Manual of basic CPR.pdf

Outline of CPR manual

I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose

II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system

III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication

IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR

V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR

VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C.

1. Heart beat Hero:
Manual of basic CPR Techniques for first
responders
Professor Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head, Department of Cardiology
Colonel Maleque Medical College, Manikganj.
Vice President, Bangladesh Society of Cardiovascular Intervention (BSCI)
E-mail: [email protected]; [email protected]

2. First Published : February 2023
Published by : ‘Dr. T. Rahman Cardiac Care
Foundation’
Printed by : Bersha Pvt. Ltd,
(8/3 Nilkhat, Dhaka-1205), Mobile : [phone]
E-mail : [email protected]
Cover Design : Kazi Atik
Price : 200/- (Two Hundred Taka) Only.
ISBN : 978-984-35-4356-1
978-984-35-4356-1 978-984-35-4356-1
“In a world where you can be anything, be the one who knows CPR.”
Heart beat Hero:
Manual of basic CPR Techniques for first
responders
Professor Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head, Department of Cardiology
Colonel Maleque Medical College, Manikganj.
Vice President, Bangladesh Society of Cardiovascular Intervention (BSCI)
E-mail: [email protected]; [email protected]
Heart beat Hero:
Manual of basic CPR Techniques for first responders
Professor Dr. Md. Toufiqur Rahman
Acknowledgement
I would like to express my sincere gratitude and appreciation to the following
individuals for their invaluable contributions to the development of this manual
on CPR (Cardiopulmonary Resuscitation):
Professor Abdullah Al Shafi Majumder, Professor Syed Azizul Haque, Professor
Md. Atahar Ali, Professor Mir Jamal uddin, Professor Mohammad Abdur Rashid,
Professor Abdul Wadud Chowdhury, Professor Razia Sultana Mahmud, Professor
Prabir Kumar Das, Dr. Kaiser Nasrullah Khan, Professor Ashok Dutta, Professor
Md. Khalequzzaman, Professor Mostafa Zaman Babul, Dr. Mohsin Ahmed, Dr.
Reyan Anis, Dr. AKM Monwarul Islam, Dr. Rumi Alam, Dr. Abdullah Salman.
Their expertise, dedication and tireless efforts have been instrumental in creating
a comprehensive and informative manual that will undoubtedly serve as a
valuable resource for healthcare professionals, first responders and individuals
seeking to acquire essential CPR skills.

3. Contents
I. Introduction about CPR 01
II. Getting Started with CPR 02
III. Basic Life Support Techniques 03
IV. Advanced Life Support Techniques 06
V. Improving Outcomes in CPR 07
VI. Special Considerations in CPR 09
VII. Conclusion 15
VIII. Appendices 16
IX. Bibliography. 22
About the Author 23
“When every second counts, knowing CPR can
make all the difference.”

4. Preface
Welcome to this manual on Basic CPR, a comprehensive guide
designed to equip with the knowledge and skills needed to perform
CPR in emergency situations. CPR or Cardiopulmonary
Resuscitation, is a critical lifesaving skill that can mean the
difference between life and death for someone experiencing cardiac
arrest or respiratory failure. This manual is designed to provide a
step-by-step guide on how to recognize an emergency, assess the
patient and administer effective CPR.
Whether you are a healthcare professional or a member of the
general public, this manual will help you understand the
fundamentals of basic CPR and how to apply them in real-life
scenarios. The manual covers the latest guidelines and techniques
recommended by major health organizations such as the American
Heart Association and the European Resuscitation Council,
ensuring that you are learning the most up-to-date methods.
Performing CPR may be a stressful experience, but this manual
aims to provide you with the confidence and knowledge needed to
respond quickly and effectively in an emergency. By following the
guidelines and practicing the techniques presented in this manual,
you can make a life-saving difference in the lives of those around
you. Thank you for choosing to learn about Basic CPR and hope this
manual proves to be a valuable resource for you.
Dedication
This manual is dedicated to all those patients who lost their lives due
to cardiac arrest without the chance to receive CPR. We acknowledge
the pain and loss that their families and loved ones have experienced
and we honour their memory by striving to ensure that others have the
opportunity to receive life-saving interventions. We hope that this
manual will serve as a useful resource for healthcare providers, first
responders and individuals seeking to learn CPR and improve their
chances of surviving a cardiac arrest. By sharing knowledge and
skills, we can work together to prevent future losses and provide a
chance for everyone to live a full and healthy life.

5. 01
I. Introduction
A. Definition of CPR
Cardiopulmonary resuscitation (CPR) is a life-saving technique that
combines chest compressions and rescue breathing to circulate
oxygenated blood throughout the body and revive a person whose
heart has stopped beating or is not effectively pumping blood.
B. Importance of CPR
CPR is crucial in emergency situations such as cardiac arrest,
drowning, suffocation or choking, where a person's life is at risk.
Immediate CPR can double or even triple the chance of survival
before medical help arrives.
C. Objective of the manual
 The objective of the manual is to provide an overview of basic
CPR techniques.
 The manual covers the steps involved in performing chest com-
pressions and rescue breathing.
 The goal is to help individuals learn how to respond effectively
in emergency situations.
 The manual aims to equip readers with the necessary knowledge
and skills to perform CPR safely and confidently.
 The manual is designed to be accessible to individuals with
varying levels of experience with CPR.
 The information presented is based on current guidelines and
best practices for performing CPR.
 The manual includes appendices with emergency response
phone numbers, CPR algorithms and flowcharts, medication
dosages and administration guidelines and a glossary of terms
and acronyms.
 By following the steps outlined in the manual, individuals can
increase the chances of survival for someone experiencing
cardiac arrest.
This manual will serve as a valuable resource for anyone interested
in learning how to perform CPR. By following the steps outlined in
this manual, individuals can learn how to respond confidently and
effectively in emergency situations, potentially saving a life.

6. 02
II. Getting Started with CPR
Cardiopulmonary resuscitation (CPR) is an emergency procedure
performed when a person's breathing or heartbeat has stopped. The
first few minutes after a cardiac arrest are critical and prompt action
can save a life. Getting started with CPR involves assessing the
situation, checking for responsiveness and activating the emergency
response system.
A. Assessing the situation
 Assess the situation for potential hazards before starting CPR.
 Look out for electrical hazards or harmful substances and move
the person away from them if possible.
 Make sure that the person is lying on a flat and firm surface.
 Remove any obstructing objects from the person's mouth or
airway to ensure a clear airway for breathing.
B. Checking for responsiveness
 The next step in CPR is to check the person's responsiveness.
 Tap the person's shoulder to try and wake them up.
 Shout, "Are you okay?" and see if the person responds.
 If the person does not respond, call out for help and start CPR
immediately.
C. Activating the emergency response system
 Call your local emergency number or activate the emergency
response system immediately.
 If there are other people around, ask someone to call while you
start CPR.
 Provide your location, the person's condition and other
necessary details to the emergency operator.
 Stay on the line and follow their instructions while you wait for
the emergency medical services (EMS) to arrive.

Keep in mind that time is critical during a cardiac arrest and every
second counts. Do not waste any time in getting started with CPR.

