responsible for improving the survival rate (Laina et al., 2016). In addition, normal saline was
provided to the patient during the resuscitation process. Evidence suggested that the efficacy
of hypertonic saline solution in cardiopulmonary resuscitation is more as compared to normal
saline solution. Meta-analysis showed a considerable increase in the rate of restoration of
spontaneous circulation (ROSC), sodium concentration of serum during CPR in case of
animal models of cardiac arrest treated with hypertonic saline solution (Li et al., 2015).
Cardiovascular disease is also associated with type 2 diabetes mellitus. In order to prevent
hypoglycemia, ampoules of dextran 50% can be administered (Fox et al., 2015).

7EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
Conclusion:
From the above discussion, it can be that cardiopulmonary resuscitation is a lifesaving
technique that can be commenced in an individual during emergency conditions of cardiac
arrest. The quick assessment of breathing pattern and the status of patient is essential in order
to apply CPR. The first bystander who recognizes the abnormal breathing pattern of the
patient should commence the CPR immediately that can increase survival rate. Early
compression is required in order to avoid the primary brain damage. Quality and
effectiveness of compression is necessary for better outcome. Delaying in action of
emergency team can deteriorate the patient’s condition, so, the prompt action and early
recognition of abnormal breathing pattern is required for decreasing the chances of survival.
Though some drugs like Epinephrine and Amiodarone have some positive effects in cardiac
arrest, yet, they fail to elicit any long-term responses in cardiac arrest.

8EVIDENCES BASED ON CARDIOPULMONARY RESUSCITATION
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