home Consultations Conducting closed cardiac massage. Indirect cardiac massage and artificial respiration - rules and techniques for its implementation. Functions of the heart and consequences of cardiac arrest

Conducting closed cardiac massage. Indirect cardiac massage and artificial respiration - rules and techniques for its implementation. Functions of the heart and consequences of cardiac arrest

When restoring breathing and cardiac activity of an unconscious victim, must be laid on its side to prevent him from suffocating with his own sunken tongue or vomit.

The retraction of the tongue is often indicated by breathing that resembles snoring and severe difficulty in inhaling.

Rules and techniques for performing artificial respiration and chest compressions

If p Animation measures are carried out by two people, one of them performs cardiac massage, the other performs artificial respiration in the mode of one insufflation every five presses on the chest wall.

When to start resuscitation measures

What to do if a person falls unconscious? First you need to identify signs of life. The heartbeat can be heard by placing your ear to the victim's chest or by feeling the pulse in the carotid arteries. Breathing can be detected by the movement of the chest, leaning towards the face and listening for inhalation and exhalation by holding a mirror to the victim’s nose or mouth (it will fog up when breathing).

If no breathing or heartbeat is detected, resuscitation should begin immediately.

How to do artificial respiration and chest compressions? What methods exist? The most common, accessible to everyone and effective:

external cardiac massage;
mouth-to-mouth breathing;
breathing "from mouth to nose".

It is advisable to conduct receptions for two people. Cardiac massage is always carried out together with artificial ventilation.

Procedure in the absence of signs of life

Free the respiratory organs (oral, nasal cavity, pharynx) from possible foreign bodies.
If there is a heartbeat, but the person is not breathing, only artificial respiration is performed.
If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do indirect cardiac massage

The technique of performing indirect cardiac massage is simple, but requires the right actions.

1. The person is laid on a hard surface, the upper body is freed from clothing.

2. To perform closed cardiac massage, the resuscitator kneels on the side of the victim.

3. The palm, with its base extended as far as possible, is placed in the middle of the chest, two to three centimeters above the sternal end (where the ribs meet).

4. Where is pressure applied to the chest during closed cardiac massage? The point of maximum pressure should be in the center, not on the left, because the heart, contrary to popular belief, is located in the middle.

5. The thumb should be facing the person’s chin or stomach. The second palm is placed crosswise on top. The fingers should not touch the patient; the palm should be placed with the base and be extended as much as possible.

6. Pressure on the heart area is done with straight arms, the elbows do not bend. Pressure should be applied with your entire weight, not just your hands. The shocks should be so strong that the chest of an adult falls by 5 centimeters.

7. With what frequency of pressure is indirect cardiac massage performed? Press on the sternum at least 60 times per minute. You need to focus on the elasticity of the sternum of a particular person, precisely on how it returns to its opposite position. For example, in an elderly person the frequency of clicks may be no more than 40–50, and in children it can reach 120 or higher.

8. How many breaths and presses should you take during artificial respiration?

Every 15 compressions assisting blows air into the victim's lungs twice in a row and again performs a heart massage.

Why is indirect cardiac massage impossible if the victim is lying on something soft? In this case, the pressure will be released not on the heart, but on the pliable surface.

Very often, ribs are broken during chest compressions. There is no need to be afraid of this, the main thing is to revive the person, and the ribs will grow together. But you need to take into account that broken ribs are most likely the result of incorrect execution and you should moderate the pressing force.

Age of the victim	How to press	Pressing point	Depth of pressing	Velocity	Inhalation/pressure ratio
Age up to 1 year	2 fingers	1 finger below the nipple line	1.5–2 cm	120 and more	2/15
Ages 1–8 years	1 hand	2 fingers from the sternum	3–4 cm	100–120	2/15
Adult	2 hands	2 fingers from the sternum	5–6 cm	60–100	2/30

Artificial respiration "mouth to mouth"

If a poisoned person has secretions in the mouth that are dangerous for the resuscitator, such as poison, poisonous gas from the lungs, or an infection, then artificial respiration is not necessary! In this case, you need to limit yourself to performing an indirect cardiac massage, during which, due to pressure on the sternum, about 500 ml of air is expelled and again absorbed.

How to do mouth-to-mouth artificial respiration?

