Basic rules for closed cardiac massage. How to do indirect cardiac massage correctly

Indirect cardiac massage is the first medical aid when it stops working, which can be provided without professional medical training.

Resuscitation actions vary depending on the number of participants and the condition of the person being resuscitated. However, discrepancies in the technique are visible only at the last stages - during compression. Preparation for massage is the same in all cases.

The rules also depend on age: an infant, a child under 8 years old, a teenager and an adult are resuscitated differently. The procedure increases the chances of survival and makes it possible to wait for the ambulance to arrive.

Indirect cardiac massage (also external or closed) is a resuscitation measure, the purpose of which is to maintain blood circulation.

The principle of the procedure is that rhythmic compression of the heart imitates its natural work and promotes the resumption of blood circulation. Problems with blood circulation can be caused by congenital and acquired diseases, overdoses, road accidents and electric shock.

The indication for the beginning of the body's revival is clinical death - the process of dying, which is characterized by the absence external signs life, with tissue metabolism and brain function still remaining.

The transition period lasts up to ten minutes after the heart stops, then the brain is destroyed and restoration of vital functions becomes impossible.

How to determine whether a person has reached clinical death or whether it has already entered the biological stage?

The main reason for resuscitation is always complete cardiac arrest. The rescuer must make sure that there is no heartbeat and only then begin to revive the body. And, prerequisite During the procedure, there is a constant assessment of the condition of the person being resuscitated.

The effectiveness of the procedure is assessed by the body returning to normal.

The person being resuscitated must:

• feel the pulse (the pulse is considered stable if it does not stop for several minutes);
• blood pressure increases;
• pupils move (constriction);
• skin tone normalizes;
• the ability to breathe will be restored.

Algorithm and execution rules

How effective the resuscitation will be depends on the technique of execution.

Not correct position hands and a disrupted sequence of stages can lead to complications: rib fractures, pneumothorax, ruptures internal organs(incorrect posture will also lead to a decrease in the frequency of pressure and subsequent cessation of resuscitation due to fatigue of the resuscitator). It is the correct position of the hands that often determines the success of the event.

Training video:

Some complications (tamponade, pneumothorax, pectus excavatum) may be contraindications to further assistance help.

Closed cardiac massage is a specific algorithm of action that should be followed for greatest effectiveness and to avoid complications:

• the victim should lie on his back, on a hard surface with his head thrown back and legs raised;
• The chest, neck and stomach should not be squeezed, so unfasten the buttons at the throat, loosen the belt;
• ensure passability respiratory tract- the oral cavity must be clean and free of mucus, vomit, and blood;
• The resuscitator should be positioned on the side so that his shoulders are above his chest (you can stand on either side, but for right-handed people more comfortable position on the right, and for left-handers on the left);
• the correct location of the hands is selected in stages: find the junction of the lower ribs with the sternum, step back two fingers up and place the base of the palm on the found point;
• before the body begins to revive, a precordial blow is performed - a manipulation performed once along the interpapillary line in the center of the sternum, applied with a fist from a height of no more than 30 centimeters, without a swing (sometimes one blow can restore blood circulation, but if there is no improvement in the condition, proceed to resuscitation );
• clasp your fingers together ( thumb the main hand points either to the chin or to the feet).

Compression technique:

• should be pressed strictly perpendicularly and with straightened arms;
• the place where the hands are applied should not change (displacement of the point of pressure can cause fractures, hematomas, ruptures);
• the chest should be pressed 3-5 centimeters, the optimal rate of compression is 60-100 per minute;
• you need to keep your hands tightly pressed to your chest;
• pressure should be resumed only after returning chest to the starting position;
• It is important to observe the rhythm of the pressure and the force applied when pressing.

External cardiac massage is inseparable from artificial lung ventilation and, depending on the number of rescuers, the technique of resuscitation changes:

The time of the procedure depends only on the success of the actions taken, the arrival of an ambulance or your physical condition(broken ribs do not affect the duration of resuscitation). At 80-100 sternum compressions per minute minimum term massage - 15-20 minutes. The maximum period depends on the improvement of the condition or the onset of biological death.

Another method of revitalizing the body is also used - direct heart massage. The point is to restore blood flow through surgery.

An operation is performed on the open sternum, during which the doctor imitates the work of the heart, squeezing the organ in his hands with a frequency of 60-70 compressions per minute. These resuscitation actions are prohibited in the absence of vocational training and outside the hospital setting.

