Basic life support (BLS) in adults
- Charles N Pozner, MD
Charles N Pozner, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Richard L Page, MD
Richard L Page, MD
- Section Editor — Cardiac Arrhythmias
- Chair, Department of Medicine
- University of Wisconsin, School of Medicine and Public Health
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Cardiopulmonary resuscitation (CPR) as we recognize it today was developed in the late 1950s and 1960s. Elam and Safar described the technique and benefits of mouth-to-mouth ventilation in 1958 . Kouwenhoven, Knickerbocker, and Jude subsequently described the benefits of external chest compressions , which in combination with mouth-to-mouth ventilation form the basis of modern CPR. External defibrillation, first described in 1957 by Kouwenhoven , has since been incorporated into resuscitation guidelines.
Basic life support consists of cardiopulmonary resuscitation and, when available, defibrillation using automated external defibrillators (AED). The keys to survival from sudden cardiac arrest (SCA) are early recognition and treatment, specifically, immediate initiation of excellent CPR and early defibrillation.
This topic review will discuss the critical facets of basic life support in adults for clinicians as presented in the American Heart Association's 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, and the update of these guidelines published in 2015 [4-6]. Advanced cardiac life support (ACLS) and other related topics, such as airway management and basic life support for infants and children, are presented separately. (See "Advanced cardiac life support (ACLS) in adults" and "Basic airway management in adults" and "Pediatric basic life support for health care providers".)
EPIDEMIOLOGY AND SURVIVAL
The exact incidence of sudden cardiac arrest (SCA) in the United States is unknown, but estimates vary from 180,000 to over 450,000 [7,8]. In North America and Europe, the estimated incidence falls between 50 to 100 per 100,000 in the general population . The most common etiology of SCA is ischemic cardiovascular disease resulting in the development of lethal arrhythmias. Resuscitation is attempted in up to two-thirds of people who sustain SCA.
Despite the development of cardiopulmonary resuscitation (CPR), electrical defibrillation, and other advanced resuscitative techniques over the past 50 years, survival rates for SCA remain low. The epidemiology and etiology of SCA are discussed in greater detail separately. (See "Overview of sudden cardiac arrest and sudden cardiac death" and "Pathophysiology and etiology of sudden cardiac arrest".)
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- EPIDEMIOLOGY AND SURVIVAL
- RESUSCITATION GUIDELINES
- Phases of resuscitation
- - Electrical phase
- - Hemodynamic phase
- - Metabolic phase
- Recognition of cardiac arrest
- Chest compressions
- - Performance of excellent chest compressions
- - Minimizing interruptions
- - Compression-only CPR (CO-CPR)
- Pulse checks and rhythm analysis
- SUMMARY AND RECOMMENDATIONS