For your own safety, it is recommended that artificial respiration is best done through a napkin, while controlling the tightness of the pressure and preventing air “leakage”. Exhalation should not be sharp. Only strong but smooth (for 1–1.5 seconds) exhalation will ensure proper movement of the diaphragm and filling of the lungs with air.

Artificial respiration from mouth to nose

Artificial respiration “mouth to nose” is performed if the patient is unable to open his mouth (for example, due to a spasm).

Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
Check the patency of the nasal passages.
If possible, the jaw should be extended.
After a maximum inhalation, you need to blow air into the injured person’s nose, tightly covering his mouth with one hand.
After one breath, count to 4 and take the next one.

Features of resuscitation in children

In children, resuscitation techniques differ from those in adults. The chest of babies under one year old is very tender and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect cardiac massage is performed not with the palms, but with two fingers. The movement of the chest should be no more than 1.5–2 cm. The frequency of compressions is at least 100 per minute. From 1 to 8 years of age, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute. The ratio of inhalation to compression on the chest in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

How to perform artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since babies have small faces, an adult can perform artificial respiration by immediately covering both the child’s mouth and nose. The method is then called “mouth to mouth and nose.” Artificial respiration is given to children at a frequency of 18–24 per minute.

How to determine if resuscitation is being performed correctly

Signs of effectiveness when following the rules for performing artificial respiration are as follows.

When artificial respiration is performed correctly, you may notice the chest moving up and down during passive inspiration.
If the movement of the chest is weak or delayed, you need to understand the reasons. Probably a loose fit of the mouth to the mouth or nose, a shallow breath, a foreign body preventing the air from reaching the lungs.
If, when you inhale air, it is not the chest that rises, but the stomach, then this means that the air did not go through the airways, but through the esophagus. In this case, you need to press on the stomach and turn the patient's head to the side, as vomiting is possible.

The effectiveness of cardiac massage also needs to be checked every minute.

If, when performing an indirect cardiac massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient for blood to flow to the brain.
If resuscitation measures are performed correctly, the victim will soon experience heart contractions, blood pressure will rise, spontaneous breathing will appear, the skin will become less pale, and the pupils will narrow.

All actions must be completed for at least 10 minutes, or better yet, before the ambulance arrives. If the heartbeat persists, artificial respiration must be performed for a long time, up to 1.5 hours.

If resuscitation measures are ineffective within 25 minutes, the victim has cadaveric spots, a symptom of a “cat” pupil (when pressure is applied to the eyeball, the pupil becomes vertical, like a cat’s) or the first signs of rigor - all actions can be stopped, since biological death has occurred.

The sooner resuscitation is started, the greater the likelihood of a person returning to life. Their correct implementation will help not only restore life, but also provide oxygen to vital organs, prevent their death and disability of the victim.

The correctness of the massage is determined by the appearance of a pulse in the carotid artery in time with pressing on the chest.

Indirect cardiac massage is performed when it is necessary to resuscitate a person in case of cardiac arrest and lack of breathing.

At the same time, the chest is compressed by pressing (pressing) and artificial respiration is performed, that is, the victim is given first aid along with artificial ventilation (IV).

Physiology of blood circulation

The heart consists of four chambers: 2 atria and 2 ventricles. The atria provide blood flow to the ventricles from the vessels. The right ventricle ejects blood into the vessels of the lungs (pulmonary circulation), the left ventricle into the aorta, tissues and organs (systemic circulation).

Through the pulmonary circulation, gas exchange processes occur: carbon dioxide enters the lungs from the blood, and oxygen from the lungs enters the blood through binding to the hemoglobin of red blood cells. Reverse metabolic processes occur in the systemic circulation, and in addition, micronutrients are supplied. Metabolic products are removed from the tissues by the kidneys, skin and lungs into the blood of the aorta.

What happens when blood circulation stops?

When blood circulation stops, tissue and gas exchange will stop. The cells will accumulate metabolic products, and the blood will accumulate carbon dioxide. Metabolism will stop, and the cells will die from poisoning with waste products and oxygen starvation.

What does indirect cardiac massage give?

Immediately after cardiac arrest, indirect cardiac massage (closed cardiac massage) is performed to restore its activity. This will maintain continuous blood flow until the functional functioning of the heart is restored.

The chest is compressed, which means that the chambers of the heart and blood will exit from the atria into the ventricles through the opened valves, then enters the vessels. Indirect heart massage activates its own electrical activity and normalizes the functioning of the vascular center. Closed heart massage helps restore the functional functioning of the heart.