On this moment, preference for resuscitation is given to indirect massage, and the use of direct massage may be due to:

• circulation disorders in the early postoperative period;
• circulatory disorders due to injury;
• circulation problems during breast surgery.

Features of the procedure in children

A number of parameters closed massage hearts are carried out differently, depending on the age of the person being resuscitated. Several age boundaries can be drawn: a child under one year old, up to 8 years old, everyone over 8 years old (reanimation for adolescents is no different from that for adults). Different approaches to resuscitation of children and adults due to the size of internal organs, fragile bone structure And physiological characteristics(for example, heart rate). At the same time, the procedure for preparing for resuscitation is the same for all cases.

Newborns and children under one year of age are placed on the resuscitator’s forearm. Place a palm under your back so that your head is higher than your body and tilted back. With children under 8 years old, they immediately move on to massage and mechanical ventilation, without precordial stroke.

Baby resuscitation technology:

• carried out with the middle and index fingers;
• pressure speed - 140 per minute;
• punching depth 1-2 centimeters;
• Ventilation - about 40 breaths per minute.

Resuscitation technology for children under 8 years of age:

• carried out with one hand;
• pressure speed is 120 per minute;
• punching depth 3-4 centimeters;
• Mechanical ventilation - 30-35 breaths per minute.

Success Not direct massage heart disease is characterized by the restoration of basic body functions that a person loses after circulatory arrest.

The indicator of effectiveness is the body returning to normal. The criterion for the effectiveness of revitalizing the body in children and adults is the same (this is evidenced by: normalizing skin tone, pupil movement and shape, palpable pulse). A massage performed incorrectly can lead to complications (for example, ribs are most often broken), but its absence is always fatal.

Therefore, when clinical death, it is necessary to urgently begin emergency resuscitation efforts. The main thing is to make sure there is no heartbeat and severe injuries chest. At the moment, there are many opportunities to learn how to properly perform cardiac massage. If you are not confident in your abilities, watch video lessons on the topic or purchase an illustrated manual in which resuscitation is depicted in pictures and photos.

Clinical death is a condition in which human body no heartbeat and respiratory functions, but irreversible processes have not yet begun. During this period, properly performed resuscitation actions can save human life, therefore, each of us should know what indirect cardiac massage is (technique). Quite often, pathologies such as stroke, heart attack, thrombosis, hemorrhage and other diseases associated with the functioning of the heart lead to cardiac arrest. of cardio-vascular system and brain. Providing first medical care is the duty of every conscientious person, and its implementation must be in accordance with medical standards. Therefore, below we will consider step by step technique perform chest compressions, and also tell you how to perform artificial ventilation.

Let's turn to physiology: what happens after the heart stops

Before disassembling, how to do it correctly artificial respiration and cardiac massage, let's turn to human physiology and consider how the heart works and vascular system, and what are the consequences of stopping blood flow in the body.

The human heart has a four-chamber structure and consists of two atria and two ventricles. Thanks to the atria, blood enters the ventricles, which, during systole, push it back into the pulmonary and systemic circulation to distribute oxygen and nutrients throughout the body.

The work of blood is as follows:

• blood flow: passing through big circle blood flow, carries vital substances for cells, while taking away decay products from them, which are then excreted from the body through the kidneys, lungs and skin;
• the task of the small circle of blood flow is to replace carbon dioxide with oxygen; this exchange occurs in the lungs during inhalation and exhalation.

When the heart stops, blood stops flowing through the arteries, veins and vessels. The entire process described above stops. Decay products accumulate in the cells, the lack of breathing leads to saturation of the blood exclusively carbon dioxide. Metabolism stops and cells die as a result of “intoxication” and lack of oxygen. For example, to kill brain cells, it is enough to stop the blood flow for up to 3–4 minutes, in exceptional cases this period is slightly increased. Therefore, it is so important to carry out resuscitation actions for the first time minutes after the heart muscles stop working.

Indirect cardiac massage: technique

To perform cardiac massage indirect way You need to place one hand (palm down) on 1/3 of the lower part of the sternum. The main center of pressure should be on the metacarpus. Place your other palm on top. The main condition is that both hands must be kept straight, then the pressure will be rhythmic with equal force. The optimal force is considered to be when the sternum drops 3–4 cm during chest compressions.

What happens in the body during resuscitation? When exposed to the chest, the chambers of the heart are compressed, while the interchamber valves open, and blood penetrates from the atria into the ventricles. The mechanical effect on the heart muscles helps push blood into the vessels, which prevents the blood flow from stopping completely. If the actions are synchronous, then the heart’s own electrical impulse is activated, thanks to which the heart “starts” and blood flow is restored.

