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Happy ending: CPR: the breath and touch of life.

On a November evening in 2010, Absalom Tsela, local guard coordinator at the U.S. Embassy in Mbabane, Swaziland, was at home with his wife when their nine-month-old baby rolled off the bed and was knocked unconscious.


The baby had stopped breathing, so Tsela took out the cardiopulmonary resuscitation instructional card he received during embassy training and began administering assisted breathing. His wife called the emergency services number, and he continued cardiopulmonary resuscitation as he carried his daughter to meet the ambulance. The emergency medical technicians administered oxygen to no avail, and Tsela continued CPR until the ambulance arrived at the emergency room--where the baby was revived after about 15 minutes. She was released later that evening and has since fully recovered.

From his first response to their arrival at the hospital, Tsela performed CPR for nearly 30 minutes. Had he not been trained in CPR, the baby probably would have had little chance of survival. Tsela credits his CPR knowledge to a 2009 first-aid/CPR course taught by U.S. Embassy in Maputo Medical Officer Ty Flewelling.

In 2010, the American Heart Association released new recommen dations for performing CPR, and the resulting publicity increased demand for training. The AHA estimates that nearly 300,000 Americans have heart attacks outside of hospitals annually, and only about 24,000, or 8 percent of them, survive. Having a bystander perform CPR can double or triple the odds of surviving.

The first documented use of mouth-to-mouth resuscitation is in the Bible, where Elisha performs it on a child. The first official recommendation of mouth-to-mouth resuscitation was in 1740, when the Paris Academy of Sciences counseled it for use with drowning victims.

It was not until 1891, however, that German surgeon Dr. Friedrich Maass described the first use of chest compressions to create an arterial pulse. From 1891 to 1960, the technique was further perfected, and evidence grew of its effectiveness to resuscitate people who had suffered cardiac arrest. The turning point came in 1960 when doctors at Johns Hopkins University School of Medicine resuscitated 14 out of 20 cardiac arrest patients by applying closed-chest cardiac massage. In 1962, cardiac defibrillation equipment arrived. By the mid-1960s, the AHA developed a training program for physicians to teach CPR, and the program is now the standard for use with victims of cardiac arrest worldwide.

In 2010, AHA released the latest--and simpler--CPR standards. Since most adult cardiac arrests are due to an abnormal heart rhythm, the AHA recommends immediate activation of the emergency response system followed by starting chest compressions for any unresponsive adult victim who is not breathing. High-quality chest compressions should be done before any rescue breaths are given. The pattern for resuscitating is "C-A-B;" that is, first focus on circulation via chest compressions, then on opening the airway and lastly on mouth-to-mouth breathing. The AHA supports chest-compression-type CPR only for use by bystanders who are untrained or uncomfortable with mouth-to-mouth ventilation or breaths.

For children, the AHA recommendations are not as clear-cut. The primary cause of pediatric cardiac arrest is asphyxia, so providing adequate ventilation or breaths along with the chest compressions is crucial. The AHA supports using the C-A-B method except for those in the first 28 days of life. There, providing breaths first is vital to resuscitation, so the recommendation is A-B-C, or airway, breathing and then compression.

Each year, the science of cardiac resuscitation grows, but a constant of the past 50 years of CPR has been the importance of having a person who is trained to respond properly when the crisis occurs. Having a trained family member, co-worker, teacher or bystander who knows what to do makes all the difference.

The author is a regional medical officer.
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Title Annotation:Medical Report
Author:Ahmed Noor, Ayan H.
Publication:State Magazine
Date:Apr 1, 2011
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