Causes of cardiac arrest

spasm of coronary vessels;
acute heart failure;
myocardial infarction;
electric shock or lightning;
severe injuries.

Cardiac arrest is characterized by:

severe pallor;
loss of consciousness;
disappearance of the pulse;
cessation of breathing or the appearance of convulsive and rare breaths with dilated pupils.

Closed (or external) cardiac massage - technique

Indirect cardiac massage (or external) is combined with other resuscitation measures to move blood from the heart into the vessels and restore breathing.

one hand is placed with the palm on the sternum in the lower part, with the main emphasis on the metacarpus;
the other hand is placed on top and both arms are straightened at the elbows to perform rhythmic pressure on the sternum;
when the sternum is lowered by 3-4 cm, the pressure force is considered normal, with a wide sternum - by 5-6 cm.

The cardiopulmonary resuscitation algorithm consists of a sequence of rapid resuscitation measures. Closed heart massage is combined with mechanical ventilation (tempo - 15x2). Add 2 breaths to 15 compressions if resuscitation is performed by 2 people. If there is one person, then the pace is 4x1.

The rules establish that the combination of chest compressions with defibrillation allows you to stop the massage only for 5-10 seconds, no more.

The technique of indirect cardiac massage involves determining the location of the xiphoid process.
The victim should lie on a hard and flat surface: board, ground, floor. A soft bed is not suitable. The resuscitator stands on the patient's left or right. His palms are on the lower end of the sternum.
The resuscitator palpates the compression point. Its location from the xiphoid process is at a distance of 2 fingers strictly in the vertical center of the body axis. The resuscitator places the palms with the base on the compression point. Increases pressure with the second hand and the weight of the body. Movements should be fast and rhythmic. The shock frequency is one shock per second.
In order for venous blood to freely fill the heart and facilitate the flow of venous blood to the heart, the resuscitator must raise his arms above the sternum after each pressure, and the victim’s legs are placed on a bolster to give them an elevated position.

External cardiac massage is performed strictly vertically at 101-112 compressions per minute.

External cardiac massage is performed for infants using the pads of the second and third fingers, for adolescents - with the palm of one hand. For adults, when applying pressure, the thumb is directed strictly towards the head or legs, which depends on which side the resuscitator is standing on. During a closed massage, the fingers are raised so as not to touch the ore cell.

The technique of external cardiac massage for children depends on the age of the baby. The procedure is as follows: the baby is placed with his back on a hard surface with his head facing him. Press on the sternum with two fingers, and place your thumbs on the front of the chest. The other two fingers are held under the back.

For children under 7 years of age, it is more convenient to perform indirect cardiac massage using the base of the palm of the hand, standing on the side. In newborns, the deflection of the chest should be 1-1.5 cm, in infants up to one year old - 2-2.5 cm, in babies older than one year - 4-4 cm.

The number of sternum compressions per minute always corresponds to the child's pulse rate in accordance with age. That's why:

During the massage, the resuscitator alternates two breaths (performs artificial ventilation of the lungs) with 15 compressions.

To determine the effectiveness of mechanical ventilation and chest compressions, the resuscitator monitors the pulse in the carotid artery and the reaction of the pupils to bright light.

Performing chest compressions and mechanical ventilation should be performed by 2 resuscitators. First aid to a victim can save his life. It is carried out before the doctor arrives.

Indirect massage of such a vital organ as the heart is carried out in cases where it stops in a person due to biological malfunctions in the body or when injured due to accidents. It is possible to bring a person back to life after the heart stops functioning in a maximum of 6 minutes, which is why it is not superfluous to know how to correctly and under what circumstances it is necessary to independently perform emergency resuscitation on the victim.

The essence of independent cardiopulmonary resuscitation

In case of cardiac arrest and complete cessation of breathing, it is necessary to establish the biological process of blood circulation and air exchange in the body. Located between the movable sternum and the stationary spine, the heart periodically contracts, receiving blood flows and pushing them into the vessels. It is these contractions that are responsible for the body. The need to artificially fill the lungs with air by a stranger simultaneously with chest compressions is due to the need for the lungs and heart to receive air flows.

Thus, indirect cardiac massage (external) is aimed at artificially simulating the function of blood circulation and breathing.

