How to Recognize Signs of Life During CPR

Recognizing signs of life during cardiopulmonary resuscitation (CPR) is a crucial aspect of the life-saving process. Understanding the dying process, including physical and emotional changes, is essential to recognizing these signs. It helps rescuers assess the effectiveness of their CPR efforts and determine if the victim is showing any positive responses. In this blog post, we will explore the key indicators that rescuers should look for when assessing signs of life during CPR. Additionally, a hospice nurse can provide valuable guidance and support tailored to the individual’s specific needs during CPR.

The Importance of Recognizing Signs of Life

CPR is performed to maintain blood circulation and oxygenation when a person is unresponsive and not breathing. The goal of CPR is to restore a heartbeat and breathing. Recognizing signs of life during CPR is essential for several reasons:

1. Assessment of Effectiveness: Rescuers need to evaluate whether their CPR efforts are effective in restoring circulation and breathing. If signs of life are detected, it indicates that CPR is working and should be continued.

2. Decision-Making: Recognizing signs of life helps rescuers make informed decisions about when to continue CPR, when to check for a pulse, or when to start rescue breaths (if trained to do so). It is also important to communicate with family members during this process to keep them informed and reassured.

3. Optimizing Care: Early identification of signs of life allows rescuers to optimize care by adjusting the depth and rate of chest compressions and ensuring proper airway management. The involvement of the palliative care team is crucial in providing support and assessing the patient’s condition during these critical moments.

Performing CPR during medical emergencies is highly stressful, and clear thinking is often compromised. Recognizing signs of life under such pressure is crucial for effective resuscitation efforts.

Key Indicators of Signs of Life During Cardiac Arrest

Rescuers should continuously monitor the victim for signs of life while performing CPR. The following are key indicators to look for:

• Breathing: Look for normal breathing patterns. Occasional gasps are not considered normal breathing.

• Chest movements: Observe the chest for any rise and fall, indicating breathing.

• Death rattle: Be aware of gurgling sounds produced by the accumulation of secretions in the airways, known as the 'death rattle'. While these sounds can be distressing, they do not indicate pain and are a natural part of the dying process.

1. Breathing and Chest Compressions

• Look for Chest Rise: Observe if the victim’s chest rises and falls with each rescue breath (if rescue breaths are being administered). This indicates that air is entering the lungs.

• Listen for Breathing Sounds: If rescue breaths are provided, listen for the sound of air entering and exiting the victim’s airway. Gurgling or other unusual sounds may indicate an obstruction or fluid in the airway. The 'death rattle' is a specific type of gurgling sound caused by the accumulation of secretions in the airways at the end of life. While distressing to hear, it does not indicate pain and is a natural part of the dying process.

• Feel for Breath: If rescue breaths are not being given, place your ear near the victim’s mouth and nose and feel for the warmth and movement of their breath. This can confirm if the person is beginning to breathe on their own.

2. Pulse

• Check for a Pulse: After every 2 minutes of CPR (or as recommended by guidelines), pause chest compressions to check for a pulse at the carotid artery (neck) or femoral artery (groin). If a pulse is detected, reassess breathing and responsiveness. It is important to perform this check quickly to minimize interruptions in chest compressions.

3. Coughing, Gagging, or Movement

• Spontaneous Movements: Occasionally, a victim may exhibit spontaneous movements, such as coughing, gagging, or limb movement, during CPR. These signs are indicative of some level of responsiveness. Spontaneous movements are part of the body's natural responses during the dying process. Even if spontaneous movements are observed, it is crucial to continue performing chest compressions until a definitive pulse is detected and the person is breathing adequately on their own.

4. Signs of Return of Circulation (ROC) and Automated External Defibrillator (AED)

• Color Change: The victim’s skin color may gradually improve from pale or cyanotic (bluish) to a more normal color as circulation improves.

• Pulse: If a pulse is absent initially, it may return with effective CPR. Continue to check for a pulse at regular intervals, but be sure not to interrupt chest compressions for more than 10 seconds.

• Spontaneous Breathing: The victim may begin to breathe spontaneously. Look for regular chest movements and listen for normal breathing sounds.

Responding to Signs of Life with Emergency Medical Services

When you recognize signs of life during CPR, follow these steps:

1. Reevaluate: Carefully reassess the victim’s breathing, pulse, and responsiveness. Ensure that the airway is open and clear. Providing pain relief is crucial to alleviate discomfort during resuscitation efforts.

2. Continue CPR: If there is still no breathing and no pulse, resume CPR immediately. Continue with high-quality chest compressions and rescue breaths as needed.

3. AED Use: If an automated external defibrillator (AED) is available, follow its prompts. The AED will analyze the heart rhythm and provide instructions accordingly. Deliver a shock if advised and then immediately resume CPR.

4. Check for Pulse: Continue to check for a pulse at regular intervals, as advised by guidelines. Ensure that these checks are brief to avoid prolonged interruptions in chest compressions.

5. Monitor Vital Signs: Continue to monitor the victim’s vital signs, such as breathing and pulse, throughout the resuscitation efforts. Be prepared to adjust your actions based on any changes in the victim’s condition.

Conclusion

Recognizing signs of life during CPR is a critical skill for rescuers. It allows them to assess the effectiveness of their efforts and make informed decisions about when to continue chest compressions, when to check for a pulse, and when to provide rescue breaths. Monitoring the victim for signs of life is an ongoing process during CPR, and rescuers should be vigilant in their observations. Timely and appropriate responses to signs of life can contribute to the successful resuscitation of a cardiac arrest victim and ultimately save lives. The palliative care team can provide essential support and guidance during the resuscitation process, ensuring that the victim receives the best possible care.