Rules for conducting resuscitation massage

Before performing indirect cardiac massage, it is necessary to find out whether there is a pulse, and also respiratory processes. If they are absent, a number of mandatory actions should be performed before starting cardiac massage and ventilation.

1. Place the person straight, preferably on a flat, hard surface.
2. Loosen clothing and determine the pressure point.
3. Kneel next to him on the side that is comfortable for you.
4. Clear the airways of possible vomit, mucus, and foreign objects.
5. An adult is given a heart massage with two hands, a child with one, and an infant with two fingers.
6. Repeated pressure is applied only after the sternum has completely returned to its original position.
7. The norm is considered to be 30 impacts on the chest, per 2 breaths, this is justified by the fact that when impacting the sternum, passive inhalations and exhalations occur.

How to resuscitate a victim: the actions of one person

One person can perform indirect cardiac massage and artificial respiration himself. Initially, the “preparatory” actions described above are performed, after which the execution technique algorithm should be as follows:

1. Initially, two air injections are made, each lasting 1–2 seconds. After the first blowing, you need to make sure that the chest drops (the air comes out) and only then make the second blow. It can be done by blowing through the mouth or nose. If artificial ventilation The lungs are carried out through the mouth, then the nose is pinched with the hand; if through the nose, then the mouth is secured with the hand. In order to protect yourself from the possibility of pathogenic microflora entering your body, you need to inflate through a napkin or handkerchief.
2. After the second injection of air, begin chest compressions. Your arms should be straight, their correct position is described above. Controlling the strength, apply 15 pressures.
3. Repeat the steps from the beginning. Resuscitation should continue until emergency assistance arrives. If 30 minutes have passed since the person began to “revive”, and no signs of life (pulse, breathing) have appeared, then biological death is declared.

If indirect cardiac massage and artificial respiration are performed by 1 person, the frequency of effects on the chest should normally be about 80–100 compressions per minute.

How should a victim be resuscitated? Actions of two people

If indirect cardiac massage and artificial respiration are performed by 2 people, then the algorithm and technique are different. Firstly, it is much easier for two people to perform resuscitation, and secondly, each of those providing assistance is responsible for a separate process, cardiac massage or ventilation of the lungs. The technique for performing resuscitation is as follows:

1. The person performing artificial respiration kneels at the head of the victim.
2. The person responsible for the process of indirect massage places the hands on the patient’s sternum.
3. Initially, two injections are made into the mouth or nose.
4. Afterwards, two impacts on the sternum.
5. Insufflations are repeated again after pressing.

The normal frequency of compressions during resuscitation by two people is about 80 times per minute.

Features of children's resuscitation

The main differences (features) of resuscitation in children are as follows:

• using only one pussy or only two fingers;
• the frequency of pressure for infants should be about 100 times per minute;
• the depth of breast descent during compression is no more than 1–2 cm;
• During resuscitation, children are given air blowing through the oral cavity and through the nasal canals, the frequency of blowing is about 35–40 times per minute;
• Since the volume of the child’s lungs is small, the air blown in should not exceed the volume that can be accommodated in the resuscitator’s mouth.

Remember that you can bring a person back to life only for the first few minutes after cardiac arrest, so do not hesitate, but immediately begin resuscitation actions.

• Main signs of cardiac arrest
• How is NMS carried out?
• Mandatory steps in the process of cardiac massage
• Recommendations for effective implementation massage
• Closed heart massage for a child 10-12 years old
• Techniques and rules for performing NMS and artificial respiration for infants

The first and main method of saving a person who has stopped breathing is chest compressions, or CCM. It can be carried out in order to restore the functioning of the heart muscle simultaneously with blood circulation, since it requires mechanical action. Only after this the body’s vital functions are restored and continuous blood flow is normalized.

If cardiac arrest occurs, then in almost any case it is necessary to perform artificial respiration. The patient will need first aid to maintain the vital functions of his body until the ambulance arrives. All activities associated with NMS require significant effort, which involves artificial respiration.