Mandatory indirect cardiac massage

Indirect cardiac massage is required for the following signs of lack of active work of the heart and lungs:

lack of breathing
absence of the slightest manifestations of pulse function
lack of reaction of the pupils to sharp bright light
bluishness of the skin
pale face

Cardiac resuscitation is carried out exclusively in combination with artificial respiration, otherwise attempts made to bring the person back to life will be unsuccessful. Indirect cardiac massage is performed in the presence of at least one cardiac arrest.

Sequence and complexity of indirect cardiac massage

A set of measures to normalize blood circulation in order to restore heartbeat and breathing consists of two main parts:

preparatory
direct massage

The preparatory part involves the correct position of the victim and the person who will perform indirect massage. First of all, the victim should be laid on a hard surface: to do this, he must be dragged onto asphalt or another hard surface. If this is not possible, you can place a board directly under the chest to increase the area of contact of the chest with the support.

The head of the person being resuscitated should be laid back; to fix this position, a special cushion or similar device should be placed under the neck.

This is necessary to carry out artificial respiration in between massage sessions, so that the blown air penetrates as deeply as possible into the chest. Before starting resuscitative actions, you must make sure that there are no foreign objects in the oral cavity.

Features and differences of cardiopulmonary resuscitation in children, contraindications

The technique for carrying out this procedure differs significantly between (up to one year old) and preschool children. The difference lies directly in the specifics of pressing on the chest.

In infants, indirect cardiac massage is performed with only two fingers: the middle and ring fingers. The frequency of massage pressure in infants should be increased to 120 per minute. The causes of cardiac and respiratory arrest can be not only injuries or accidents. A baby's heart may stop due to congenital diseases or sudden death syndrome. In preschool children, only the base of one palm is involved in the process of cardiac resuscitation.

The effectiveness of indirect massage

The effectiveness of cardiopulmonary resuscitation can be judged by the signs of life that appear in the victim. This is a renewal of the pulse, the appearance of weak breathing or a sharp deep sigh, the reaction of the pupils to a sharp and bright light also appears, namely their narrowing, further normalization and restoration of breathing, an increase in pressure, the disappearance of pallor and cyanosis on the arms and neck.

If necessary, you can finish indirect cardiac massage after palpating the pulse of the carotid artery, however, to stabilize the condition, it can be carried out for a longer time.

Specialists and doctors recommend not to stop resuscitating the victim until the ambulance arrives, even if there are no signs of life and no improvement in his condition. Official permission to stop performing chest compressions can only be given by a qualified physician.

What is unacceptable during external cardiac massage

To achieve the exceptional effectiveness of indirect cardiac massage, namely the resumption of normal blood circulation and the air exchange process, and bringing a person to his senses through tactile acupressure on the heart through the chest, you must follow some simple recommendations:

Act confidently and calmly, do not fuss.
Due to lack of self-confidence, do not leave the victim in danger, but be sure to carry out resuscitation measures.
Carry out preparatory procedures quickly and thoroughly, in particular, freeing the oral cavity from foreign objects, tilting the head to the position necessary for artificial respiration, freeing the chest from clothing, and a preliminary examination to detect penetrating wounds.
Do not tilt the victim’s head back excessively, as this may create obstacles to the free flow of air into the lungs.
Continue to resuscitate the victim’s heart and lungs until doctors or rescuers arrive.

Injuries, wounds, and poisoning can cause the main “motor” of the body, the human heart, to stop. Stopping blood circulation entails the cessation of tissue metabolism and gas exchange. Without blood circulation, metabolic products accumulate inside the cells, and carbon dioxide accumulates in the blood. Metabolism stops, cells begin to die due to lack of oxygen and intoxication with metabolic products.

In this case, it is very important to at least try to carry out resuscitation measures - cardiac massage. There is a limited time allotted for this procedure - only thirty minutes. After this period, clinical death becomes irreversible.

Symptoms of cardiac arrest

Signs indicating cardiac arrest are: stopping the pulse (inability to feel the pulse in the carotid artery); respiratory arrest (the patient’s chest is motionless, a mirror brought to the mouth and nose does not fog); dilated pupils that do not respond to light; loss of consciousness, and the person does not come to his senses when hearing loud sounds or patting on the face; bluish-gray skin tone.

Types of heart massage

Today, there are two methods of cardiac massage: direct (open) and indirect (closed).

