Standard Protocol for External Chest Compressions | Wellbeing

Preparation and Positioning Ideally, the procedure should be performed by doctors, nurses, or individuals trained in CPR techniques. Necessary equipment includes a crash cart, ambu bag, mask, endotracheal tube, monitor, defibrillator, and emergency medications like Adrenaline. The patient must be placed in a supine position (lying flat on their back) on a hard, firm surface. If the patient is on a mattress, a backboard should be placed under their back to ensure effective compressions.

Step-by-Step Procedure

1. Recognition and Initial Action: Upon discovering an unconscious patient suspected of cardiac arrest, quickly approach, assess the situation, and call for support. Position the patient correctly and immediately clear the airway while checking for breathing and a carotid pulse.

2. Compression Technique:

   • Hand Placement: Locate the xiphoid process (the lower tip of the breastbone). Place the heel of the first hand on the sternum, just above this point. Place the second hand on top of the first, interlocking the fingers tightly.

   • Body Mechanics: The direction of force must be perpendicular to the patient's chest. Keep your shoulders, elbows, and wrists locked in a straight line.

   • Action: The guiding principle is to push "Fast and Hard." Ensure the chest recoils (expands) completely after each compression and minimize interruptions.

3. Specific Ratios and Depth:

   • For Adults and Children (>8 years): Compress at the center of the chest (nipple line) to a depth of 4-5 cm using the heels of both hands.

   • For Infants (<1 year): Compress just below the nipple line (lower half of the sternum). Use the 2-finger technique (for a single rescuer) or the 2-thumb encircling hands technique (for two rescuers). The depth should be 1/3 to 1/4 of the chest thickness.

   • Frequency: Maintain a rate of at least 100 compressions per minute.

   • Ventilation Ratio: Perform 30 compressions to 2 breaths (30:2) for adults (and for children/infants with a single rescuer). Use a 15:2 ratio for children/infants if two rescuers are present.

Potential Complications If chest compressions are performed in the wrong location, with incorrect technique, or with excessive force, complications may occur, including rib fractures, sternum fractures, pneumothorax, or lung contusions.