Therefore it is important that providers carefully familiarize themselves with this technique. Indications Chest compressions are generally indicated for all patients in cardiac arrest. Unlike other medical interventions, chest compressions can be initiated by any healthcare

provider without a physician’s order. This is based on implied patient consent for emergency treatment [3]. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate find more the emergency response system and immediately start chest compressions [4]. The risk of serious injury from chest compressions to patients who are not in cardiac arrest is negligible [5], while any delay in starting chest compressions has grave implications for outcome. Due to the importance of starting chest compressions early, pulse and breathing checks were de-emphasized in the most recent CPR guidelines [4]. Thus,

healthcare providers should take no longer than 10 seconds to check for a pulse. The carotid or femoral pulses are preferred locations for pulse checks since peripheral arteries can be unreliable. Contraindications In certain mTOR activation circumstances it is inappropriate to initiate chest compressions. A valid Do Not Resuscitate (DNR) order that prohibits chest compressions is an absolute contra-indication. DNR orders are considered by the attending physician on the basis of patient autonomy and treatment futility. The principle of patient autonomy dictates that competent patients have a right to refuse medical treatment [6]. Therefore a DNR order should be documented if patients do not wish to be treated with chest compressions. For patients with impaired decision-making, previous preferences should be taken into account when making decisions regarding DNR. The principle of treatment futility dictates that healthcare providers are not obliged to provide treatment if this would be futile [6]. Therefore a DNR order should be documented if chest compressions would be unlikely to confer a survival benefit or acceptable quality of life. However, few criteria

can reliably predict the futility of starting chest compressions. If there is any uncertainty Telomerase regarding DNR status then chest compressions should be started immediately while the uncertainties are addressed. Compressions may subsequently be terminated as soon as a valid DNR order is produced. Of note, patients with implantable left ventricular assist devices [7–9] or patients with total artificial hearts or biventricular assist devices [10] who Selleckchem Rabusertib suffer cardiac arrest from device failure should be resuscitated using a backup pump (e.g. ECMO [11, 12]) if this is available rather than with chest compressions. The Physiology of Chest Compressions Chest compressions generate a small but critical amount of blood flow to the heart and brain.