Direct massage is carried out exclusively by qualified medical professionals and only in certain conditions: in particular, during surgery on the thoracic or abdominal organs. The essence of this procedure is to directly compress the heart muscle with your hands through an incision in the chest or abdomen (in this case, massage is carried out through the diaphragm). Due to the complexity of performing direct massage of the heart muscle, it is not a resuscitation measure that can be performed by people who do not have the appropriate medical education and training.

At the same time, indirect (closed) massage of the heart muscle can be carried out in “field” conditions. This is the simplest way to help restore cardiac activity. No medical devices are required to perform it.

Indirect cardiac massage provides that during pressure on the chest, the chambers of the heart will also be compressed. As a result, blood will enter the ventricles from the atria through the valves, and then go into the vessels. Thanks to rhythmic pressure on the chest, the movement of blood through the vessels will not stop. As a result, the organ’s own electrical activity and independent functioning are activated.

Of course, a cardiac massage can only be successful if the algorithm of action is carefully followed and the rescuer follows the approved technique for carrying out resuscitation measures. Massage must be combined with artificial ventilation. Each pressure on the victim’s chest provokes the release of about five hundred milliliters of air. When the compression stops, the same portion of air is sucked into the lungs. As a result, passive inhalation and exhalation occur.

The essence and algorithm of massage

External cardiac massage is a rhythmic compression of the heart through compressions that are performed between the sternum and the spine. Experts note that the chest of a person with cardiac arrest becomes more pliable due to loss of muscle tone, making it easy to perform compressions. The person providing assistance, if the NMS technique is followed, can easily displace the chest by three to five centimeters. Compression of the heart leads to a decrease in its volume and an increase in intracardiac pressure.

Rhythmic pressure on the chest area results in a difference in pressure inside the heart cavities, the blood vessels that extend from the heart muscle. Blood from the left ventricle travels through the aorta to the brain, while from the right ventricle it flows to the lungs, where it is oxygenated.

After the pressure on the chest stops, the heart muscle straightens, intracardiac pressure decreases, and the chambers fill with blood. As a result, artificial circulation is recreated.

You can perform a closed massage of the heart muscle only on a hard surface. No soft sofas will do; the person must be placed on the floor. After this, it is necessary to perform the so-called precordial punch. It should be directed to the middle third of the chest. The impact height should be thirty centimeters. In order to conduct a closed cardiac massage, the person providing assistance places the palm of one hand on the other, after which he begins to perform uniform pushes according to the established technique.

Rules for performing massage

For the emergency measures taken to be effective, it is extremely important to follow the cardiac massage technique. Only in this case, the efforts made to restore the victim’s cardiac activity can be justified.

When performing cardiac massage, the following rules should be observed:

The rescuer kneels in front of the victim lying on the ground or floor. It doesn't matter which side he is on. However, if the rescuer is right-handed, it will be more convenient for him to perform a precordial blow if he places his right hand towards the victim.
Place the base of your right palm slightly above the xiphoid process. The thumb should be directed either towards the chin or towards the victim’s abdomen.
The arms of the person performing chest compressions must be fully straightened. When the chest is displaced, the center of gravity must be moved to the chest of the person being assisted. As a result, the rescuer will be able to preserve his strength. If you bend your arms at the elbow joints, they will quickly get tired.
For resuscitation to be successful, first aid must arrive within half an hour. The frequency of pressure on the victim’s chest is sixty times per minute.
The depth to which chest compressions must be performed is three to five centimeters. In this case, the person providing assistance should not take their palms off the victim’s chest.
The next pressure on the chest should be done only after it returns to its original position.
During NMS, rib fractures are possible. This is not a reason to stop resuscitation measures. The only clarification is that pressure should be performed a little less often, but their depth should remain the same.
Simultaneously with NMS, artificial respiration is also performed. The ratio of chest compressions to ventilation should be 30:2. Compression on the victim's chest provokes exhalation, and the return of the chest to its original position is a passive inhalation. As a result, the lungs are saturated with oxygen.
During resuscitation measures, more attention should be paid to closed cardiac massage rather than artificial respiration.