Main signs of cardiac arrest

Cardiac arrest is the sudden and complete cessation of cardiac activity, which certain cases may occur simultaneously with bioelectric activity myocardium. The main reasons for stopping are the following:

1. Ventricular asystole.
2. Paroxysmal tachycardia.
3. and etc.

Among the predisposing factors are:

1. Smoking.
2. Age.
3. Alcohol abuse.
4. Genetic.
5. Excessive stress on the heart muscle (for example, playing sports).

Sudden sometimes occurs due to injury or drowning, possibly due to blocked airways as a result of electric shock.

IN the latter case clinical death inevitably occurs. It should be remembered that the following signs can signal sudden stop cardiac activity:

1. Consciousness is lost.
2. Rare convulsive sighs appear.
3. Arises severe pallor on the face.
4. In area carotid arteries the pulse disappears.
5. Breathing stops.
6. The pupils dilate.

Indirect cardiac massage is performed until independent cardiac activity is restored, among the signs of which are the following:

1. The man regains consciousness.
2. A pulse appears.
3. Pallor and cyanosis decrease.
4. Breathing resumes.
5. The pupils narrow.

Thus, in order to save the life of the victim, it is necessary to carry out resuscitation actions, taking into account all the prevailing circumstances, and at the same time call an ambulance.

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How is NMS carried out?

Carrying out NMS, or external cardiac massage, is performed during artificial ventilation of the lungs.

This is done by alternating ventilation and massage, regardless of the reasons why the heart stopped. The main thing is to remember the timeliness and correctness of actions related to cardiac resuscitation of a patient whose body has lost its vital functions. This leads to the death of the victim before the ambulance arrives.

The victim's body shows signs of cardiac arrest, so he needs emergency help. It can only be provided by those people who were near him at that moment. First, they kneel near the patient’s chest and determine the area on the palm that should be pressed. It is easy to bend the base of the palm by applying sufficient pressure.

It is necessary to correctly follow the massage technique, rhythmically squeezing the chest and pressing on it with both hands, which causes the blood to be squeezed out of the heart muscle, which begins to spread through the vessels. The heart is pressed against the spine. The process of blood circulation in the victim’s body is resumed if about 60-70 presses are made with both hands per minute. If there is no cardiac activity, then these manipulations will be sufficient.

If clinical death occurs, muscle tone is significantly reduced, so the mobility of the chest increases, which makes it easier to perform actions related to simulating the work of the heart muscle. Whether there is blood circulation is determined simultaneously with the observation of the pulse. It is measured in the wrist, neck or femoral artery.

If the condition is terminal, then the pulse should be felt where the area of ​​the carotid artery is located, since it is not possible to determine it at the level of the wrist. For this purpose, fingers are placed on the larynx, on top of the so-called Adam's apple, after which they are moved along the neck.

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Mandatory steps in the process of cardiac massage

According to the technique, the rescuer begins to conduct NMS by standing up right side from a patient. To locate the xiphoid process, first run a finger along the person's ribs. Using the index and middle fingers, find the tubercle on the sternum small size, which should be lower than the level of the nipples, or on it. Then it is necessary, measuring two fingers above the xiphoid process, left hand Place your palm down in this place.

The base of the palm is placed on the found place. Next, place your palm on top of your left hand right hand on her back side so that your fingers point up. This position of the hands will allow you to block the hands using the fingers fastened with a lock. It is important to ensure that the rescuer places his shoulders directly above the patient’s chest, placing his palms on his sternum and straightening his elbows.

At the next stage, they begin to massage, pressing with both hands on the chest. The chest is pressed down no less than 3-5 cm. The rescuer must push the sternum with pushes so that it can be shifted exactly 3-5 cm in the direction of the spine, holding it for about half a second (if the victim is an adult). After this, the rescuer must relax his arms, but do not lift them from his chest. We should not forget about artificial respiration, which is given to the patient.

With NMS, it is necessary to compress the heart, that is, its muscles, where the sternum and spine are located, which is associated with squeezing blood into the arteries. When the pressure stops, the heart fills with blood through the veins. It is important to remember that when correct implementation NMS provides only 20-40% of normal blood circulation healthy person, which is sufficient to maintain the body’s vital functions for an hour before the ambulance arrives. In this regard, you cannot stop the actions, but you can interrupt for seconds and continue the actions.

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Should be paid Special attention on the location of the rescuer, who needs to be significantly higher than the patient’s body. He can sit on a chair or kneel next to the victim if he is lying on the floor. It is necessary to ensure that the arms are straight during the massage, so you need to apply pressure when using the strength of the arms simultaneously with the weight of the victim’s torso. This allows for efficiency in order to save energy, so that NMS can be performed for a long time.

