When Should You Not Perform CPR?

Understanding When Performing CPR Isn't the Right Choice MD:

CPR can significantly increase someone’s chances of making it through emergencies like sudden cardiac arrest or near-drowning incidents. It’s a lifesaving technique that pushes oxygen-rich blood to the heart and brain, keeping the person alive until professional help arrives.

However, there are moments when giving someone CPR might not be the best move. Sometimes, jumping in with chest compressions and rescue breaths is unsafe or not recommended. This information might make you wonder, “When should you not perform CPR?”

In this article, we’ll walk you through situations where CPR might do more harm than good and why it’s essential to recognize these exceptions. So, let’s get into the specifics of when not to apply this lifesaving technique.

The Goal of CPR

The purpose of CPR is pretty straightforward: to save lives by keeping blood flowing and oxygen circulating when the heart can’t do its job. Whether due to a cardiac arrest, drowning, or suffocation, when someone’s heartbeat or breathing stops, every second counts.

For every minute that a victim doesn’t receive CPR, their chances of making it through decrease by 7%-10%. So, by stepping in and performing CPR, you’re buying them more time and maintaining essential body functions until the pros can take over. It’s not about being a hero but a crucial link in the chain of survival. Here are the situations in which you should consider CPR:

    • Sudden collapses

    • Near-drownings

    • Severe allergic reactions

    • Electrocution

    • Choking

    • Overdoses

When Is CPR Not Recommended?

Despite CPR’s effectiveness, you should know when it should not be attempted. Performing CPR in certain situations isn’t just unnecessary but also harmful. Understanding these scenarios ensures you make the best decisions in high-stress moments, prioritizing your safety and the safety of the person you’re trying to help.

Let’s break down these situations so you’re better prepared if you ever find yourself in a position where you’re considering administering CPR.

No Signs Of Life

When a person has shown no signs of life for a while, CPR is not only futile but can put unnecessary strain on the rescuer and the victim’s body. Certain signs indicate a person has passed away, and starting CPR won’t change that outcome. These signs include:

    • Rigor mortis: Stiffening of a body’s muscles after death. It starts 2 to 6 hours after death and lasts 72 hours.

    • Lividity: The pooling and settling of blood in the body’s lowermost (dependent) parts following death. That occurs as the heart stops pumping, and gravity causes blood to settle in areas of the body that are closest to the ground.

    • Decomposition: Organic substances break down into simpler matter in what is called decomposition. After death, the human body goes through biological processes that cause the decomposition of tissues and organs.

    • Catastrophic head injury: This type of injury is caused by a variety of incidents, including vehicle accidents, falls, violent assaults, and sports-related impacts. Catastrophic head injuries can lead to immediate loss of consciousness, profound brain damage, and death.

Obvious Signs of Life

If someone is showing clear signs of life but is perhaps unconscious, CPR might not be the best response either. Remember, CPR is for individuals who are not breathing and do not have a detectable pulse. Starting chest compressions or rescue breaths isn’t just unnecessary but could do more harm than good if the person you’re trying to help is:

    • Breathing

    • Coughing

    • Moving

    • Making sounds

    • Has a strong pulse

In these cases, your best move is to monitor their condition closely, make them as comfortable as possible, and wait for professional medical help. Always err on the side of caution and double-check for breathing and a pulse before deciding to begin CPR.

Unsafe Environment

Another important thing is to consider your safety and the safety of the person in need. If the environment around you is unsafe – think fire, toxic gas, live electricity, or even the threat of violence – starting CPR might not be the best idea. In Arizona, accidents are the third leading cause of death, so make sure you’re not adding to those statistics by putting yourself in unnecessary danger.

In these instances, your priority must be to get yourself and the person to a safer location or call for emergency services trained to handle these risky situations. Remember, you can’t help someone else if you become a victim yourself.

Lack of Consent from a Conscious Victim

If someone is still conscious and tells you they don’t want CPR if they lose consciousness, you need to listen. It might seem strange, but they can refuse extraordinary measures. You’re not doing them a favor but violating their personal choice.

Respecting their wishes is important, even if you don’t agree with them. And, if they’re unable to speak but have somehow indicated they don’t want CPR, that’s a signal to back off.

Do Not Resuscitate (DNR) Orders

A DNR is a legal document signed by a patient and their healthcare provider that clearly states CPR should not be performed if their heart stops. It’s not a decision made lightly and needs to be respected, no matter how much you want to jump in and help.

If you know that a DNR order exists, you must respect that wish, even if it feels counterintuitive. Ignoring a DNR order can land you in a heap of legal trouble, not to mention the ethical implications of disregarding someone’s clearly stated wishes about their health care.

Alternatives to CPR

When CPR isn’t an option for various reasons, you might feel helpless and unsure about what to do next. However, there are other actions you can take to be of assistance in an emergency.

    • Calling emergency services: This should be your immediate response when encountering someone in distress. In Arizona, 911 operators must have CPR training and can guide you through what to do. They can also instruct you on other ways to help while waiting for professional medical help.

    • Basic first aid measures: If the person is conscious and safe, you can help them stay comfortable and calm. Check for any bleeding and apply direct pressure to stop it. If they’re experiencing a shock, try to keep them warm. Avoid moving them unnecessarily, especially if you suspect any injuries to their spine or neck, as this could cause further harm.

    • Using an AED: If the person is unresponsive and not breathing, and CPR alone isn’t viable or sufficient, an AED can be a lifesaver. These devices come with clear instructions and will guide you through the process, including when to stand back and allow the machine to analyze the person’s heart rhythm and, if necessary, deliver an electric shock to restart it.

Special Considerations When Doing CPR

Not all CPR situations are the same, and there are specific considerations to keep in mind, especially when the person in need is an infant, child, or pregnant woman.

Infants and Children

Performing CPR on young ones isn’t the same as what you’ve learned for adults. Their bodies are more fragile, and their airways are smaller, so you’ve got to adjust your approach. For infants under a year, use the index and middle finger for chest compressions and push about an inch and a half deep.

For children between one and puberty, use one hand (or two if you can’t exert enough pressure with one) and compress about two inches deep. Be gentler with breaths – their lungs can’t take as much air as an adult’s, so a gentle puff will do.

Pregnant Women

If a pregnant woman needs CPR, you have to consider not just her but the baby as well. Positioning is key here. Tilt her body slightly to the left to avoid putting pressure on the vena cava. This adjustment helps maintain blood flow to her heart and the baby.

Also, chest compressions need to be higher up on the sternum, considering the upward shift of her organs. Remember, the goal is to ensure oxygen flow to the mother and the baby until professional help arrives.

The Final Stop

Understanding when should you not perform CPR is as critical as knowing how to perform it properly. CPR shouldn’t be administered to someone breathing normally or with a pulse and in situations where you or the victim could be in further danger.

Recognizing these scenarios can prevent harm and ensure CPR is used effectively and only when needed. This knowledge underscores the importance of being trained and certified in CPR. Getting trained empowers you to act confidently in emergencies, making a real difference in someone’s chance of survival. So, take the step, get trained, and be ready to help when it counts.