Immediately begin Basic Life Support (BLS) during CPA.
One cycle of BLS is 2 minutes of sustained compression and ventilation (simultaneously if two rescuers are present). If only one rescuer, a compression to ventilation ratio of 30:2 is recommended.
Body position: lateral recumbency on either side (Figure 1 above) with rescuer adjacent to the MWD’s back.
Hand position: at the widest point of the chest (thoracic pump theory). Only in very lean and narrow chested MWDs can the hands be positioned directly over the heart at the point of the flexed elbow on the body wall (cardiac pump theory).
Rate: 100 – 120 compressions per minute.
Depth: 1/3 to ½ the width of the chest. ALWAYS allow for complete elastic recoil of the chest wall.
Mouth-to-snout resuscitation may be attempted if there is only a single rescuer (rate of 30 compressions to 2 breaths). In MWDs that may pose risk to the rescuer (e.g., potential zoonotic disease, illicit drug or HAZMAT exposure), perform chest compression-only CPR.
Intubate (with a cuffed endotracheal tube) as soon as possible after initiating chest compressions. DO NOT STOP chest compressions to achieve intubation (intubate in lateral recumbency). Inflate the cuff and secure the tube.
Perform a tracheostomy or cricothyrotomy (see Emergency Airway Management K9 CPG) if airway cannot be obtained (while continuing chest compressions).
Supply 100% oxygen during CPR when possible.
Rate: 10 breaths per minute. Each breath should be 1 second long, with full release after each breath.
Tidal volume: 10 mL/kg is recommended and can be achieved using a 1 second inspiratory time with a bag valve mask (BVM) / AMBU bag.