7. “You don't have to be a superhero to save a life, just know CPR.”
03
III. Basic Life Support Techniques
Cardiopulmonary resuscitation (CPR) is a critical emergency
procedure performed on individuals experiencing cardiac arrest or
other life-threatening medical emergencies. Basic life support
(BLS) refers to the initial medical care given to a victim in cardiac
arrest before advanced medical care arrives. Effective BLS
techniques can help maintain blood flow and oxygenation to vital
organs, thereby increasing the chances of survival.
A. Key components of basic life support
The key components of basic life support include early recognition
of the emergency, prompt activation of the emergency response
system, performing high-quality chest compressions, delivering
rescue breaths, utilizing an automated external defibrillator (AED)
and administering medications if necessary.
B. The ABCs of CPR
The ABCs of CPR stand for airway, breathing and circulation. These
three components form the foundation of BLS and should be
addressed in the following order:
Airway: Open the airway by tilting the head back and lifting the
chin. This will help clear any obstructions and allow for better
breathing.
Breathing: Check for breathing by looking for chest rise and fall or
by feeling for breaths on the victim's neck. If the victim is not
breathing, deliver rescue breaths.
Circulation: If the victim is not breathing or has no pulse, begin
chest compressions to maintain blood flow and oxygenation to vital
organs.
C. Performing chest compressions
Performing high-quality chest compressions is essential in BLS. To
perform chest compressions:
 Place the victim on a firm, flat surface.
 Kneel next to the victim's chest.
 Place the heel of one hand on the centre of the victim's chest.
 Place the other hand on top of the first hand and interlock the
fingers.
 Keep your arms
straight and
shoulders directly
over your hands.
 Push down hard
and fast, allowing
the chest to recoil
completely
between
compressions.
 Deliver
compressions at a
rate of 100 to 120
per minute.
2. Call 999

8. 04
III. Basic Life Support Techniques
Cardiopulmonary resuscitation (CPR) is a critical emergency
procedure performed on individuals experiencing cardiac arrest or
other life-threatening medical emergencies. Basic life support
(BLS) refers to the initial medical care given to a victim in cardiac
arrest before advanced medical care arrives. Effective BLS
techniques can help maintain blood flow and oxygenation to vital
organs, thereby increasing the chances of survival.
A. Key components of basic life support
The key components of basic life support include early recognition
of the emergency, prompt activation of the emergency response
system, performing high-quality chest compressions, delivering
rescue breaths, utilizing an automated external defibrillator (AED)
and administering medications if necessary.
B. The ABCs of CPR
The ABCs of CPR stand for airway, breathing and circulation. These
three components form the foundation of BLS and should be
addressed in the following order:
Airway: Open the airway by tilting the head back and lifting the
chin. This will help clear any obstructions and allow for better
breathing.
Breathing: Check for breathing by looking for chest rise and fall or
by feeling for breaths on the victim's neck. If the victim is not
breathing, deliver rescue breaths.
Circulation: If the victim is not breathing or has no pulse, begin
chest compressions to maintain blood flow and oxygenation to vital
organs.
C. Performing chest compressions
Performing high-quality chest compressions is essential in BLS. To
perform chest compressions:
 Place the victim on a firm, flat surface.
 Kneel next to the victim's chest.
 Place the heel of one hand on the centre of the victim's chest.
 Place the other hand on top of the first hand and interlock the
fingers.
 Keep your arms
straight and
shoulders directly
over your hands.
 Push down hard
and fast, allowing
the chest to recoil
completely
between
compressions.
 Deliver
compressions at a
rate of 100 to 120
per minute.
(999)

9. 05
D. Delivering rescue breaths
Rescue breaths are delivered to provide oxygen to the victim's
lungs. To deliver rescue breaths:
 Ensure the airway is open.
 Pinch the victim's nose shut.

Take a normal breath and place your mouth over the victim's mouth.
 Blow into the victim's mouth for 1 second to make the chest rise.
 Take a second breath and deliver it the same way.
E. Utilizing an automated external defibrillator (AED)
An AED is a portable device that analyzes the victim's heart rhythm
and delivers an electric shock if needed to restore a normal
heartbeat. To utilize an AED:
 Turn on the AED and follow the prompts.
 Apply the electrode pads to the victim's bare chest as directed.
 Stand clear and allow the AED to analyze the heart rhythm.
 If a shock is advised, ensure that no one is touching the victim
and press the shock button as directed.
 Immediately resume CPR. VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.

10. 06
E. Utilizing an automated external defibrillator (AED)
An AED is a portable device that analyzes the victim's heart rhythm
and delivers an electric shock if needed to restore a normal
heartbeat. To utilize an AED:
 Turn on the AED and follow the prompts.
 Apply the electrode pads to the victim's bare chest as directed.
 Stand clear and allow the AED to analyze the heart rhythm.
 If a shock is advised, ensure that no one is touching the victim
and press the shock button as directed.
 Immediately resume CPR.
F. Administering medications during CPR
In some cases, medications such as epinephrine or amiodarone may
be administered during CPR. Only trained medical personnel should
administer medications during CPR.
IV. Advanced Life Support Techniques
A. Advanced airway management: The various advanced airway
management techniques that healthcare professionals usually use during
CPR, including endotracheal intubation, supraglottic airway devices
(e.g. laryngeal mask airway) cricothyroidotomy and also the indications
and contraindications for these techniques, as well as the potential
complications will be discussed in next manual on advanced CPR.
B. Advanced monitoring techniques: The various monitoring
techniques that are used during CPR, including invasive (e.g.
arterial line, central venous catheter) and non-invasive (e.g. pulse
oximetry, capnography) methods and also the indications and
contraindications for each method, as well as the potential
 Effective team dynamics: Effective communication and
coordination among the team members involved in the resuscitation
efforts can improve the chances of a successful outcome.
B. Strategies for improving CPR outcomes:
Several strategies can be employed to improve CPR outcomes.
Some of the strategies include:
 Training and education: Proper training and education of
healthcare providers and laypersons in basic and advanced life
support techniques can improve CPR outcomes.
 Implementation of guidelines: The implementation of
guidelines developed by professional organizations, such as the
American Heart Association, can ensure that the latest
evidence-based practices are followed during resuscitation efforts.
 Technology: The use of technology, such as high-fidelity
simulators, can improve the quality of training and allow for
practice in realistic scenarios.
 Quality improvement initiatives: The implementation of
quality improvement initiatives, such as regular debriefing sessions
and continuous monitoring of resuscitation efforts can help identify
areas for improvement and lead to better outcomes.
C. The role of high-quality CPR in improving outcomes:
 High-quality CPR is crucial for increasing the chances of
survival during cardiac arrest.
 To perform high-quality CPR, it is important to deliver chest
compressions at the correct depth and rate, with minimal
interruptions.
 Effective ventilation and early de-fibrillation also play a crucial
role in improving outcomes.
 Monitoring the quality of CPR continuously and making
necessary adjustments is essential to optimize outcomes.
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
complications will be discussed in next manual on advanced CPR.
C. Invasive interventions: The various invasive interventions that
are used during CPR, including chest tube placement,
pericardiocentesis and needle decompression of a tension
pneumothorax and also indications and contraindications for each
intervention, as well as the potential complications will be discussed
in next manual on advanced CPR.
D. Extracorporeal membrane oxygenation (ECMO): The use of
ECMO as an advanced life support technique for patients in cardiac
arrest who have failed conventional CPR and also indications and
contraindications for ECMO, as well as the potential complications
and also a general overview of how ECMO works and what is
involved in managing patients who are on ECMO will be discussed
in next manual on advanced CPR.
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes:
Effective CPR is critical for increasing the likelihood of survival for
an individual experiencing cardiac arrest. Several factors can impact
the outcome of CPR. Understanding these factors is vital to improve
CPR outcomes. Some of the factors that influence CPR outcomes
include:
 Response time: The time between when the cardiac arrest
occurs and the initiation of CPR plays a crucial role in determining
the survival rate.
 Quality of chest compressions: High-quality chest compressions
that are delivered at the proper depth, rate and with minimal
interruptions can increase the chances of a successful outcome.
 Early de-fibrillation: Early de-fibrillation can restore the
heart's normal rhythm and increase the chances of survival.
 Effective airway management: Clearing the airway and
providing adequate ventilation during CPR can improve
oxygenation and ventilation.

