You come across a person in critical medical distress in an out-of-hospital setting. You have a working knowledge of CPR and are confident you can help. Knowing all this, we ask you this: When should you not perform CPR, and when is it crucial to do so? It’s essential to understand both situations and their requirements, regardless of your CPR skills and abilities.
In cases of cardiac arrest, for example, the administration of CPR techniques, such as chest compressions, rescue breaths, and perhaps even the use of an AED, can save the victim’s life with a significant percentage of success. However, even if you find yourself perfectly capable of administering this help, sometimes you shouldn’t because of a clear risk to yourself and others in the vicinity or simply because of the victim’s wishes.
Knowing the bounds and limits of CPR is just as important as knowing how to perform it, so today’s focus will be on those instances where you should refrain from performing CPR or stop performing it. Let’s get right into the topic.
The Purpose of CPR
Even though the purpose of CPR is clear to most people reading this, it is still essential to cover it, as it relates to important aspects of our subject today – when should you not perform CPR.
The key purpose of administering CPR is to effectively mimic the work of someone’s heart and lungs when they are unable to perform their tasks. During CPR, chest compressions simulate the heat’s contractions when working properly, allowing you to push the blood around the body as if the heart is still working.
Since the main role of blood is to deliver oxygen to the organs in the body, most notably the brain, CPR utilizes rescue breaths to oxygenate the blood pumped via chest compressions.
An additional aspect of CPR is using an AED in instances of cardiac arrest to shock the heart back into rhythm using an electrical current. Ultimately, the underlying reason we do CPR is to keep someone’s brain oxygenated, therefore keeping them alive until professional medical help can arrive.
When Should You Not Perform CPR
Several situations exist where administering CPR is not advised, or worse, administering it may cause more harm than good to the victim, or even yourself. As rare as these instances might be, you need to be aware of them as a person certified to administer CPR:
- Apparent Death: As potent as CPR is as a technique to keep someone alive, there is such a thing as the point of no return, past which no CPR effort can revive a victim. Cases demonstrating clear signs of apparent death, like cold skin, stiffening of the muscles (rigor mortis), and lividity (discoloration of the skin on the lowermost parts of the body), mean that performing CPR is going to be useless.
- Signs of Life: On the other side of this spectrum is when the person you’re already giving CPR to shows unmistakable signs of life. If a victim can breathe on their own and have a notable, strong heartbeat, even if they are unconscious, you should stop performing CPR altogether. Administering CPR to someone demonstrating these signs is counter-productive and can make their condition worse.
- Fatigue: It takes a lot of effort to perform CPR. In some cases, CPR can take up to 30 minutes or even an hour before help arrives or the victim shows signs of life. Extreme physical exertion can make you a victim, so beware of that.
- Arrival of Emergency Medical Service (EMS): When professional medical services arrive, your role as a rescuer administering CPR is done. Given that the goal is to keep a victim alive until EMS arrives, you’ve done all you could and need to discontinue CPR once paramedics are ready to take over.
- An Unsafe Scene: In some situations, a scene can pose potentially serious risks to your safety or get in the way of effective CPR administration. Your safety, as well as that of the victim and any bystander, is a priority. Examples of safety hazards preventing you from giving CPR include ongoing violence, environmental dangers, difficult terrain, etc.
- Certain Medical Conditions: Some underlying medical conditions are incompatible with CPR, meaning you can do more harm by performing it. Terminal illnesses and extreme traumatic injuries effectively render CPR useless.
Ethical Considerations
The decision to perform or withhold CPR is not one to be taken lightly from an ethical standpoint. A person has the right to demand that they are not revived if they even suffer a SCA. This is known as a DNR Order (Do Not Resuscitate), a directive issued by a doctor per a person’s wishes and demands. As long as you are aware such an order exists, you should not attempt to revive the person through CPR, the use of an AED, or anything of the sort.
Respecting the victim’s autonomy and honoring their wishes is important, even though it may seem ethically erroneous at the moment. In cases where a DNR was not distinctly visible or otherwise communicated, you are not subject to any fallout from performing successful CPR on a person holding such a directive.
CPR Training and Education
Proper CPR training plays a crucial role in understanding how to perform CPR to the best of your abilities and when to refrain from it. This subject is covered in CPR courses and certification classes available throughout Los Angeles and is an essential aspect of CPR.
While you can’t get into legal trouble by giving CPR to a victim you’re not supposed to, courtesy of Good Samaritan Laws, you can cause harm or trauma to the victim, despite your best intentions.
CPR training programs cover topics such as recognizing cardiac arrest, learning to look for signs of life and death, optimal practices in performing CPR techniques, and methods of assessing a scene and examining a victim before commencing with CPR. By staying well-informed, you equip yourself to make better decisions in the heat of the moment and provide appropriate first aid to those in critical need.
Conclusion
Even if you are CPR certified and know how to give rhythmic chest compressions and deep rescue breaths, it’s essential to understand when should you not perform CPR.
When you know that you should not administer CPR, you can assess a scene and a victim using a wider perspective, which will also improve your or the EMT’s CPR effort if necessary. Ethical considerations are also important, as difficult as they might be for some rescuers to abide by. Remember that the wishes of the victim are what matters the most.
Realizing the limitations surrounding CPR is a crucial aspect of mastering the skill set that has the potential to save a life in certain medical emergencies. Getting certified by enrolling in one of our comprehensive courses will provide you with all the knowledge required to perform CPR and know when to stop. So, choose a CPR course and start working towards your certificate today!