Algorithm for performing indirect cardiac massage

Closed cardiac massage will be effective only if it is performed in accordance with the algorithm. You must proceed as follows:

First of all, determine the place where the compression will be carried out. There is a common belief that a person's heart is on the left. This is not entirely true. In fact, you should not press on the left side, but on the center of the chest. This is extremely important, because if you apply compression to the wrong place, you can not only fail to achieve the desired effect, but also cause harm. The point that we need is located in the center of the chest, at a distance of two fingers from the center of the sternum (where the ribs touch).
Place the heel of your palm at this point so that your thumb “looks” either at the victim’s stomach or chin, depending on which side of him you are on. Place your second palm crosswise on top of the first. Please note that only the base of the palm should be in contact with the body of the person you are helping. Fingers should remain hanging.
Don't bend your elbows. It is necessary to apply pressure using your own weight, and not the strength of your arm muscles, because otherwise you will quickly get tired, and the force of pressure at each point will be different.
With each pressure, the victim's chest should drop to a depth of five centimeters. In other words, the compression must be strong, because this is the only way you will be able to properly disperse the blood throughout the body so that it delivers oxygen to the brain.
Artificial ventilation is performed between compressions. Its cyclicity is two breaths for every fifteen shocks.

Signs that resuscitation was successful are the appearance of a pulse in the area of the carotid artery, as well as the reaction of the person’s pupils to light.

Conducting a closed heart massage for a child

Unfortunately, sometimes there are situations when, for one reason or another, a child’s heart stops. In this case, the reaction of people nearby should be immediate - the baby must immediately begin closed heart massage, since every second of lost time brings a tragic outcome closer.

In infants, clinical death can be caused not only by sudden death syndrome, but also by neurological diseases, sepsis, drowning, airway obstruction, acute bronchospasm, pneumonia, severe trauma or serious burns and other diseases.

Indications for chest compressions for infants and older children are: sudden deterioration in the child’s condition, fainting, absence of heartbeat when palpating the carotid artery, cessation of respiratory activity, lack of pupillary response to light.

Features of the procedure for children

Carrying out resuscitation of children has a number of features.

First of all, chest compressions should begin in babies immediately after signs of clinical death have been detected. At the same time, artificial respiration is carried out, before starting which it is necessary to ensure the free passage of air through the respiratory tract.

Indirect cardiac massage in newborns is performed with little effort. Infants are placed on their backs, with their shoulders facing them. The thumbs should touch the front of the chest, and their base will be on the lower third of the chest.

In addition, a closed massage of the heart muscle of a newborn can be performed by placing it on your forearm, and holding its head slightly tilted back in the palm of your hand.

When performing NMS, children under one year of age should use only two fingers for pressure - the second and third. The frequency of compressions should be from eighty to one hundred per minute.

Heart massage for children aged one to seven is done while standing to the side of them, using the heel of the palm.

When resuscitating children over eight years old, massage is done with both hands. The main thing when performing NMS for a child is to carefully calculate the strength. Excessively strong pressure can lead to damage to the chest, which, in turn, can lead to injuries to internal organs and the development of hemo- and pneumothorax.

Technique for performing NMS for children

When resuscitating a child, a strict sequence of actions must be carefully followed.

The child should be placed on any hard surface; infants can be placed on their own forearm. Hands are placed 1.5-2.5 cm above the xiphoid process. Pressures are performed rhythmically; the time of maximum deflection of the chest should not exceed one second. The amplitude of pressure and their frequency varies depending on the age of the child. Babies up to five months of age should be given up to one hundred and forty pressures per minute, the sternum should bend to a depth of one and a half centimeters. Children aged six months to one year should do 130-135 compressions, and the sternum should bend two to two and a half centimeters. Frequency of clicks from one to two - 120-125, from two to three - 110-115, from three to four - 100-105, from four to six - 90-100, from six to eight - 85-90, from eight to ten - 80-85, from ten to twelve - about 80, from twelve to fifteen - 75.

Resuscitation can be considered successful if the baby’s condition improves: his pupils constrict in response to light, eyelid tone appears, reflex movements of the larynx are recorded, a pulse can be detected in the carotid and femoral arteries, the color of the skin and mucous membranes improves.

Article publication date: 02/08/2017

Article updated date: 12/18/2018

From this article you will learn: what is indirect cardiac massage, why, to whom and who can do it. Is it possible to harm a person by performing this procedure, and how to make it really help.

Indirect cardiac massage is an emergency resuscitation measure aimed at replacing and restoring stopped cardiac activity.

This procedure is the most important for saving the life of a person whose heart has stopped and is in a state of clinical death. Therefore, every person must be able to do cardiac massage. Even if you are not a specialist, but you at least know approximately how this procedure should take place, do not be afraid to do it.

