Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Basic life support (BLS) in adults

INTRODUCTION

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 [1]. Kouwenhoven, Knickerbocker, and Jude subsequently described the benefits of external chest compressions [2], which in combination with mouth-to-mouth ventilation forms the basis of modern CPR. External defibrillation, first described in 1957 by Kouwenhoven [3], 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 are early recognition and early treatment, specifically, immediate initiation of high quality CPR and early defibrillation [4].

This topic review will discuss critical facets of basic life support in adults as presented in the American Heart Association's 2005 guidelines for basic life support. Advanced cardiac life support, 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 "Overview of basic life support in infants and children".)

EPIDEMIOLOGY AND SURVIVAL

Sudden cardiac arrest (SCA) is the second leading cause of death in both the United States and Canada [4-6], outranked only by cancer. Four hundred thousand to 460,000 people in the United States [7,8] and 700,000 people in Europe [9,10], suffer SCA each year. The most common etiology of SCA is ischemic cardiovascular disease resulting in the development of lethal arrhythmias [11-13]. Although resuscitation is attempted in up to two-thirds of people who sustain SCR, survival rates remain low, despite the development over the past 50 years of cardiopulmonary resuscitation (CPR), electrical defibrillation, and other advanced resuscitative techniques [14-17].

Assessments of survival from SCA have reached widely disparate conclusions. In the out-of-hospital setting, studies have reported survival rates of 1 to 6 percent [18-20]. Three systematic reviews of survival-to-hospital discharge from out-of-hospital SCA reported 5 to 10 percent survival among those treated by emergency medical services (EMS) and 15 percent survival when the underlying rhythm disturbance was ventricular fibrillation (VF) [20-22]. An analysis of a national registry of in-hospital SCA reported a 17 percent survival to discharge [20].
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Safar, P, Escarraga, LA, Elam, JO. A comparison of the mouth-to-mouth and mouth-to-airway methods of artificial respiration with the chest-pressure arm-lift methods. N Engl J Med 1958; 258:671.
  2. Kouwenhoven, WB, Jude, JR, Knickerbocker, GG. Closed-chest cardiac massage. JAMA 1960;173:1064.
  3. Kouwenhoven, WB, Milnor, WR, Knickerbocker, GG, Chestnut, WR. Closed chest defibrillation of the heart. Surgery 1957; 42:550.
  4. Vaillancourt, C, Stiell, IG. Cardiac arrest care and emergency medical services in Canada. Can J Cardiol 2004; 20:1081.
  5. Zheng, ZJ, Croft, JB, Giles, WH, Mensah, GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001; 104:2158.
  6. Chugh, SS, Jui, J, Gunson, K, et al. Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large US community. J Am Coll Cardiol 2004; 44:1268.
  7. American Heart Association. Heart Disease and Stroke Statistics- 2005 Update, American Heart Association, Dallas, TX 2004.
  8. Ballew, KA, Philbrick, JT. Causes of variation in reported in-hospital CPR survival: a critical review. Resuscitation 1995; 30:203.
  9. Sans, S, Kesteloot, H, Kromhout, D. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 1997; 18:1231.
  10. State-specific mortality from sudden cardiac death- United States, 1999. MMWR Morb Mortal Wkly Rep 2002; 51:123.
  11. Reichenbach, DD, Moss, NS, Meyer, E. Pathology of the heart in sudden cardiac death. Am J Cardiol 1977; 39:865.
  12. Myerburg, RJ, Catsellanos, A. Cardiac arrest and sudden cardiac death. In: Heart disease: a textbook of cardiovascular medicine, 5th ed, Vol. 1, Braunwald, E (Ed), WB Saunders, Philadelphia 1997. p.742.
  13. Domanski, MJ, Zipes, DP, Schron, E. Treatment of sudden cardiac death. Current understandings from randomized trials and future research directions. Circulation 1997; 95:2694.
  14. Eisenberg, MS, Mengert, TJ. Cardiac resuscitation. N Engl J Med 2001; 344:1304.
  15. Becker, LB. The epidemiology of sudden death. In: Cardiac Arrest: The Science and Practice of Resuscitation Medicinem, Paradis, NA, Halperin, HR, Nowak, RM (Eds), Williams & Wilkins, Baltimore 1996. p.28.
  16. Rea, TD, Eisenberg, MS, Sinibaldi, G, White, RD. Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 2004; 63:17.
  17. Ehlenbach, WJ, Barnato, AE, Curtis, JR, et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009; 361:22.
  18. Engdahl, J, Holmberg, M, Karlson, BW, et al. The epidemiology of out-of-hospital 'sudden' cardiac arrest. Resuscitation 2002; 52:235.
  19. Herlitz, J, Bahr, J, Fischer, M, et al. Resuscitation in Europe: a tale of five European regions. Resuscitation 1999; 41:121.
  20. Peberdy, MA, Kaye, W, Ornato, JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003; 58:297.
  21. Wik, L, Hansen, TB, Fylling, F, et al. Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. JAMA 2003; 289:1389.
  22. Cobb, LA, Fahrenbruch, CE, Walsh, TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA 1999; 281:1182.
  23. Abella, BS, Alvarado, JP, Myklebust, H, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293:305.
  24. Wik, L, Kramer-Johansen, J, Myklebust, H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005; 293:299.
  25. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2005. Part 1: Introduction. Circulation 2005; 112:IV.
  26. Nolan, J. European resuscitation council guidelines for resuscitation 2005 section 1. Introduction. Resuscitation 2005; 67 Suppl 1:S3.