Fingers should not rest on the chest, as it is necessary to effective massage. All forces must be directed to the lower third of the sternum, and not to the area itself chest wall, which will reduce the risk associated with rib fractures.

If the patient is in horizontal position on a hard, flat surface, it is easier for the rescuer to apply pressure on the sternum so that the heart muscle can contract. The NMS scheme involves not only correct location, but also the right way to press.

Having quickly begun to implement NMS, forcefully press on the sternum area. It can go to a depth equal to half the height of the entire chest. The pressure is immediately followed by relaxation.

It is important to monitor the coincidence of moments associated with pressure and relaxation. It is necessary to compress the patient’s sternum with such force that it is pressed against the spine by 5-6 cm, at a pace close to normal heart rhythms.

Cardiac massage should be performed for at least 30 minutes. Performing external massage hearts must remember that you cannot stop the massage process until 30 presses have been made. If you rest often, this will only harm the victim, since resuscitation carried out in these rhythms causes a complete cessation of the blood circulation process.

Having made 30 presses on the chest area, about two breaths are taken into the patient’s mouth, which can be done after 150 times. It is necessary to maintain a pressure speed of about 100 times per minute, which is suitable for any patient, with the exception of a newborn.

You should wait for an ambulance or do necessary actions until the pulse resumes in the area of ​​the carotid artery. If there is no pulse, then the massage should be continued until signs of biological death begin to appear, developing after clinical death has occurred within an hour.

If the heart stops beating, a properly performed external cardiac massage can save a life. This involves rhythmic pressure on bottom part sternum for artificial pumping of blood. Such actions help restore your own electrical activity myocardium and prevent the death of brain cells.

Read in this article

When is artificial massage needed?

The main indication for performing indirect cardiac massage is to stop its work. This may happen when:

• drowning,
• electric shock,
• rhythm disturbances (ventricular fibrillation, sinus node weakness),
• stroke and
• pulmonary embolism,
• hypothermia (excessive hypothermia),
• shock due to blood loss, anaphylaxis,
• poisoning carbon monoxide, alcohol, medications.

In order to be sure of cardiac arrest, you need to identify the following signs:

• no pulsation of the carotid arteries (check with the second and third fingers);
• there is no breathing (the chest is motionless, there is no fogging on the glass or mirror when approaching the face);
• the pupils are dilated, if you shine a flashlight on them, there is no constriction;
• loss of consciousness is indicated by a tap on the face or loud sounds, if the patient does not respond to them, then this is a sign of unconsciousness;
• the skin of the face and body is pale with a grayish-bluish tint.

If the person performing resuscitation does not know how to correctly determine the pulse, then it is considered absent. To start a closed massage, the absence of consciousness and breathing is enough.

The most important factor determining later life a patient with clinical death are the first 7 minutes after cardiac arrest. Brain cells begin to die after 3-5 minutes of stopping the flow of blood into them. After 30 minutes any resuscitation measures will be useless.

Correct sequence of actions

The complete complex for preventing death consists of the following stages:

1. Recognize cardiac arrest.
2. Call an ambulance.
3. Start external massage and ventilation (massage is a priority).
4. Intensive drug therapy.

First aid to the victim is often provided by a person who does not have special knowledge and experience, therefore, according to the latest recommendations of resuscitators, until the arrival of a special team, you can limit yourself to only closed heart massage.

A break in chest compressions severely disrupts the blood supply to the brain, so a break for ventilation should not be taken longer than 10 seconds after every 30 compressions.

Position of the patient before the procedure

In order to compress the chest, the victim's back must be on a hard surface. Therefore, it is laid on the floor or ground. A bed or sofa is not suitable for this purpose. The chest is freed from clothing, the belt is unfastened.

The airways should be cleared of contents whenever possible. To do this, use a spoon or similar object to clean the oral cavity. If the mouth is closed, then lower jaw required to move forward: throw back your head, place index fingers behind the ears and with a strong movement pull the jaw up and forward.

Execution technique

When providing first aid, closed massage techniques and artificial ventilation are used. Direct impact on the heart can only be carried out during cardiac surgery.

Indirect external (closed)

Before starting, a precordial blow is applied to the heart area. It is sometimes enough to trigger independent contractions. For this clenched fist you need to sharply hit the sternum 2 - 3 cm above the xiphoid process. A blow to the heart is more effective if no more than 20 seconds have passed since the stop. Contraindicated for children weighing up to 15 kg.