11. 07
IV. Advanced Life Support Techniques
A. Advanced airway management: The various advanced airway
management techniques that healthcare professionals usually use during
CPR, including endotracheal intubation, supraglottic airway devices
(e.g. laryngeal mask airway) cricothyroidotomy and also the indications
and contraindications for these techniques, as well as the potential
complications will be discussed in next manual on advanced CPR.
B. Advanced monitoring techniques: The various monitoring
techniques that are used during CPR, including invasive (e.g.
arterial line, central venous catheter) and non-invasive (e.g. pulse
oximetry, capnography) methods and also the indications and
contraindications for each method, as well as the potential
 Effective team dynamics: Effective communication and
coordination among the team members involved in the resuscitation
efforts can improve the chances of a successful outcome.
B. Strategies for improving CPR outcomes:
Several strategies can be employed to improve CPR outcomes.
Some of the strategies include:
 Training and education: Proper training and education of
healthcare providers and laypersons in basic and advanced life
support techniques can improve CPR outcomes.
 Implementation of guidelines: The implementation of
guidelines developed by professional organizations, such as the
American Heart Association, can ensure that the latest
evidence-based practices are followed during resuscitation efforts.
 Technology: The use of technology, such as high-fidelity
simulators, can improve the quality of training and allow for
practice in realistic scenarios.
 Quality improvement initiatives: The implementation of
quality improvement initiatives, such as regular debriefing sessions
and continuous monitoring of resuscitation efforts can help identify
areas for improvement and lead to better outcomes.
C. The role of high-quality CPR in improving outcomes:
 High-quality CPR is crucial for increasing the chances of
survival during cardiac arrest.
 To perform high-quality CPR, it is important to deliver chest
compressions at the correct depth and rate, with minimal
interruptions.
 Effective ventilation and early de-fibrillation also play a crucial
role in improving outcomes.
 Monitoring the quality of CPR continuously and making
necessary adjustments is essential to optimize outcomes.
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
complications will be discussed in next manual on advanced CPR.
C. Invasive interventions: The various invasive interventions that
are used during CPR, including chest tube placement,
pericardiocentesis and needle decompression of a tension
pneumothorax and also indications and contraindications for each
intervention, as well as the potential complications will be discussed
in next manual on advanced CPR.
D. Extracorporeal membrane oxygenation (ECMO): The use of
ECMO as an advanced life support technique for patients in cardiac
arrest who have failed conventional CPR and also indications and
contraindications for ECMO, as well as the potential complications
and also a general overview of how ECMO works and what is
involved in managing patients who are on ECMO will be discussed
in next manual on advanced CPR.
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes:
Effective CPR is critical for increasing the likelihood of survival for
an individual experiencing cardiac arrest. Several factors can impact
the outcome of CPR. Understanding these factors is vital to improve
CPR outcomes. Some of the factors that influence CPR outcomes
include:
 Response time: The time between when the cardiac arrest
occurs and the initiation of CPR plays a crucial role in determining
the survival rate.
 Quality of chest compressions: High-quality chest compressions
that are delivered at the proper depth, rate and with minimal
interruptions can increase the chances of a successful outcome.
 Early de-fibrillation: Early de-fibrillation can restore the
heart's normal rhythm and increase the chances of survival.
 Effective airway management: Clearing the airway and
providing adequate ventilation during CPR can improve
oxygenation and ventilation.

12. 08
IV. Advanced Life Support Techniques
A. Advanced airway management: The various advanced airway
management techniques that healthcare professionals usually use during
CPR, including endotracheal intubation, supraglottic airway devices
(e.g. laryngeal mask airway) cricothyroidotomy and also the indications
and contraindications for these techniques, as well as the potential
complications will be discussed in next manual on advanced CPR.
B. Advanced monitoring techniques: The various monitoring
techniques that are used during CPR, including invasive (e.g.
arterial line, central venous catheter) and non-invasive (e.g. pulse
oximetry, capnography) methods and also the indications and
contraindications for each method, as well as the potential
 Effective team dynamics: Effective communication and
coordination among the team members involved in the resuscitation
efforts can improve the chances of a successful outcome.
B. Strategies for improving CPR outcomes:
Several strategies can be employed to improve CPR outcomes.
Some of the strategies include:
 Training and education: Proper training and education of
healthcare providers and laypersons in basic and advanced life
support techniques can improve CPR outcomes.
 Implementation of guidelines: The implementation of
guidelines developed by professional organizations, such as the
American Heart Association, can ensure that the latest
evidence-based practices are followed during resuscitation efforts.
 Technology: The use of technology, such as high-fidelity
simulators, can improve the quality of training and allow for
practice in realistic scenarios.
 Quality improvement initiatives: The implementation of
quality improvement initiatives, such as regular debriefing sessions
and continuous monitoring of resuscitation efforts can help identify
areas for improvement and lead to better outcomes.
C. The role of high-quality CPR in improving outcomes:
 High-quality CPR is crucial for increasing the chances of
survival during cardiac arrest.
 To perform high-quality CPR, it is important to deliver chest
compressions at the correct depth and rate, with minimal
interruptions.
 Effective ventilation and early de-fibrillation also play a crucial
role in improving outcomes.
 Monitoring the quality of CPR continuously and making
necessary adjustments is essential to optimize outcomes.
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
complications will be discussed in next manual on advanced CPR.
C. Invasive interventions: The various invasive interventions that
are used during CPR, including chest tube placement,
pericardiocentesis and needle decompression of a tension
pneumothorax and also indications and contraindications for each
intervention, as well as the potential complications will be discussed
in next manual on advanced CPR.
D. Extracorporeal membrane oxygenation (ECMO): The use of
ECMO as an advanced life support technique for patients in cardiac
arrest who have failed conventional CPR and also indications and
contraindications for ECMO, as well as the potential complications
and also a general overview of how ECMO works and what is
involved in managing patients who are on ECMO will be discussed
in next manual on advanced CPR.
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes:
Effective CPR is critical for increasing the likelihood of survival for
an individual experiencing cardiac arrest. Several factors can impact
the outcome of CPR. Understanding these factors is vital to improve
CPR outcomes. Some of the factors that influence CPR outcomes
include:
 Response time: The time between when the cardiac arrest
occurs and the initiation of CPR plays a crucial role in determining
the survival rate.
 Quality of chest compressions: High-quality chest compressions
that are delivered at the proper depth, rate and with minimal
interruptions can increase the chances of a successful outcome.
 Early de-fibrillation: Early de-fibrillation can restore the
heart's normal rhythm and increase the chances of survival.
 Effective airway management: Clearing the airway and
providing adequate ventilation during CPR can improve
oxygenation and ventilation.
“CPR: Empowering everyday heroes to save lives.”

13. 09
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.

14. 10
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.

15. 11
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.

16. 12
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.

17. 13
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.

18. 14
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VII. Conclusion
 This manual provides an overview of the basic steps involved in
performing CPR, including assessing the situation, checking for
responsiveness and activating the emergency response system.
 Key components of basic life support were discussed, such as
the ABCs of CPR, performing chest compressions, delivering
rescue breaths, utilizing an automated external defibrillator
(AED) and administering medications during CPR.
 Factors influencing CPR outcomes, strategies for improving
CPR outcomes and the role of high-quality CPR in improving
outcomes were discussed.

Special considerations in CPR were also covered, including CPR
in special populations and settings and CPR during a pandemic.
 This manual provides a comprehensive guide to performing
CPR effectively and efficiently.
 Healthcare providers and first responders can use this manual to
learn and apply the key concepts and techniques of CPR.

The manual can serve as a valuable reference for individuals
interested in learning CPR and improving their knowledge and skills.
 By following the steps and guidelines provided in this manual,
individuals can help increase the chances of survival during a
cardiac arrest emergency.
 Future research can focus on developing new and improved
CPR techniques to enhance its effectiveness.
 Research can also explore factors that influence CPR outcomes,

Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
such as age, gender, underlying medical conditions and
environmental factors.
 The use of new technologies, including artificial intelligence
and machine learning, can be studied to improve CPR outcomes.
 The efficacy of CPR in special populations, such as pregnant
women, children and elderly individuals, can be explored to
identify the most effective techniques for these groups.

19. 15
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VII. Conclusion
 This manual provides an overview of the basic steps involved in
performing CPR, including assessing the situation, checking for
responsiveness and activating the emergency response system.
 Key components of basic life support were discussed, such as
the ABCs of CPR, performing chest compressions, delivering
rescue breaths, utilizing an automated external defibrillator
(AED) and administering medications during CPR.
 Factors influencing CPR outcomes, strategies for improving
CPR outcomes and the role of high-quality CPR in improving
outcomes were discussed.

Special considerations in CPR were also covered, including CPR
in special populations and settings and CPR during a pandemic.
 This manual provides a comprehensive guide to performing
CPR effectively and efficiently.
 Healthcare providers and first responders can use this manual to
learn and apply the key concepts and techniques of CPR.

