CPR for Special Populations: Adaptations and Considerations


A new set of guidelines for cardiopulmonary resuscitation (CPR) has been released. These guidelines are designed to improve the quality and effectiveness of CPR by providing healthcare providers with the latest scientific evidence on how to provide effective care to their patients. For example, the new guidelines now include special populations including pre-hospital emergency medical services (EMS), cardiac arrest from nontraumatic etiology, asphyxial cardiac arrest, and hypothermia-induced cardiac arrest. However, these special populations may require extra precautions when administering CPR because of unique circumstances surrounding their health conditions—which means it's important for anyone providing emergency care to know what those circumstances are so they can properly adapt their techniques accordingly.


Asthma is a common chronic condition that affects the airways. It can be life-threatening if not treated properly or quickly. Asthma is not contagious, but it can cause symptoms like wheezing, coughing, chest tightness, and shortness of breath.

If you're helping someone who has asthma:

  • Know their history of asthma (how long have they had it? How often do they use medication?)
  • If you don't know anything about their history with asthma assume that it's mild (and make sure to tell them how important it is to keep an auto-injector nearby).

If they are coughing, ask if it's an asthma attack. If they are wheezing, ask if there is anything that helps their cough. If they say yes (they can breathe easier), then help them get to an emergency room right away.

Congenital heart disease

If you are in a situation where you need to perform CPR on someone with congenital heart disease, it is important to check for signs of CHD before beginning CPR. If the person has symptoms of CHD such as shortness of breath or chest pain, call 911 immediately and wait for medical professionals to arrive on the scene.

If there are no signs of CHD present, but you have reason to believe that this person may have had surgery in the past related to their heart (such as an appendectomy), check with a medical professional before performing CPR on them.

Coronary artery disease or myocardial infarction

  • If you are not trained in CPR, do not attempt to provide it.
  • Provide CPR only when the person is in cardiac arrest.
  • Only provide chest compressions that are at least 2 inches deep and at a rate of 100 per minute (or faster). Be sure to lock your hands together over the chest as you compress it so that your fingers do not slip off the sternum during each compression cycle. This can cause bruising or broken ribs for patients with coronary artery disease or myocardial infarction who have fragile blood vessels in their heart muscle tissue due to poor circulation caused by blocked arteries.


In addition to the general considerations for people with diabetes, there are some issues that are specific to this population. Diabetes is a serious condition that can lead to heart disease and stroke. It can cause numbness in the hands or feet; blurred vision; dry, itchy skin; infections (e.g., athlete's foot); problems with blood vessels in legs (peripheral vascular disease); infections in ears/eyes (retinopathy) or belly area (ascites).

Difficult airway management

Difficult airway management is a serious problem. It can be life-threatening, and it's one of the most difficult things for healthcare providers to deal with. The most common cause of respiratory failure is respiratory depression caused by an overdose or drug interaction, but other causes include:

  • lack of oxygen due to respiratory disease
  • brain injury that affects breathing patterns (such as stroke)
  • trauma to the head or neck region that causes swelling in these areas

Obesity and morbid obesity

In addition to the usual considerations for performing CPR, you should also be aware of some modifications for obese patients.

  • Use a defibrillator. An automatic external defibrillator (AED) can be used on morbidly obese individuals when there is no pulse or respirations are less than 8 breaths per minute; manual defibrillation should be used only after manual CPR has been performed for at least one minute and someone trained in its use is present.
  • Use a pocket mask with suction to help remove obstructions from the airway if necessary. It's important not to let air escape into your patient's lungs during this step; otherwise, they could develop pneumothorax or pulmonary edema later on!

Older adults

Older adults are at higher risk of sudden cardiac arrest. They are more likely to have heart disease, lung disease, or dementia. They may also be on medications that make them more susceptible to sudden cardiac arrest. Because of their age and overall health status, older adults tend to present with unusual symptoms such as confusion or dizziness rather than chest pain--and these symptoms may not be recognized as signs of a life-threatening emergency by bystanders who witness them.

  • Older adults may be unable to lay flat on the floor and therefore should be positioned in bed instead of lying down flat if at all possible.
  • Older patients often have weakness in their arms due to chronic conditions like arthritis or diabetes; therefore they may not be able to perform chest compressions effectively.

If you're not sure what to do when providing CPR, check with a medical professional.

If you're not sure what to do when providing CPR, check with a medical professional.

  • Call 911 immediately and ask for help.
  • Follow the instructions of a medical professional on the phone or at the scene (if there is one).
  • If you are not trained in CPR, you can still be of help by calling 911 and providing information about the incident.
  • If it is an emergency, you can call 911 before performing any kind of intervention such as chest compressions or mouth-to-mouth resuscitation.

If someone has stopped breathing or their heart has stopped beating due to cardiac arrest:


As a healthcare provider, it's important to be familiar with the special considerations and adaptations needed when providing CPR to certain populations. This includes knowing how to perform chest compressions over an obese abdomen or chest without injuring your patient.


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