For effective resuscitation, indirect massage is much more important than all other measures, so it must be carried out as early as possible and for as long as possible before the arrival of the medical team or the appearance of signs of biological death.

Rules for closed cardiac massage:

• Kneel near your chest.
• Place straightened arms on the lower third of the sternum 2 cm above the costal angle, the shoulders of the person providing assistance are above the patient’s chest.
• Pressing is done with the lower zone of the palm with both hands (one on top of the other, fingers crossed).
• The pressure on the chest should not be due to the muscles of the arms, but the weight of the torso, the direction is strictly perpendicular.
• The deflection depth is 5 cm, the rhythm is 100 compressions per minute.

Intense pressure can cause rib fractures. This is more common in older people, but is not a reason to stop resuscitation.

Watch the video about the technique of performing indirect cardiac massage:

With ventilation

When inhaling air into the patient’s mouth, you need to check the patency of the respiratory tract, empty the mouth and nasal passages, and tilt the head back so that the chin is directed upward. Principles of artificial ventilation:

• take a deep breath,
• pinch the patient's nose and exhale into the mouth,
• after 4 seconds repeat,
• continue external cardiac massage.

To protect the resuscitator and the victim, barriers are used - a handkerchief or special masks available in the first aid kit. Effectiveness is assessed by raising the chest.

The main differences between direct and indirect

To perform direct cardiac massage, the surgeon must compress the ventricles in a rhythm of up to 60 contractions with one or both hands, forcing blood to move through the arteries. This method is used if, during an operation, a straight line is recorded on the patient’s ECG. It is justified only in cardiac arrest with an open chest or if there is surgical access near the diaphragm. Most often, such actions are carried out with.

Indirect massage requires the integrity of the chest, since it is performed by compressing it. Both types of massage lose their significance if they are started late, when the body has already experienced metabolic disorders or has arrived terminal stage serious illness internal organs.

How to massage children

The basic rules of cardiopulmonary resuscitation after 1 year do not differ. For newborns, the chest is covered with the palms, while the chest is placed on the lower third of the sternum. thumbs, and the rest are placed under the back (the resuscitator is located on the side of the head). Pressures are applied with one finger, their depth is about 1.5 - 2 cm, and the frequency is 130 - 140 per minute.

Older children receive assistance just like adults, but up to 2 years old it is enough to use 2-3 fingers, and after that the strength of one palm is enough. Teenagers can squeeze the chest with both hands, but the pressure should be less intense than with adults.

Cardiac defibrillation is performed for indications such as heart rhythm disturbances. The method of electrical defibrillation is quite simple; it is performed by trainers, hotel staff, and flight attendants.

The uninterrupted functioning of the heart is a prerequisite for the continuation of life. 5 minutes after it stops, the cerebral cortex begins to die, so it is extremely important to start performing artificial or indirect cardiac massage (ICM) as early as possible, even if you are not entirely sure of the correctness of your actions.

The main task of cardiac massage is to artificially replace myocardial contractions in cases where they have been stopped.

This can be achieved in two ways:

• performing chest compressions by non-specialists, rescuers or medical staff Ambulance teams;
• manual manipulation by a cardiac surgeon directly on the heart during surgery.

Massage manipulations are aimed at maintaining blood circulation large vessels brain, lungs and myocardium. The correct frequency and depth of indirect impact on the heart through the chest wall can provide a 60% release of blood volume compared to the blood flow that occurs with self-contracting myocardium.

Pressure imitates contraction of the heart muscle (systole), and its cessation during complete weakening of the chest - relaxation (diastole).

IN basic complex resuscitation measures also include ensuring airway patency and performing artificial pulmonary ventilation (ALV). Their the main objective– this is the maintenance of gas exchange by forced renewal of air.

On a note. It has been established that the main factor in the success of resuscitation is adequate actions during chest compressions. If you are afraid or disdainful to perform artificial respiration, then be sure to give the victim chest compressions, according to the rules described below.

Conditions under which external cardiac massage can be performed

Indications for chest compressions are the cessation of heartbeats - the onset of clinical death, recognized by the following signs:

• persistent loss of consciousness;
• lack of pulse;
• respiratory arrest;
• huge pupils that do not react to light.

For heart pain and/or other symptoms observed with cardiovascular diseases, for example, slowing down inhalations and exhalations, indirect massage and mechanical ventilation are prohibited.

Attention. Artificial massage for the heart, “for future use” can end either in stopping its work, or in a significant deterioration in the condition of the sick person.