You will not harm the patient if you do something not quite right, and if you do nothing, it will lead to his death. The main thing is to make sure that there are really no heartbeats. Otherwise, even a perfectly performed massage will cause harm.

The essence and meaning of cardiac massage

The purpose of cardiac massage is to artificially recreate and replace cardiac activity if it stops. This can be achieved by squeezing the cavities of the heart from the outside, which imitates the first phase of cardiac activity - contraction (systole) with further weakening of pressure on the myocardium, which imitates the second phase - relaxation (diastole).

This massage can be done in two ways: direct and indirect. The first is possible only with surgery, when there is direct access to the heart. The surgeon takes it in his hand and performs a rhythmic alternation of compression and relaxation.

Indirect cardiac massage is called indirect because there is no direct contact with the organ. Compression is applied through the chest wall, as the heart is located between the spine and the sternum. Effective pressure on this area can release about 60% of the blood volume into the vessels compared to self-contracting myocardium. Thus, blood will be able to circulate through the largest arteries and vital organs (brain, heart, lungs).

Indications: who really needs this procedure

The most important thing in cardiac massage is to determine whether a person needs it or not. There is only one indication - complete. This means that even if an unconscious patient has severe rhythm disturbances, but at least some cardiac activity is preserved, it is better to refrain from the procedure. Compressing the contracting heart can cause it to stop.

The exception is cases of severe ventricular fibrillation, in which they seem to tremble (about 200 times per minute), but do not perform a single full contraction, as well as weakness of the sinus node and, in which the heartbeat is less than 25 beats per minute. If such patients are not helped, the condition will inevitably worsen and cardiac arrest will occur. Therefore, they can also be given indirect massage if there is no other way to help.

The rationale for the feasibility of this procedure is described in the table:

Clinical death is the stage of dying after the cessation of cardiac activity lasting 3–4 minutes. After this time, irreversible processes occur in the organs (primarily in the brain) - biological death occurs. Therefore, the only time when you need to do cardiac massage is the period of clinical death. Even if you don't know when your heart stopped and you're not sure if there's a heartbeat, look for other signs of cardiac arrest.

The sequence of actions that make up the technique of indirect cardiac massage includes:

1. Determine whether the patient has a pulse and heartbeat:

Feel the anterolateral surfaces of the neck with your fingers in the projection of the location of the carotid arteries. The absence of pulsation indicates cardiac arrest.
Listen with your ear or phonendoscope to the left half of the chest.

2. If you doubt the absence of heartbeats, before performing chest compressions, determine other signs of clinical death:

3. If these signs occur, feel free to begin chest compressions, following the technique:

Place the patient on his back, but only on a hard surface.
Open the patient's mouth, if there is mucus, vomit, blood or any foreign bodies in it, clean the oral cavity with your fingers.
Tilt the victim's head back well. This will prevent the tongue from retracting. It is advisable to fix it in this position by placing any cushion under the neck.
Stand to the patient's right at chest level.
Place the hands of both hands on the sternum at a point that is located two fingers above the lower end of the sternum (the border between the middle and lower third).
The hands should lie in this way: the fulcrum of one hand is the soft part of the palm in the area of the eminence of the thumb and little finger just below the wrist. Place the second hand on the one located on the chest and interlace their fingers into a lock. Fingers should not rest on the ribs, as they can cause fractures during the massage.
Bend over the victim so that with your correctly positioned hands you seem to be resting on the sternum. Arms should be straight (elbows bent).

The technique for performing chest compressions should be as follows:

At least 100 times per minute.
So that it is pressed in 3–5 cm.
Apply compression not by bending and straightening your arms at the elbows, but by applying pressure throughout your entire body. Your hands should be a kind of transmission lever. This way you won’t get tired and will be able to massage as much as you need. This procedure requires a lot of strength and energy.

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Indirect cardiac massage can last about 20 minutes. After every minute, assess whether a pulse appears in the carotid arteries. If after this time the heartbeat has recovered, further massage is not advisable.

It is not necessary to perform artificial respiration simultaneously with cardiac massage, but it is possible. The correct technique in this case: after 30 pressures, take 2 breaths.

Forecast

The effectiveness of chest compressions is unpredictable - from 5 to 65% result in restoration of cardiac activity and saving a person’s life. The prognosis is better when it is performed in young people without concomitant diseases and injuries. But cardiac arrest without indirect massage 100% ends in death.