EUROS 20: How prompt CPR saved Christian Erikson Life: What is CPR? When and How is it Performed?

Good morning and a Happy New Month to everyone.

The Euro 20 has really been exciting and unpredictable with the unexpected elimination of all members of the Group of Death (Group F) - title holders Portugal, last year finalists France and Germany amongst other moments.

This is sequel to my earlier post EUROS 20: Learning from how prompt CPR (Cardiopulmonary Resuscitation) saved Christian Erikson Life.

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The Inter Milan midfielder was given CPR on the pitch during Denmark's Euro 2020 match against Finland but what is it, how did it save his life and how should you behave if you find yourself in an emergency?

What is CPR?

CPR is a shortened form for Cardiopulmonary Resuscitation, and it is an emergency technique done to combine artificial ventilation and chest compressions in order to perfuse vital organs or restore circulation in cardiac standstill.

What is a Cardiac Arrest?

Christian Erikson was said to have had a cardiac arrest so what is it?

The heart receives and pumps blood to the entire body - that is its basic function.
A cardiac arrest is simply the sudden stoppage of spontaneous and effective heart function - to pump blood.

NB: Cardiac arrest isn't the same as a heart attack - which is when blood flow to a part of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.

The Goal of Cardiopulmonary Resuscitation?

The goal is to maintain oxygen delivery to vital organs to preserve function and brain viability.

Three minutes after the onset of cardiac arrest, a lack of blood flow starts to damage the brain, and 10 minutes after, the chances of survival are low. Therefore, bystanders have only a few minutes to act to optimize a victim’s chances of survival and recovery.

The Chain Of Survival

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The “Chain of Survival” refers to the chain of events that must occur in rapid succession to maximize the chances of survival from sudden cardiac arrest (SCA).

It shows that each link is critical and interdependent, and that the chain of survival is only as strong as its weakest link, like any chain.

Bystanders can help save lives by addressing the first four links in the Chain of Survival.

Recognizing the Signs of Sudden Cardiac Arrest (SCA):

Signs of sudden cardiac arrest are sudden and drastic and include:
A Sudden collapse, Absent pulse, No breathing, Unconsciousness.

Sometimes some signs may occur before sudden cardiac arrest. These might include: Chest discomfort, Shortness of breath, Weakness, Palpitations (Fast-beating, fluttering or pounding heart).

But in vast majority of cases it occurs with no warning.

Call 911 (or your National Emergency Service Number):

If you recognize an impending cardiac arrest or witness the cardiac arrest and have immediate access to a telephone, call before beginning CPR.

Start CPR.

In order to perform CPR, the DR. CAB guideline should be applied:
DR. CAB means an Assessment of Danger, Responsiveness, Circulation, Airway, Breathing.

1. Danger Assessment:

This intends to eliminate or minimize risk to the rescuer. So the bystander rescuer should be beware of any environmental danger (such as traffic, electricity, gas), any corrosive chemicals around, Infections that may be present such as Tuberculosis and HIV and should aim to practice universal precautions.

2. Responsiveness:

You can assess responsiveness of the patient by Shaking and Shouting.
Since CPR is only performed if the adult is not breathing, and their blood is not circulating that is why it is important to ensure that the person does not respond to verbal or physical calls to attention before starting the CPR process.

If the victim is unresponsive, Shout for help and move to the next step.

3. Assess Circulation:

Check the Central pulses - The Carotid Pulse (which may be felt on either side of the front of the neck just below the angle of the jaw) and the Femoral Pulse (in the inner thigh) and this should take less than 10 seconds.

If Circulation is absent, Immediately start Chest compressions.

How to perform Chest Compressions:

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a) Place the heel of one hand in the center of the chest
b) Place other hand on top
c) Interlock fingers
d) Compress the chest [Chest Compressions should be done at a rate of 100-120 per minute with a compression depth of 4-5 cm. The force of compression should be equal to the relaxation.]
e) When possible, change CPR operator every 2 min to avoid fatigue and maintain quality of compressions.

In order to get the right amount of chest compressions per minute, you can learn the song Stayin' Alive by the Bee Gees.

I'm no Bruno Mars, but you can watch me sing it here in my previous post "Stayin' Alive" (instrumental cover) by @davidjossy

4. Assessing and opening the Airway

Open their mouth and check for any obstruction, such as food or vomit. Remove any obstruction if it is loose. If it is not loose, trying to grasp it may push it farther into the airway.

Removal is done by a Finger-Sweep using the index finger. It's discouraged to do a blind finger sweep, so you should see whatever you would want to remove before performing a finger sweep.

Place the victim carefully on his/her back and kneel beside his/her chest. Tilt their head back slightly by lifting their chin (Head-tilt/Chin-lift),

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or in victims who are suspected to have some damage to their cervical spine the Jaw-thrust method is used - where you use your index and middle fingers to physically push the back aspect of their Jaw upwards while your thumbs push down on the chin to open the mouth.


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These techniques focuses on preventing the tongue from falling back and obstructing the airways.

5. Assess and Ensure Breathing:

In assessment of breathing,
a) Look for chest movement.
b) Listen for breath sounds.
c) Feel for expired air.

This is done by placing your ear over victim's mouth so breathing can be heard and felt while also looking for rising chest or abdomen which indicates breathing.

Assess for 10 seconds before deciding breathing is absent.

If breathing is absent, then begin Rescue breathing (Expired air ventilation) which contains about 16-17% oxygen.

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Its done by:

Maintaining Head-tilt/chin-lift position
Occluding the victim's nose
Taking a deep breath
Ensuring a good mouth-to-mouth seal.
Blowing steadily for 1 secs into victim's mouth
Watch for Chest rising,
Still maintaining chin lift, remove mouth and watch the chest fall.

For every 30 compressions, 2 breaths should be given and they should be about 1 second apart.

Use of Automated External Defibrillators (AED):

An AED is a light, battery-operated, portable device that checks the heart's rhythm and sends a shock to the heart to restore a normal rhythm. This is essential in restarting a heart that has stopped functioning.
They are very easy to use as in most cases you just required to follow the voice instructions.

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NB: Resuscitation should be continued until one of the three occurs:
Qualified help arrives and takes over
The victim shows signs of life
You are exhausted

If the victim shows signs of life then he/she should be placed in the recovery position as shown below:

Tilt head backwards, ensure clear airway and straighten head and neck
Place arm at side and other arm against chest with hand on cheek
Bring far knee up to 90 degree angle
Roll victim over toward you with knee at angle and ensure head is supported.

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To conclude, just like Christian Erikson survived a heart attack through quick and focused actions by his teammates and the healthcare team, so likewise we can all play a part in ensuring the survival of victims who have a cardiac arrest by informing emergency services immediately and performing prompt CPR.

This will go a very long way in saving lives and it should be encouraged and taught everywhere.

Thanks for reading through
and a Happy New Month once again!

CC:
@njaywan
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