Cardiopulmonary resuscitation (CPR) is a life-saving technique used to maintain blood flow and oxygenation to vital organs during cardiac arrest 1,2. While the fundamental principles remain consistent, the context in which CPR is performed—at home, in a hospital, or during surgery—introduces specific challenges and considerations.
CPR at Home
Cardiac arrest at home is often unexpected, and immediate CPR by bystanders can make a significant difference to patient outcome. First, it is important to recognize cardiac arrest by checking for unresponsiveness, absence of breathing, or abnormal gasping, after which one should call emergency services to ensure professional assistance, perform chest compressions at a rate of 100–120 per minute, push hard and fast on the center of the chest with full recoil, and/or use an automated external defibrillator (AED), if available, by following its instructions. Limited access to professional medical equipment highlights the importance of public CPR training initiatives and widespread AED placement in communities to improve survival rates 3. Ideally, emergency medical services can soon take over CPR and transfer the patient from the home to the hospital.
CPR in the Hospital
In hospitals, cardiac arrest is more likely to be anticipated due to close monitoring of high-risk patients, with access to advanced tools and a trained CPR team. Arrests are typically identified through telemetry or observation, prompting the activation of the hospital’s “code” protocol. High-quality chest compressions are initiated immediately with minimal interruptions, advanced defibrillators are used to treat shockable rhythms like ventricular fibrillation or pulseless ventricular tachycardia, and intravenous medications such as epinephrine are administered to support circulation and rhythm control.
Following resuscitation, patients are transferred to intensive care for ongoing monitoring, with advanced techniques like targeted temperature management (TTM) employed to enhance neurological recovery 4. The availability of trained professionals, advanced equipment, and continuous monitoring ensures rapid intervention and early detection, significantly improving outcomes 5,6.
CPR in Surgery
Cardiac arrest during surgery is rare but particularly challenging due to the complexity of the patient’s condition and the effects of anesthesia. It is identified through sudden changes in vital signs, such as hypotension or arrhythmia, prompting immediate chest compressions, although surgical constraints may require a different approach—for example, in open-chest procedures, direct cardiac massage may be performed. The anesthesiologist secures the airway and optimizes ventilation while the surgeon focuses on identifying and addressing reversible causes like hypovolemia, tension pneumothorax, or embolism. Managing the arrest requires maintaining a sterile surgical field and coordinating between the surgical and anesthesia teams to balance CPR with ongoing surgical needs. Post-arrest, patients are stabilized, transferred for intensive care, and managed for surgery-related complications alongside cardiac recovery 7,8.
Conclusion
CPR is a vital intervention across all settings, with each context requiring specific strategies and adaptations. Awareness, training, and preparation are crucial to ensure that timely and effective CPR is delivered whether at home, in the hospital, or in surgery, improving the chances of survival and recovery.
References
1. CPR Steps | How to Perform CPR. Red Cross https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr-steps.
2. How Can I Do CPR? Cleveland Clinic https://my.clevelandclinic.org/health/treatments/17680-cardiopulmonary-resuscitation-cpr.
3. Easy Step by Step Guide to Performing CPR at Home. https://www.uscpronline.com/.
4. Omairi, A. M. & Pandey, S. Targeted Temperature Management. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2024).
5. Cheema, M. A. et al. Duration of in-hospital cardiopulmonary resuscitation and its effect on survival. Indian Heart J 71, 314–319 (2019). DOI: 10.1016/j.ihj.2019.09.002
6. Clinical Practice Guidelines : Resuscitation: Hospital Management of Cardiopulmonary Arrest. https://www.rch.org.au/clinicalguide/guideline_index/Resuscitation__Hospital_Management_of_Cardiopulmonary_Arrest/.
7. CPR in Operation Theater: Guidelines and Technologies Used. https://cprcare.com/blog/cpr-in-operation-theater-ensuring-life-saving-measures-in-critical-surgical-settings/.
8. Hinkelbein, J. et al. Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery. Eur J Trauma Emerg Surg 49, 2031–2046 (2023). DOI: 10.1097/EJA.0000000000001813