The manual can serve as a valuable reference for individuals
interested in learning CPR and improving their knowledge and skills.
 By following the steps and guidelines provided in this manual,
individuals can help increase the chances of survival during a
cardiac arrest emergency.
 Future research can focus on developing new and improved
CPR techniques to enhance its effectiveness.
 Research can also explore factors that influence CPR outcomes,
VIII. Appendices
A. Emergency Response Phone Numbers
Emergency response phone numbers, such as 999 or other local
emergency numbers, for quick reference in case of an emergency.
B. CPR Algorithms and Flowcharts
CPR algorithms and flowcharts are visual aids that can guide rescu-
ers in making critical decisions during resuscitation. The American
Heart Association and other organizations have developed standard-
ized algorithms and flowcharts that are used in CPR training and
practice. These resources typically outline the sequence of steps to
be taken during CPR, including assessments, interventions and
treatments. Some common CPR algorithms and flowcharts include:
i. Basic Life Support Algorithm: This algorithm outlines the basic
steps of CPR, including checking responsiveness, activating the
emergency response system, starting chest compressions and rescue
breaths and using an AED if available.
ii. Adult Cardiac Arrest Algorithm: This algorithm provides a
more detailed approach to CPR for adult patients in cardiac arrest,
including assessment of the patient's breathing and pulse,
performing high-quality CPR and using advanced airway
management techniques and medications as needed.
iii. Paediatric Cardiac Arrest Algorithm: This algorithm is
similar to the adult algorithm but is tailored to the unique needs of
paediatric patients, including age-appropriate CPR techniques,
recognition of respiratory and cardiac arrest and consideration of
underlying medical conditions.
iv. Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Algorithm: This algorithm is used specifically for patients in
cardiac arrest with these particular arrhythmias and includes steps
for de-fibrillation, advanced airway management and medication
administration.
v. Bradycardia Algorithm: This algorithm is used for patients with
a heart rate less than 60 beats per minute and includes steps for
identifying and treating the underlying cause of the bradycardia, as
well as medication administration and advanced airway
management as needed.
So, CPR algorithms and flowcharts can be useful tools for guiding
rescuers through the complex process of resuscitation, ensuring that
critical steps are not missed and increasing the likelihood of a
successful outcome.
C. Medication Dosages and Administration Guidelines
Medication administration during CPR should only be performed by
trained healthcare professionals with appropriate knowledge and
skills. The dosages and administration guidelines listed here are for
informational purposes only and should not be used as a substitute
for proper training and medical advice.
Epinephrine:
Dosage: 1 mg IV/IO every 3-5 minutes
Administration: Administer as soon as possible during CPR. May be
given via an endotracheal tube if IV/IO access is not available.
Amiodarone:
Dosage: 300 mg IV/IO push, followed by a second dose of 150 mg
IV/IO after 3-5 minutes if needed
Administration: Administer in patients with shock-refractory
ventricular fibrillation or pulseless ventricular tachycardia.
Vasopressin:
Dosage: 40 units IV/IO as a single dose
Administration: May be used as an alternative to the first or second
dose of epinephrine.
Lidocaine:
Dosage: 1-1.5 mg/kg IV/IO, followed by a maintenance infusion of
1-4 mg/min
Administration: Administer in patients with pulseless ventricular
tachycardia or ventricular fibrillation after de-fibrillation and
epinephrine have been given.
Atropine:
Dosage: 0.5 mg IV/IO every 3-5 minutes, up to a maximum dose of 3 mg
Administration: May be used in patients with symptomatic
bradycardia.
D. Glossary of Terms and Acronyms
A comprehensive glossary of common terms and acronyms used in
CPR, including medical terminology, CPR-specific terminology
and abbreviations will help users understand the various terms and
acronyms used in the manual and facilitate communication between
healthcare providers during CPR.
CPR: Cardiopulmonary resuscitation
AED: Automated external defibrillator
BLS: Basic life support
ALS: Advanced life support
EMS: Emergency medical services
PEA: Pulseless electrical activity
VF: Ventricular fibrillation
VT: Ventricular tachycardia
ROSC: Return of spontaneous circulation
ET tube: Endotracheal tube
ETT: Endotracheal intubation
NRB mask: Non-rebreather mask
Bag-valve-mask: A manual resuscitator device used to deliver
positive pressure ventilation during CPR
ACLS: Advanced cardiac life support
PALS: Paediatric advanced life support
CAB: Compressions, airway, breathing
CO
2
detector: A device that measures the level of carbon dioxide in
exhaled air, used to assess the effectiveness of CPR
ECG: Electrocardiogram
IO access: Intra osseous access, a method of administering fluids
and medications during CPR via a needle inserted into the bone
marrow
CPR feedback device: A device that provides real-time feedback
on the quality of chest compressions during CPR
Epinephrine: A medication used during CPR to stimulate the heart
and blood vessels

Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
such as age, gender, underlying medical conditions and
environmental factors.
 The use of new technologies, including artificial intelligence
and machine learning, can be studied to improve CPR outcomes.
 The efficacy of CPR in special populations, such as pregnant
women, children and elderly individuals, can be explored to
identify the most effective techniques for these groups.
Amiodarone: A medication used during CPR to treat certain types
of abnormal heart rhythms.
Atropine: A medication used during CPR to increase heart rate in
certain situations.
Vasopressin: A medication used during CPR to increase blood
pressure and blood flow to vital organs.

20. 16
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VIII. Appendices
A. Emergency Response Phone Numbers
Emergency response phone numbers, such as 999 or other local
emergency numbers, for quick reference in case of an emergency.
B. CPR Algorithms and Flowcharts
CPR algorithms and flowcharts are visual aids that can guide rescu-
ers in making critical decisions during resuscitation. The American
Heart Association and other organizations have developed standard-
ized algorithms and flowcharts that are used in CPR training and
practice. These resources typically outline the sequence of steps to
be taken during CPR, including assessments, interventions and
treatments. Some common CPR algorithms and flowcharts include:
i. Basic Life Support Algorithm: This algorithm outlines the basic
steps of CPR, including checking responsiveness, activating the
emergency response system, starting chest compressions and rescue
breaths and using an AED if available.
ii. Adult Cardiac Arrest Algorithm: This algorithm provides a
more detailed approach to CPR for adult patients in cardiac arrest,
including assessment of the patient's breathing and pulse,
performing high-quality CPR and using advanced airway
management techniques and medications as needed.
iii. Paediatric Cardiac Arrest Algorithm: This algorithm is
similar to the adult algorithm but is tailored to the unique needs of
paediatric patients, including age-appropriate CPR techniques,
recognition of respiratory and cardiac arrest and consideration of
underlying medical conditions.
iv. Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Algorithm: This algorithm is used specifically for patients in
cardiac arrest with these particular arrhythmias and includes steps
for de-fibrillation, advanced airway management and medication
administration.
v. Bradycardia Algorithm: This algorithm is used for patients with
a heart rate less than 60 beats per minute and includes steps for
identifying and treating the underlying cause of the bradycardia, as
well as medication administration and advanced airway
management as needed.
So, CPR algorithms and flowcharts can be useful tools for guiding
rescuers through the complex process of resuscitation, ensuring that
critical steps are not missed and increasing the likelihood of a
successful outcome.
C. Medication Dosages and Administration Guidelines
Medication administration during CPR should only be performed by
trained healthcare professionals with appropriate knowledge and
skills. The dosages and administration guidelines listed here are for
informational purposes only and should not be used as a substitute
for proper training and medical advice.
Epinephrine:
Dosage: 1 mg IV/IO every 3-5 minutes
Administration: Administer as soon as possible during CPR. May be
given via an endotracheal tube if IV/IO access is not available.
Amiodarone:
Dosage: 300 mg IV/IO push, followed by a second dose of 150 mg
IV/IO after 3-5 minutes if needed
Administration: Administer in patients with shock-refractory
ventricular fibrillation or pulseless ventricular tachycardia.
Vasopressin:
Dosage: 40 units IV/IO as a single dose
Administration: May be used as an alternative to the first or second
dose of epinephrine.
Lidocaine:
Dosage: 1-1.5 mg/kg IV/IO, followed by a maintenance infusion of
1-4 mg/min
Administration: Administer in patients with pulseless ventricular
tachycardia or ventricular fibrillation after de-fibrillation and
epinephrine have been given.
Atropine:
Dosage: 0.5 mg IV/IO every 3-5 minutes, up to a maximum dose of 3 mg
Administration: May be used in patients with symptomatic
bradycardia.
D. Glossary of Terms and Acronyms
A comprehensive glossary of common terms and acronyms used in
CPR, including medical terminology, CPR-specific terminology
and abbreviations will help users understand the various terms and
acronyms used in the manual and facilitate communication between
healthcare providers during CPR.
CPR: Cardiopulmonary resuscitation
AED: Automated external defibrillator
BLS: Basic life support
ALS: Advanced life support
EMS: Emergency medical services
PEA: Pulseless electrical activity
VF: Ventricular fibrillation
VT: Ventricular tachycardia
ROSC: Return of spontaneous circulation
ET tube: Endotracheal tube
ETT: Endotracheal intubation
NRB mask: Non-rebreather mask
Bag-valve-mask: A manual resuscitator device used to deliver
positive pressure ventilation during CPR
ACLS: Advanced cardiac life support
PALS: Paediatric advanced life support
CAB: Compressions, airway, breathing
CO
2
detector: A device that measures the level of carbon dioxide in
exhaled air, used to assess the effectiveness of CPR
ECG: Electrocardiogram
IO access: Intra osseous access, a method of administering fluids
and medications during CPR via a needle inserted into the bone
marrow
CPR feedback device: A device that provides real-time feedback
on the quality of chest compressions during CPR
Epinephrine: A medication used during CPR to stimulate the heart
and blood vessels

Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
Amiodarone: A medication used during CPR to treat certain types
of abnormal heart rhythms.
Atropine: A medication used during CPR to increase heart rate in
certain situations.
Vasopressin: A medication used during CPR to increase blood
pressure and blood flow to vital organs.