  27. Iwami, T, Nichol, G, Hiraide, A, et al. Continuous improvements in "chain of survival" increased survival after out-of-hospital cardiac arrests: a large-scale population-based study. Circulation 2009; 119:728.
  28. Weisfeldt, ML, Becker, LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA 2002; 288:3035.
  29. Van Hoeyweghen, RJ, Bossaert, LL, Mullie, A, et al. Belgian Cerebral Resuscitation Study Group. Quality and efficiency of bystander CPR. Resuscitation 1993; 26:47.
  30. Gallagher, EJ, Lombardi, G, Gennis, P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 1995; 274:1922.
  31. Berg, RA, Sanders, AB, Kern, KB, et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 2001; 104:2465.
  32. Kellum, MJ, Kennedy, KW, Barney, R, et al. Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest. Ann Emerg Med 2008; 52:244.
  33. Abella, BS, Sandbo, N, Vassilatos, P, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation 2005; 111:428.
  34. Guidelines 2000 for cardiopulmonary care: international consensus on science. Circulation 2000; 102(suppl):384.
  35. Ristagno, G, Tang, W, Chang, YT, et al. The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation. Chest 2007; 132:70.
  36. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007; 369:920.
  37. Kern, KB, Hilwig, RW, Berg, RA, et al. Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario. Circulation 2002; 105:645.
  38. Eftestol, T, Sunde, K, Steen, PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation 2002; 105:2270.
  39. Garza, AG, Gratton, MC, Salomone, JA, et al. Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest. Circulation 2009; 119:2597.
  40. Ashton, A, McCluskey, A, Gwinnutt, CL, Keenan, AM. Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min. Resuscitation 2002; 55:151.
  41. Ochoa, FJ, Ramalle-Gomara, E, Lisa, V, Saralegui, I. The effect of rescuer fatigue on the quality of chest compressions. Resuscitation 1998; 37:149.
  42. Hightower, D, Thomas, SH, Stone, CK, et al. Decay in quality of closed-chest compressions over time. Ann Emerg Med 1995; 26:300.
  43. Sanders, AB, Kern, KB, Berg, RA, et al. Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios. Ann Emerg Med 2002; 40:553.
  44. Iwami, T, Kawamura, T, Hiraide, A, et al. Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation 2007; 116:2900.
  45. Bohm, K, Rosenqvist, M, Herlitz, J, et al. Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation 2007; 116:2908.
  46. Hallstrom, A, Cobb, L, Johnson, E, Copass, M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 2000; 342:1546.
  47. Berg, RA, Wilcoxson, D, Hilwig, RW, et al. The need for ventilatory support during bystander CPR. Ann Emerg Med 1995; 26:342.
  48. Berg, RA, Kern, KB, Hilwig, RW, et al. Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation. Circulation 1997; 95:1635.
  49. Waalewijn, RA, Tijssen, JG, Koster, RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation 2001; 50:273.
  50. Sayre, MR, Berg, RA, Cave, DM, et al. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008; 117:2162.
  51. Kern, KB, Hilwig, RW, Berg, RA, Ewy, GA. Efficacy of chest compression-only BLS CPR in the presence of an occluded airway. Resuscitation 1998; 39:179.
  52. Kern, KB. Cardiopulmonary resuscitation without ventilation. Crit Care Med 2000; 28:N186.
  53. Aufderheide, TP, Sigurdsson, G, Pirrallo, RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 2004; 109:1960.
  54. Ewy, GA. Cardiocerebral resuscitation: the new cardiopulmonary resuscitation. Circulation 2005; 111:2134.
  55. Kern, KB, Valenzuela, TD, Clark, LL, et al. An alternative approach to advancing resuscitation science. Resuscitation 2005; 64:261.
  56. Steen, S, Liao, Q, Pierre, L, et al. The critical importance of minimal delay between chest compressions and subsequent defibrillation: a haemodynamic explanation. Resuscitation 2003; 58:249.
  57. Aufderheide, TP, Lurie, KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med 2004; 32:S345.
  58. Morrison, LJ, Dorian, P, Long, J, et al. Out-of-hospital cardiac arrest rectilinear biphasic to monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT). Resuscitation 2005; 66:149.
  59. Martens, PR, Russell, JK, Wolcke, B, et al. Optimal Response to Cardiac Arrest study: defibrillation waveform effects. Resuscitation 2001; 49:233.
  60. Carpenter, J, Rea, TD, Murray, JA, et al. Defibrillation waveform and post-shock rhythm in out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation 2003; 59:189.
  61. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2005. Part 3: Defibrillation. Circulation 2005; 112:3.
  62. Stiell, IG, et al. BIPHASIC Trial A randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 2007; 115:1511.
  63. Rea, TD, Shah S, Kudenchuk PJ, et al. Automated external defibrillators: to what extent does the algorithm delay CPR? Ann Emerg Med 2005; 46:132.
  64. Herlitz, J, Bang, A, Alsen, B, Aune, S. Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR. Resuscitation 2002; 53:21.
  65. Yu, T, Weil, MH, Tang, W, et al. Adverse outcomes of interrupted precordial compression during automated defibrillation. Circulation 2002; 106:368.
  66. Bahr, J, Klingler, H, Panzer, W, et al. Skills of lay people in checking the carotid pulse. Resuscitation 1997; 35:23.
  67. White, RD, Russell, JK. Refibrillation, resuscitation and survival in out-of-hospital sudden cardiac arrest victims treated with biphasic automated external defibrillators. Resuscitation 2002; 55:17.
  68. Berg, MD, Clark, LL, Valenzuela, TD, et al. Post-shock chest compression delays with automated external defibrillator use. Resuscitation 2005; 64:287.
white circle LOG IN
white circle DEMO