Basic life support: adult

Basic life support is a fundamental skill required by all health professionals and is listed by the Nursing and Midwifery Council (2018) as an essential standard of proficiency for nurses. This article outlines the procedure for managing an in-hospital cardiac arrest in an adult patient (Figure 1). Cardiac arrest is defined as:

“The heart suddenly and unexpectantly stopping, resulting in blood stopping flow to the brain and other vital organs, within the body” (National Heart, Lung and Blood Institute, 2022).

It is vital that early recognition and immediate action is taken to restore heart activity as soon as possible. This is achieved through cardiopulmonary resuscitation and the use of a defibrillator or automatic external defibrillator (Perkins et al, 2021a).

Most cases of cardiac arrest occur in adults, with 72% occurring at home and 15% at work in the UK (Perkins et al, 2021a). The annual incidence of in-hospital cardiac arrests in the UK is 1–1.5 per 1000 hospital admissions (Perkins et al, 2021a).

Individuals must be assessed in a timely, structured and effective manner as most in-hospital cardiac arrests are identified by registered nurses (Rajeswaran et al, 2018).

Health professionals should use the ABCDE assessment tool, which covers:

• airway
• breathing
• circulation
• disability
• exposure (Resuscitation Council UK, 2021a)

Before commencing the ABCDE tool, the nurse must check for a response from the patient and ensure that their surroundings are safe (Resuscitation Council UK, 2021a).

The initial patient assessment involves using the ‘look, listen and feel’ approach (Resuscitation Council, 2021a). Checking for a response involves shouting in both of the patient’s ears and gently shaking their shoulders [is this only if they haven’t responded to gently asking? I feel being shouted at is the last resort]. The nurse should ask the patient if they are okay; a verbal response indicates that their airway is probably patent. If they do not respond, this indicates critical illness

• fully-stocked resuscitation trolley, including airway adjuncts
• oxygen
• defibrillator or automatic external defibrillator
• bag valve and mask with appropriate mask to fit the patient’s mouth and nose

A full list of equipment required by the Resuscitation Council (2023) can be found at: https://www.resus.org.uk/library/quality-standards-cpr/acute-care-equipment-and-drug-lists

1. Following the initial assessment and confirmation of cardiac arrest, begin cardiopulmonary resuscitation. In adult patients, this is done by starting 30 chest compressions. Place one hand on top of the other and interlock the fingers on the lower half of the sternum, in the centre of the chest. Ensure your body is directly over the patient and your arms are in a fully outstretched position. Compressions should be at a depth of 5 cm (no more than 6 cm), at a rate of 100–120 compressions per minute, with as minimal interruptions as possible (Figure 1). During compression, allow the chest to fully recoil and do not lean on the chest when it has recoiled. The patient must be on a firm flat base, or if in a bed, ensure the bed is flat (Perkins et al, 2021b)

Maintaining everyone’s safety is paramount while giving basic life support and cardiopulmonary resuscitation during a cardiac arrest. This requires the nurse to risk assess throughout the process to maintain safety (Perkins et al, 2021a). Resuscitation Council UK (2022) recommends using FFP3 masks or respirators and eye protection when performing chest compressions in patients with suspected or confirmed COVID-19.

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2. Use evidence-based, best practice approaches to undertake the following procedures:

2.15 administer basic physical first aid

2.16 recognise and manage seizures, choking and anaphylaxis, providing appropriate basic life support

Resuscitation Council UK:

Adult basic life support guidelines

Quality standards: acute care equipment and drug lists

References

National Heart, Lung, and Blood institute. What is a cardiac arrest? 2022. https://www.nhlbi.nih.gov/health/cardiac-arrest (accessed 9 May 2024)

Nursing and Midwifery Council. Future nurse: standards of proficiency for registered nurses. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 9 May 2024)

Perkins GD, Nolan JP, Soar J et al. Epidemiology of cardiac arrests guidelines. 2021a. https://www.resus.org.uk/library/2021-resuscitation-guidelines/epidemiology-cardiac-arrest-guidelines (accessed 9 May 2024)

Perkins GD, Colquhoun M, Deakin CD et al. Adult basic life support guidelines. 2021b. https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines (accessed 9 May 2024)

Rajeswaran L, Cox M, Moeng S, Tsima BM. Assessment of nurses' cardiopulmonary resuscitation knowledge and skills within three district hospitals in Botswana. Afr J Prim Health Care Fam Med. 2018;10(1):e1-e6. https://doi.org/10.4102/phcfm.v10i1.1633

Resuscitation Council UK. The ABCDE approach. 2021a. https://www.resus.org.uk/library/abcde-approach (accessed 9 May 2024)

Resuscitation Council UK. Airway management and ventilation. 2021b. https://lms.resus.org.uk/modules/m65-non-technical-skills/resources/chapter_7.pdf (accessed 9 May 2024)

Resuscitation Council UK. Guidance: COVID-19 update to resuscitation council UK (RCUK) guidance for practice. 2022.