How to start the indirect myocardial massage procedure

Before we talk directly about the heart massage technique itself, let’s pay attention preparatory actions, which will simultaneously serve as permission to carry it out:

• Quickly inspect the scene to avoid getting caught yourself. similar situation, for example, do not get an electric shock from a bare wire.
• Check the victim's consciousness. It is forbidden to shake him violently, hit him on the cheeks, pour water on him, let him sniff ammonia or ammonia, or waste time looking for and applying a mirror to his lips. Firmly squeeze the person who you think is lifeless by the arm or leg, carefully jog and call out to him loudly.
• If there is no reaction, make sure the victim is lying on a hard, level surface and turn him onto his back. If there is no need, then do not move or carry a person in trouble anywhere.
• Open the victim’s mouth slightly and tilt your ear towards him so that you can see his chest from the side and above; if you can, then try to feel the pulse where you can and know how. For 10 seconds, examine your breathing using the “SOS – listen, feel, see” method (see photo above). Here's what it is:
  1. C – listen with your ear for sounds of inhalation and exhalation;
  2. O – try to feel the presence of exhalation with your cheek;
  3. C – look at the chest, whether it moves or not.

Why is the need for cardiac massage primarily determined by the absence of respiratory cycles, and not by cardiac arrest?

• Firstly, it is difficult for ordinary people to quickly feel a “healthy” pulse on the wrist, even in normal situation, what can we say about extreme conditions, in which, in addition to weak beating and/or too rare beats, it is recommended to palpate the heart rate on the carotid artery.
• Secondly, a frightened person may be afraid to open the victim’s eyes to determine the size of the pupils, moisture and transparency of the cornea, or may not be able to correctly assess these characteristics.
• Third, because loss of breathing quite quickly ends in cardiac arrest and loss of consciousness. If there is no breathing, the main thing is to ensure access of blood to the brain and prevent its cortex from dying.

Indirect cardiac massage technique

Currently, not for doctors or rescuers, but for ordinary people who, due to the current circumstances, are forced to provide assistance in starting the heart and restoring respiratory cycles, the following procedure is recommended:

• C (circulacion) – performing a cycle of external cardiac massage;
• A (airwey) – control and ensure free passage of air into the lungs;
• B (breathe) – artificial ventilation of the lungs.

How to do indirect cardiac massage correctly

1. The position of the hands of the person providing assistance should be perpendicular to the victim’s chest, and he himself should be on the side of it.
2. The palms should be folded one on top of the other, and the fingers should be raised, or the fingers should be interlocked.
3. In order not to injure the lower extremity of the sternum - xiphoid process, the base of the “lower” palm should be rested in its middle.
4. The frequency of compressions during chest compressions is the optimal rate for an adult from 100 to 120 compressions per second.
5. When doing presses, do not bend your elbows! The pressure occurs due to the weight of the body during its tilt.
6. The number of massage pressures in one continuous cycle is 30 times.
7. The pressure should be such that the palms “sink down” by 5-6 cm.

On a note. It is imperative to ensure that the ratio of the time of pressing and the time of returning the hands to the starting position is the same. This is extremely important for filling the heart chambers with a sufficient volume of blood.

Ensuring access of air to the lungs and artificial ventilation of the lungs

Because the cardiac massage provides only blood movement and cannot prevent hypoxia of the tissues of the cerebral cortex, then to ensure gas exchange, massage should be combined with mechanical ventilation.

Before starting artificial respiration, it is necessary to facilitate free access of air into the lungs.

First, place the victim’s head in a position that prevents the tongue from retracting (see picture above):

• tilt your head back - at the same time press on your forehead with one hand and lift your neck with the other (1);
• push the lower jaw forward - pick up the lower jaw with your fingers and align the lower and upper teeth in one plane (2);
• open your mouth, pulling your chin down a little (3);
• Check the position of the tongue, and if it is stuck, pull it out with two fingers.

Then check the position of the tongue and the presence of mucus. If necessary, the tongue is pulled out with 2 fingers, like tongs, and the mucus is collected with the index finger, acting as a spatula.

Important. If a neck fracture is suspected, the head is not thrown back, and when performing artificial inhalation, in order not to further move the vertebrae, they try not to strong pressure on the mouth.