21. 17
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VIII. Appendices
A. Emergency Response Phone Numbers
Emergency response phone numbers, such as 999 or other local
emergency numbers, for quick reference in case of an emergency.
B. CPR Algorithms and Flowcharts
CPR algorithms and flowcharts are visual aids that can guide rescu-
ers in making critical decisions during resuscitation. The American
Heart Association and other organizations have developed standard-
ized algorithms and flowcharts that are used in CPR training and
practice. These resources typically outline the sequence of steps to
be taken during CPR, including assessments, interventions and
treatments. Some common CPR algorithms and flowcharts include:
i. Basic Life Support Algorithm: This algorithm outlines the basic
steps of CPR, including checking responsiveness, activating the
emergency response system, starting chest compressions and rescue
breaths and using an AED if available.
ii. Adult Cardiac Arrest Algorithm: This algorithm provides a
more detailed approach to CPR for adult patients in cardiac arrest,
including assessment of the patient's breathing and pulse,
performing high-quality CPR and using advanced airway
management techniques and medications as needed.
iii. Paediatric Cardiac Arrest Algorithm: This algorithm is
similar to the adult algorithm but is tailored to the unique needs of
paediatric patients, including age-appropriate CPR techniques,
recognition of respiratory and cardiac arrest and consideration of
underlying medical conditions.
iv. Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Algorithm: This algorithm is used specifically for patients in
cardiac arrest with these particular arrhythmias and includes steps
for de-fibrillation, advanced airway management and medication
administration.
v. Bradycardia Algorithm: This algorithm is used for patients with
a heart rate less than 60 beats per minute and includes steps for
identifying and treating the underlying cause of the bradycardia, as
well as medication administration and advanced airway
management as needed.
So, CPR algorithms and flowcharts can be useful tools for guiding
rescuers through the complex process of resuscitation, ensuring that
critical steps are not missed and increasing the likelihood of a
successful outcome.
C. Medication Dosages and Administration Guidelines
Medication administration during CPR should only be performed by
trained healthcare professionals with appropriate knowledge and
skills. The dosages and administration guidelines listed here are for
informational purposes only and should not be used as a substitute
for proper training and medical advice.
Epinephrine:
Dosage: 1 mg IV/IO every 3-5 minutes
Administration: Administer as soon as possible during CPR. May be
given via an endotracheal tube if IV/IO access is not available.
Amiodarone:
Dosage: 300 mg IV/IO push, followed by a second dose of 150 mg
IV/IO after 3-5 minutes if needed
Administration: Administer in patients with shock-refractory
ventricular fibrillation or pulseless ventricular tachycardia.
Vasopressin:
Dosage: 40 units IV/IO as a single dose
Administration: May be used as an alternative to the first or second
dose of epinephrine.
Lidocaine:
Dosage: 1-1.5 mg/kg IV/IO, followed by a maintenance infusion of
1-4 mg/min
Administration: Administer in patients with pulseless ventricular
tachycardia or ventricular fibrillation after de-fibrillation and
epinephrine have been given.
Atropine:
Dosage: 0.5 mg IV/IO every 3-5 minutes, up to a maximum dose of 3 mg
Administration: May be used in patients with symptomatic
bradycardia.
D. Glossary of Terms and Acronyms
A comprehensive glossary of common terms and acronyms used in
CPR, including medical terminology, CPR-specific terminology
and abbreviations will help users understand the various terms and
acronyms used in the manual and facilitate communication between
healthcare providers during CPR.
CPR: Cardiopulmonary resuscitation
AED: Automated external defibrillator
BLS: Basic life support
ALS: Advanced life support
EMS: Emergency medical services
PEA: Pulseless electrical activity
VF: Ventricular fibrillation
VT: Ventricular tachycardia
ROSC: Return of spontaneous circulation
ET tube: Endotracheal tube
ETT: Endotracheal intubation
NRB mask: Non-rebreather mask
Bag-valve-mask: A manual resuscitator device used to deliver
positive pressure ventilation during CPR
ACLS: Advanced cardiac life support
PALS: Paediatric advanced life support
CAB: Compressions, airway, breathing
CO
2
detector: A device that measures the level of carbon dioxide in
exhaled air, used to assess the effectiveness of CPR
ECG: Electrocardiogram
IO access: Intra osseous access, a method of administering fluids
and medications during CPR via a needle inserted into the bone
marrow
CPR feedback device: A device that provides real-time feedback
on the quality of chest compressions during CPR
Epinephrine: A medication used during CPR to stimulate the heart
and blood vessels

Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
Amiodarone: A medication used during CPR to treat certain types
of abnormal heart rhythms.
Atropine: A medication used during CPR to increase heart rate in
certain situations.
Vasopressin: A medication used during CPR to increase blood
pressure and blood flow to vital organs.

22. 18
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VIII. Appendices
A. Emergency Response Phone Numbers
Emergency response phone numbers, such as 999 or other local
emergency numbers, for quick reference in case of an emergency.
B. CPR Algorithms and Flowcharts
CPR algorithms and flowcharts are visual aids that can guide rescu-
ers in making critical decisions during resuscitation. The American
Heart Association and other organizations have developed standard-
ized algorithms and flowcharts that are used in CPR training and
practice. These resources typically outline the sequence of steps to
be taken during CPR, including assessments, interventions and
treatments. Some common CPR algorithms and flowcharts include:
i. Basic Life Support Algorithm: This algorithm outlines the basic
steps of CPR, including checking responsiveness, activating the
emergency response system, starting chest compressions and rescue
breaths and using an AED if available.
ii. Adult Cardiac Arrest Algorithm: This algorithm provides a
more detailed approach to CPR for adult patients in cardiac arrest,
including assessment of the patient's breathing and pulse,
performing high-quality CPR and using advanced airway
management techniques and medications as needed.
iii. Paediatric Cardiac Arrest Algorithm: This algorithm is
similar to the adult algorithm but is tailored to the unique needs of
paediatric patients, including age-appropriate CPR techniques,
recognition of respiratory and cardiac arrest and consideration of
underlying medical conditions.
iv. Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Algorithm: This algorithm is used specifically for patients in
cardiac arrest with these particular arrhythmias and includes steps
for de-fibrillation, advanced airway management and medication
administration.
v. Bradycardia Algorithm: This algorithm is used for patients with
a heart rate less than 60 beats per minute and includes steps for
identifying and treating the underlying cause of the bradycardia, as
well as medication administration and advanced airway
management as needed.
So, CPR algorithms and flowcharts can be useful tools for guiding
rescuers through the complex process of resuscitation, ensuring that
critical steps are not missed and increasing the likelihood of a
successful outcome.
C. Medication Dosages and Administration Guidelines
Medication administration during CPR should only be performed by
trained healthcare professionals with appropriate knowledge and
skills. The dosages and administration guidelines listed here are for
informational purposes only and should not be used as a substitute
for proper training and medical advice.
Epinephrine:
Dosage: 1 mg IV/IO every 3-5 minutes
Administration: Administer as soon as possible during CPR. May be
given via an endotracheal tube if IV/IO access is not available.
Amiodarone:
Dosage: 300 mg IV/IO push, followed by a second dose of 150 mg
IV/IO after 3-5 minutes if needed
Administration: Administer in patients with shock-refractory
ventricular fibrillation or pulseless ventricular tachycardia.
Vasopressin:
Dosage: 40 units IV/IO as a single dose
Administration: May be used as an alternative to the first or second
dose of epinephrine.
Lidocaine:
Dosage: 1-1.5 mg/kg IV/IO, followed by a maintenance infusion of
1-4 mg/min
Administration: Administer in patients with pulseless ventricular
tachycardia or ventricular fibrillation after de-fibrillation and
epinephrine have been given.
Atropine:
Dosage: 0.5 mg IV/IO every 3-5 minutes, up to a maximum dose of 3 mg
Administration: May be used in patients with symptomatic
bradycardia.
D. Glossary of Terms and Acronyms
A comprehensive glossary of common terms and acronyms used in
CPR, including medical terminology, CPR-specific terminology
and abbreviations will help users understand the various terms and
acronyms used in the manual and facilitate communication between
healthcare providers during CPR.
CPR: Cardiopulmonary resuscitation
AED: Automated external defibrillator
BLS: Basic life support
ALS: Advanced life support
EMS: Emergency medical services
PEA: Pulseless electrical activity
VF: Ventricular fibrillation
VT: Ventricular tachycardia
ROSC: Return of spontaneous circulation
ET tube: Endotracheal tube
ETT: Endotracheal intubation
NRB mask: Non-rebreather mask
Bag-valve-mask: A manual resuscitator device used to deliver
positive pressure ventilation during CPR
ACLS: Advanced cardiac life support
PALS: Paediatric advanced life support
CAB: Compressions, airway, breathing
CO
2
detector: A device that measures the level of carbon dioxide in
exhaled air, used to assess the effectiveness of CPR
ECG: Electrocardiogram
IO access: Intra osseous access, a method of administering fluids
and medications during CPR via a needle inserted into the bone
marrow
CPR feedback device: A device that provides real-time feedback
on the quality of chest compressions during CPR
Epinephrine: A medication used during CPR to stimulate the heart
and blood vessels

Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
Amiodarone: A medication used during CPR to treat certain types
of abnormal heart rhythms.
Atropine: A medication used during CPR to increase heart rate in
certain situations.
Vasopressin: A medication used during CPR to increase blood
pressure and blood flow to vital organs.

23. 19
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VIII. Appendices
A. Emergency Response Phone Numbers
Emergency response phone numbers, such as 999 or other local
emergency numbers, for quick reference in case of an emergency.
B. CPR Algorithms and Flowcharts
CPR algorithms and flowcharts are visual aids that can guide rescu-
ers in making critical decisions during resuscitation. The American
Heart Association and other organizations have developed standard-
ized algorithms and flowcharts that are used in CPR training and
practice. These resources typically outline the sequence of steps to
be taken during CPR, including assessments, interventions and
treatments. Some common CPR algorithms and flowcharts include:
i. Basic Life Support Algorithm: This algorithm outlines the basic
steps of CPR, including checking responsiveness, activating the
emergency response system, starting chest compressions and rescue
breaths and using an AED if available.
ii. Adult Cardiac Arrest Algorithm: This algorithm provides a
more detailed approach to CPR for adult patients in cardiac arrest,
including assessment of the patient's breathing and pulse,
performing high-quality CPR and using advanced airway
management techniques and medications as needed.
iii. Paediatric Cardiac Arrest Algorithm: This algorithm is
similar to the adult algorithm but is tailored to the unique needs of
paediatric patients, including age-appropriate CPR techniques,
recognition of respiratory and cardiac arrest and consideration of
underlying medical conditions.
iv. Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Algorithm: This algorithm is used specifically for patients in
cardiac arrest with these particular arrhythmias and includes steps
for de-fibrillation, advanced airway management and medication
administration.
v. Bradycardia Algorithm: This algorithm is used for patients with
a heart rate less than 60 beats per minute and includes steps for
identifying and treating the underlying cause of the bradycardia, as
well as medication administration and advanced airway
management as needed.
So, CPR algorithms and flowcharts can be useful tools for guiding
rescuers through the complex process of resuscitation, ensuring that
critical steps are not missed and increasing the likelihood of a
successful outcome.
C. Medication Dosages and Administration Guidelines
Medication administration during CPR should only be performed by
trained healthcare professionals with appropriate knowledge and
skills. The dosages and administration guidelines listed here are for
informational purposes only and should not be used as a substitute
for proper training and medical advice.
Epinephrine:
Dosage: 1 mg IV/IO every 3-5 minutes
Administration: Administer as soon as possible during CPR. May be
given via an endotracheal tube if IV/IO access is not available.
Amiodarone:
Dosage: 300 mg IV/IO push, followed by a second dose of 150 mg
IV/IO after 3-5 minutes if needed
Administration: Administer in patients with shock-refractory
ventricular fibrillation or pulseless ventricular tachycardia.
Vasopressin:
Dosage: 40 units IV/IO as a single dose
Administration: May be used as an alternative to the first or second
dose of epinephrine.
Lidocaine:
Dosage: 1-1.5 mg/kg IV/IO, followed by a maintenance infusion of
1-4 mg/min
Administration: Administer in patients with pulseless ventricular
tachycardia or ventricular fibrillation after de-fibrillation and
epinephrine have been given.
Atropine:
Dosage: 0.5 mg IV/IO every 3-5 minutes, up to a maximum dose of 3 mg
Administration: May be used in patients with symptomatic
bradycardia.
D. Glossary of Terms and Acronyms
A comprehensive glossary of common terms and acronyms used in
CPR, including medical terminology, CPR-specific terminology
and abbreviations will help users understand the various terms and
acronyms used in the manual and facilitate communication between
healthcare providers during CPR.
CPR: Cardiopulmonary resuscitation
AED: Automated external defibrillator
BLS: Basic life support
ALS: Advanced life support
EMS: Emergency medical services
PEA: Pulseless electrical activity
VF: Ventricular fibrillation
VT: Ventricular tachycardia
ROSC: Return of spontaneous circulation
ET tube: Endotracheal tube
ETT: Endotracheal intubation
NRB mask: Non-rebreather mask
Bag-valve-mask: A manual resuscitator device used to deliver
positive pressure ventilation during CPR
ACLS: Advanced cardiac life support
PALS: Paediatric advanced life support
CAB: Compressions, airway, breathing
CO
2
detector: A device that measures the level of carbon dioxide in
exhaled air, used to assess the effectiveness of CPR
ECG: Electrocardiogram
IO access: Intra osseous access, a method of administering fluids
and medications during CPR via a needle inserted into the bone
marrow
CPR feedback device: A device that provides real-time feedback
on the quality of chest compressions during CPR
Epinephrine: A medication used during CPR to stimulate the heart
and blood vessels
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
Amiodarone: A medication used during CPR to treat certain types
of abnormal heart rhythms.
Atropine: A medication used during CPR to increase heart rate in
certain situations.
Vasopressin: A medication used during CPR to increase blood
pressure and blood flow to vital organs.

24. 20
VI. Special Considerations in CPR
A. CPR in special populations:
i. Infants and children: CPR techniques for infants and children
differ from those used for adults due to differences in anatomy and
physiology.
In this section, the key differences in CPR techniques for infants and
children, including proper compression depth and rate and the use of
automated external defibrillators (AEDs) will be discussed.
Compression Depth and Rate:
The depth and rate of compressions in CPR for infants and children are
different than those for adults. For infants, the compression depth should
be about 1.5 inches (4 cm) and the compression rate should be about 100
to 120 compressions per minute. For children, the compression depth
should be about 2 inches (5 cm) and the compression rate should also be
about 100 to 120 compressions per minute.
Rescue Breathing:
In infants, rescue breathing should be administered by covering both
the mouth and nose of the infant with your mouth and blowing a
gentle breath until the chest rises. For children, rescue breathing
should be administered by covering the child's mouth with your
mouth and sealing it then blowing enough air to make the chest rise.
Use of AEDs:
AEDs are used for children over one year of age who have suffered
sudden cardiac arrest. Paediatric AED pads are used and the AED will
adjust the energy level based on the child's weight. If a Paediatric AED
is not available, an adult AED can be used, but the pads should be
placed on the child's chest and back rather than the chest and abdomen.
It is important to note that CPR for infants and children should only be
performed by those who have received proper training and certification
in Paediatric CPR. The American Heart Association and other
organizations provide training courses specifically for Paediatric CPR.
ii. Pregnant women: Performing CPR on a pregnant woman
requires certain modifications to the standard techniques to ensure
the safety of both the mother and the fetus. The main modification
involves using manual left uterine displacement to prevent
aortocaval compression, which can reduce blood flow to the heart
and brain of the mother and the fetus.
To perform manual left uterine displacement during CPR, follow
these steps:
 Position the woman on a flat surface with a tilt of about 30
degrees to the left side.
 Place your left hand under the woman's left hip, with your
fingers pointing towards her head.
 Use your left hand to push the woman's uterus to the left side of
her abdomen, while at the same time lifting her left hip slightly
off the surface.

