Question: CPR guidelines: I understand that we start CPR with a patient less than 16 years old, heart rate less than 60 and signs of poor perfusion, agonal respirations as per the CPR guidelines. My question is if we have the same situation with an adult patient, what would be beneficial for this type of patient (CPR)?

This question was at least partially answered previously on ASK MAC with the following: The provision of CPR is defined by the Heart and Stroke Foundation of Ontario Guidelines (HSFO) and not the Base Hospital. CPR should be initiated when a pulse is not present and a patient has no perfusion (apart from children). While it is tempting to begin CPR early in anticipation of an imminent arrest, it is also possible that patients in the condition you describe are maintaining some degree of cerebral perfusion and beginning active chest compressions would possibly be painful as well as asynchronous with the still contracting myocardium.

There is no evidence to suggest benefit or harm for starting compressions in an adult patient with bradycardia, a pulse present and signs of poor perfusion. However compressions in this patient population are not recommended by the most recent AHA guidelines or the provincial standards so therefore we would not recommend compressions for the patient you describe. In this situation assisting the patients ventilation with BVM (i.e. the pulmonary part of CPR) as per the BLS Patient Care standards may be indicated. If the patient loses their pulse one would then move to the Cardiac Arrest medical directive and begin compressions.

BLS,Cardiac/Circulation,Medical Cardiac Arrest,Miscellaneous

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