Mechanical ventilation techniques and rules

If, after the first 30 rhythmic pressures on the middle of the sternum and restoration of airway patency, cardiac activity has not resumed, alternating mechanical ventilation with the mouth-to-mouth technique and IMS begins:

1. Take a deep breath yourself, pinching the victim’s nose with two fingers.
2. Within 1 second, exhale your air completely into his mouth. At this time, squint your eyes and look at the chest to see if it has expanded or not.
3. Pause for 2-4 seconds. It will simulate passive exhalation.
4. Repeat the exhalation into your mouth for a second, controlling the movements of your chest.
5. Straighten up and begin doing 30 presses to the middle of the chest.

Number of artificial breaths

There is no need to make more than 2 exhalations into the victim’s mouth. Their excess amount increases tidal volume, which leads to a decrease in cardiac output and blood circulation.

Artificial respiration techniques

The “mouth to mouth” method is replaced by “mouth to nose” if a person has an injury to his mouth or is unable to open it. In this case, you need to monitor the tightness of the ventilator, supporting your chin with your fingers just in case.

Reasons for the ineffectiveness of mechanical ventilation

If the chest does not inflate during the first artificial breaths, this may result in:

• insufficient sealing of the respiratory tract - the nose (or mouth) is not tightly closed;
• weak exhalation force of the person providing assistance;
• availability in oral cavity affected by mucus or foreign objects.

What to do in the first two cases is clear, but when trying to extract foreign object with the help of big and index finger, act extremely carefully so as not to push it even deeper.

Features of cardiopulmonary resuscitation in children

To help children, you should remember a few simple and easy to remember rules:

1. Execution algorithm cardiopulmonary resuscitation, tempo and frequency of compression during chest compressions for everyone age categories, starting from birth, is the same, as is its ratio with mechanical ventilation – 30 to 2.
2. U infant tilting your head back should be easy. Strong neck deflection in infants leads to airway obstruction!
3. For a child aged 1 to 10 years, pressing on the middle of the sternum is carried out with only one hand. In newborns and infants, indirect heart massage is performed with bundles of 2 (middle and ring) or 3 (+ index) fingers.
4. Air is blown into the infant's mouth and nose at the same time. This technique is also recommended for use in older children, as long as the size of the facial skull allows such a girth to be made without violating its tightness.
5. Be careful! The force, depth and volume of air during passive inspiration should not be large, especially if mechanical ventilation is performed on an infant. Conventionally, the volume should be equal to the quantity air that fits “between your cheeks”, taken in without take a deep breath, and the exhalation should be like a blow.

On a note. The recommended force (depth) of pressure in children and newborns is approximately 1/3 of the chest diameter. There is no need to be afraid of breaking bones. At this age, they are still pliable and have not completely ossified.

When you can and should call for help

It is absolutely impossible to delay the start of external cardiac massage, but when you can be distracted by calls for help and calling Ambulance?

Presence of people and age of the unconscious person	Procedure
	Call loudly and briefly to those you see. Do this without stopping pressing on the sternum. After their arrival, quickly ask to call an ambulance, continuing resuscitation efforts. After the call, they can help, for example, you continue to do mechanical ventilation, and they, alternating with each other, do IMS.
	After performing “SOS”, first call an ambulance. Otherwise, all your efforts to maintain blood flow in the cerebral cortex may be pointless if professional medical assistance is not provided in a timely manner.
	No calls! First of all, do 4-5 cycles of IMS + ventilation. And only after that, stop to call an ambulance.

Duration of the IC and actions performed after it

It is necessary to continue resuscitation measures until you are relieved by a medic or rescuer who arrives on call.

If your actions were successful - signs of life appeared, then you need to follow the “Actions after resuscitation” protocol:

• Lay the person down as in the picture above. While in it, he will not be able to accidentally tip over on his back. This will save him from choking on vomit, which quite often begins to erupt after IMS. For insurance, you can put a pillow, a rolled blanket or any other object, even a hard one, under your back, and cover it with a blanket on top. Note:
  1. the left palm is placed under the cheek, but it is better to left forearm served as a cushion for the neck;
  2. the left leg is bent and rests the knee on the floor;
  3. The entire body is not clearly positioned on its side, but its stomach is slightly turned toward the floor.
• The infant should be held in your arms, in a position on your side, so that you can see his face and chest at all times.
• Do not give medications, drink, eat or give injections under any circumstances.
• Do not leave a person unattended, monitoring the continuity of his breathing.

And at the end of this article, in order to convince you that doing cardiac massage and artificial respiration is not very difficult, take a look short video With correct technique performing these resuscitation procedures. The price of your composure, overcoming uncertainty and fears is a saved human life.