Use your right hand to perform chest compressions as usual, being
careful to maintain the tilt of the woman's body to the left side.
 In addition to using manual left uterine displacement, other
modifications to CPR techniques for pregnant women may
include adjusting the compression depth and rate and
positioning the woman's head to avoid obstructing the airway.
 The recommended compression depth for pregnant women is
around 4 cm or 1.5 inches, which is shallower than the 5-6 cm
depth recommended for non-pregnant adults. The compression
rate should be around 100-120 compressions per minute, which
is the same as for non-pregnant adults.
 When using an AED on a pregnant woman, it is important to
position the pads appropriately to avoid placing one of them
over the woman's abdomen. The pads should be placed in the
standard position for adults, but care should be taken to ensure
that the pad on the woman's right side is placed high on the chest
and the pad on the left side is placed below the left breast.
So, performing CPR on a pregnant woman requires certain
modifications to ensure the safety of both the mother and the fetus.
These modifications include using manual left uterine displacement,
adjusting the compression depth and rate and positioning the AED pads
appropriately. Healthcare providers and first responders should receive
appropriate training to perform CPR on pregnant women effectively.
Older adults: Performing CPR on older adults requires
consideration of their unique characteristics, including increased
risk of underlying comorbidities and frailty.
1. Underlying comorbidities: Older adults commonly have
multiple chronic conditions such as heart disease, diabetes and
respiratory disorders. These comorbidities can affect the
effectiveness of CPR and increase the risk of complications.
2. Frailty: Frail older adults may have reduced physiological
reserve, making them more vulnerable to the stresses of CPR.
Frailty can affect the quality of chest compressions, ventilation and
response to resuscitation efforts.
3. Chest compressions: Due to changes in the aging chest wall and
rib stiffness, older adults may require additional force during chest
compressions. However, caution should be exercised to prevent rib
fractures or damage to fragile structures.
4. Medications: Older adults often take multiple medications, some
of which may interact with CPR interventions or influence the
underlying cardiac arrest. Awareness of the medications they are
taking is crucial to provide appropriate care.
5. Personalized approach: Considering an individual's functional
status, overall health and advance care preferences is vital in
determining the appropriateness and goals of CPR. The
decision-making process may involve discussions with the patient,
their family and healthcare professionals.
6. Post-resuscitation care: Older adults who survive cardiac arrest
may require specialized post-resuscitation care, including
addressing the underlying cause, managing comorbidities and
providing rehabilitation to optimize their recovery.
So, performing CPR on older adults requires a tailored approach
that considers their unique physiological, medical and functional
characteristics. Effective communication, shared decision-making
and careful consideration of their overall health status are crucial in
providing appropriate and compassionate care.
B. CPR in special settings:
iii. In-hospital CPR:
 Cardiopulmonary resuscitation (CPR) is performed in two
primary settings: in-hospital and out-of-hospital.
 In-hospital CPR is performed in medical facilities while
out-of-hospital CPR is performed in non-medical settings.
 The role of the healthcare team is a significant difference
between in-hospital and out-of-hospital CPR.
 In a hospital setting, the healthcare team, including physicians,
nurses and other medical professionals, are typically available to
perform CPR and provide advanced life support.
 Out-of-hospital CPR is often performed by laypersons who may
have limited training in CPR and emergency medical care.

Another significant difference is the availability of specialized equipment.
 Healthcare providers in a hospital setting have access to
advanced monitoring techniques and specialized equipment,
such as defibrillators, that can improve outcomes during CPR.
 Out-of-hospital CPR may not have immediate access to
specialized equipment or advanced monitoring techniques and
providers must rely on basic life support techniques.
 In-hospital CPR often follows a more systematic approach while
out-of-hospital CPR may require improvisation and adaptation
based on the situation at hand.
 The layperson may need to take on multiple roles during
out-of-hospital CPR, including providing CPR, calling for
emergency services and coordinating with the healthcare team.
 Healthcare providers must be trained to perform CPR in both
in-hospital and out-of-hospital settings and be prepared to adapt
their techniques based on the available resources and the
specific needs of the patient.
iv. Out-of-hospital CPR: Performing CPR in a non-hospital
setting, such as a public place, home, or during transportation,
presents unique challenges that require specific training and
preparation. These challenges include:
The need for bystander CPR: In many cases, the first person on the
scene of a cardiac arrest is a bystander without medical training. These
individuals must recognize the signs of cardiac arrest, call for emergency
services and initiate CPR until advanced medical help arrives.
The use of automated external defibrillators (AEDs): Bystanders
may be hesitant to use AEDs due to fear or lack of training.
Providing AED training to the general public and increasing public
awareness of AEDs can improve outcomes in out-of-hospital CPR.
Potential delays in emergency medical services response time:
EMS may have to navigate traffic or challenging terrain to reach the
patient, which can cause delays in providing advanced medical care.
Delayed CPR or de-fibrillation can decrease the chances of survival.
Therefore, bystander CPR and the use of AEDs can help bridge the
gap until advanced medical care arrives.
Environmental factors: Adverse weather conditions, the presence
of hazardous materials and difficult access to the patient can all pose
challenges in performing CPR. Bystanders must be trained to adapt
their techniques to address these challenges, such as moving the
patient to a safer location or protecting themselves from
environmental hazards.
Healthcare providers must be trained to adapt their techniques to
address these unique challenges in non-hospital CPR. Bystander
CPR and the use of AEDs are critical components of out-of-hospital
CPR and can improve outcomes until advanced medical help
arrives. Public education and awareness can help overcome barriers
to the use of AEDs and increase the number of bystanders willing
and able to provide CPR in non-hospital settings.
C. CPR during a pandemic:
 CPR during a pandemic poses an increased risk of transmission
of infectious diseases, including COVID-19, as cardiac arrest
patients may be asymptomatic carriers of the virus.
 Healthcare providers performing CPR are at higher risk of
exposure to the virus, making it crucial to follow infection
control measures to prevent the spread of disease.
 The American Heart Association and the CDC have provided
recommendations for modifications to CPR techniques during a
pandemic, including reducing the number of healthcare
providers present, wearing appropriate PPE and minimizing
interruptions during chest compressions.

Proper use of PPE is crucial during CPR in a pandemic setting to
reduce the risk of exposure to infectious agents, including gloves,
gowns, masks and eye protection. N95 respirators may be necessary
in high-risk situations involving aerosol-generating procedures.
VIII. Appendices
A. Emergency Response Phone Numbers
Emergency response phone numbers, such as 999 or other local
emergency numbers, for quick reference in case of an emergency.
B. CPR Algorithms and Flowcharts
CPR algorithms and flowcharts are visual aids that can guide rescu-
ers in making critical decisions during resuscitation. The American
Heart Association and other organizations have developed standard-
ized algorithms and flowcharts that are used in CPR training and
practice. These resources typically outline the sequence of steps to
be taken during CPR, including assessments, interventions and
treatments. Some common CPR algorithms and flowcharts include:
i. Basic Life Support Algorithm: This algorithm outlines the basic
steps of CPR, including checking responsiveness, activating the
emergency response system, starting chest compressions and rescue
breaths and using an AED if available.
ii. Adult Cardiac Arrest Algorithm: This algorithm provides a
more detailed approach to CPR for adult patients in cardiac arrest,
including assessment of the patient's breathing and pulse,
performing high-quality CPR and using advanced airway
management techniques and medications as needed.
iii. Paediatric Cardiac Arrest Algorithm: This algorithm is
similar to the adult algorithm but is tailored to the unique needs of
paediatric patients, including age-appropriate CPR techniques,
recognition of respiratory and cardiac arrest and consideration of
underlying medical conditions.
iv. Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Algorithm: This algorithm is used specifically for patients in
cardiac arrest with these particular arrhythmias and includes steps
for de-fibrillation, advanced airway management and medication
administration.
v. Bradycardia Algorithm: This algorithm is used for patients with
a heart rate less than 60 beats per minute and includes steps for
identifying and treating the underlying cause of the bradycardia, as
well as medication administration and advanced airway
management as needed.
So, CPR algorithms and flowcharts can be useful tools for guiding
rescuers through the complex process of resuscitation, ensuring that
critical steps are not missed and increasing the likelihood of a
successful outcome.
C. Medication Dosages and Administration Guidelines
Medication administration during CPR should only be performed by
trained healthcare professionals with appropriate knowledge and
skills. The dosages and administration guidelines listed here are for
informational purposes only and should not be used as a substitute
for proper training and medical advice.
Epinephrine:
Dosage: 1 mg IV/IO every 3-5 minutes
Administration: Administer as soon as possible during CPR. May be
given via an endotracheal tube if IV/IO access is not available.
Amiodarone:
Dosage: 300 mg IV/IO push, followed by a second dose of 150 mg
IV/IO after 3-5 minutes if needed
Administration: Administer in patients with shock-refractory
ventricular fibrillation or pulseless ventricular tachycardia.
Vasopressin:
Dosage: 40 units IV/IO as a single dose
Administration: May be used as an alternative to the first or second
dose of epinephrine.
Lidocaine:
Dosage: 1-1.5 mg/kg IV/IO, followed by a maintenance infusion of
1-4 mg/min
Administration: Administer in patients with pulseless ventricular
tachycardia or ventricular fibrillation after de-fibrillation and
epinephrine have been given.
Atropine:
Dosage: 0.5 mg IV/IO every 3-5 minutes, up to a maximum dose of 3 mg
Administration: May be used in patients with symptomatic
bradycardia.
D. Glossary of Terms and Acronyms
A comprehensive glossary of common terms and acronyms used in
CPR, including medical terminology, CPR-specific terminology
and abbreviations will help users understand the various terms and
acronyms used in the manual and facilitate communication between
healthcare providers during CPR.
CPR: Cardiopulmonary resuscitation
AED: Automated external defibrillator
BLS: Basic life support
ALS: Advanced life support
EMS: Emergency medical services
PEA: Pulseless electrical activity
VF: Ventricular fibrillation
VT: Ventricular tachycardia
ROSC: Return of spontaneous circulation
ET tube: Endotracheal tube
ETT: Endotracheal intubation
NRB mask: Non-rebreather mask
Bag-valve-mask: A manual resuscitator device used to deliver
positive pressure ventilation during CPR
ACLS: Advanced cardiac life support
PALS: Paediatric advanced life support
CAB: Compressions, airway, breathing
CO
2
detector: A device that measures the level of carbon dioxide in
exhaled air, used to assess the effectiveness of CPR
ECG: Electrocardiogram
IO access: Intra osseous access, a method of administering fluids
and medications during CPR via a needle inserted into the bone
marrow
CPR feedback device: A device that provides real-time feedback
on the quality of chest compressions during CPR
Epinephrine: A medication used during CPR to stimulate the heart
and blood vessels
“The ultimate life skill: knowing how to perform CPR.”
 Other infection control measures during CPR in a pandemic setting
include frequent hand hygiene, decontamination of equipment and
surfaces and proper disposal of biohazardous waste.
 Providers should also use caution when performing airway
management and suctioning as these procedures can generate aerosols
that may increase the risk of transmission of infectious agents.
 Healthcare providers must be trained to follow proper infection
control procedures and adapt their techniques to reduce the risk of
transmission of infectious diseases during CPR in a pandemic setting.
 Following these recommendations can help ensure the safety of
healthcare providers and reduce the spread of infectious diseases
during CPR and other healthcare interventions.
Amiodarone: A medication used during CPR to treat certain types
of abnormal heart rhythms.
Atropine: A medication used during CPR to increase heart rate in
certain situations.
Vasopressin: A medication used during CPR to increase blood
pressure and blood flow to vital organs.

25. 21
Bibliography
1. American Heart Association. (2015). Basic Life Support (BLS).
https://cpr.heart.org/en/cpr-courses-and-kits/healthcare-pro-
fessional/basic-life-support-bls
2. European Resuscitation Council. (2021). Guidelines for Resuscitation 2021.
https://cprguidelines.eu/
3. Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R.,
Bhanji, F., Abella, B. S., Kleinman, M. E., Edelson, D. P., Berg, R. A., &
Aufderheide, T. P. (2013). Cardiopulmonary resuscitation quality: [corrected]
improving cardiac resuscitation outcomes both inside and outside the hospi-
tal: a consensus statement from the American Heart Association. Circulation,
128(4), 417–435. https://doi.org/10.1161/CIR.0b013e31829d8654
4. Neumar, R. W., Otto, C. W., Link, M. S., Kronick, S. L., Shuster, M., Calla-
way, C. W., Kudenchuk, P. J., Ornato, J. P., McNally, B., Silvers, S. M.,
Passman, R. S., White, R. D., Hess, E. P., Tang, W., Davis, D., Sinz, E.,
Morrison, L. J., & Executive summary: 2015 American Heart Association
guidelines update for cardiopulmonary resuscitation and emergency cardio-
vascular care. Circulation, 132(18 Suppl 2), S315-67. https://-
doi.org/10.1161/CIR.0000000000000259
“CPR: One skill that can change everything.”

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27. About the Author
Professor Dr. Md. Toufiqur Rahman was born
in Chuadanga, Bangladesh. He completed his
secondary and higher secondary education
from Ideal School, Motijheel and Notre Dame
College, Dhaka respectively. Dr. Rahman
then went on to pursue his MBBS degree from
Dhaka Medical College in 1997. He excelled
in his studies and was recognized as one of the
top performers in his class.
Following the completion of his MBBS,
Dr. Rahman underwent training and
academic attachments at several institutions.
He obtained FCPS degree in Internal Medicine in 2003. He also
completed his MD degree in Cardiology at the NICVD, Dhaka,
where he went on to serve as an Assistant Registrar, Assistant
Professor, Associate Professor and eventually, Professor of
Cardiology. He worked in this capacity until March 2018 when he
joined Colonel Malek Medical College in Manikganj as the
Professor and Head of Cardiology. He has since been instrumental
in establishing the department of cardiology at the college and has
played a key role in training young doctors in the field of cardiology.
Dr. Rahman has a long list of qualifications and fellowships,
including FACC, FESC, FAPSC, FAPSIC, FAHA, FRCPE,
FRCPG, FSCAI, FCCP, FACP and FASE. He has also served as the
Editorial Associate of Cardiovascular Journal.
Throughout his career, Dr. Rahman has been involved in various
teaching activities in different medical colleges and post graduate
institutions. He has published numerous research papers in both
national and international journals and has presented at many
conferences and workshops. He is considered an authority in the
field of cardiology and is often invited to deliver lectures and
presentations at medical conferences and symposiums.
Apart from his professional achievements, Dr. Rahman is also
known for his philanthropic work. He is actively involved in various
social initiatives and has played a key role in organizing medical
camps in rural areas.In recognition of his contributions to the field
of medicine, Dr. Rahman has received several awards and
accolades. He continues to inspire and mentor young doctors and is
regarded as a role model by many in the medical fraternity.
23

28. Books are available at:
Medinova Medical Services Ltd. Malibag Branch
Popular Diagnostic Centre, Unit-2, Shantinagar, Dhaka
Rokomari.com
Mobile: [phone]
Available books of same author
From Heartbeat to Healing:
A Comprehensive guide to
Cardiac Rehabilitation
Prof. Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head of The Department of Cardiology
Colonel Maleque Medical College, Manikganj.
E-mail: [email protected]; [email protected]
From Stress to Success:
A Guide to Hypertension
Management
Prof. Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head of The Department of Cardiology
Colonel Maleque Medical College, Manikganj.
E-mail: [email protected]; [email protected]
Breaking the Silence:
Understanding and Coping with
Peripartum Cardiomyopathy
Prof. Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head of The Department of Cardiology
Colonel Maleque Medical College, Manikganj.
E-mail: [email protected]; [email protected]
Visualizing the Heart: A
Comprehensive Guide to Diagnostic
Tests and Imaging Modalities in
Cardiovascular Medicine
Prof. Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head of The Department of Cardiology
Colonel Maleque Medical College, Manikganj.
E-mail: [email protected]; [email protected]