CPR, or cardiopulmonary resuscitation, is a vital emergency procedure that can be life-saving when administered correctly. However, like any medical intervention, certain complications can arise, prompting questions about how to proceed. One such scenario is when the subject of CPR vomits. This guide aims to address the question: “Should you stop CPR if the person vomits? Here’s what to do.”

Vomiting during CPR is not uncommon. The physiological stress of cardiac arrest, the chest compressions themselves, and the potential for a regurgitation reflex can all contribute to emesis. It is crucial to understand that while it may seem alarming, vomiting does not automatically necessitate stopping CPR.

Causes of Vomiting During CPR

Several factors can trigger vomiting in an unconscious individual receiving CPR.

Gag Reflex and Regurgitation

The body’s natural gag reflex is designed to prevent foreign objects from entering the airway. Once a person loses consciousness, this reflex can become diminished, but it doesn’t disappear entirely. The pressure from chest compressions, especially if the diaphragm is compressed, can sometimes trigger a regurgitation of stomach contents.

Underlying Medical Conditions

The initial cause of the cardiac arrest may also play a role. Conditions affecting the gastrointestinal system or neurological disorders could predispose an individual to vomiting.

Administration of Breaths

When providing rescue breaths, air can inadvertently enter the stomach. This can lead to gastric distension, increasing the likelihood of vomiting. Proper head-tilt chin-lift technique and delivering breaths at a pace that allows for chest rise without excessive gastric inflation are key to mitigating this.

The Physiological Impact of Vomiting

Vomiting itself, while messy, is not the primary life-threatening issue in a cardiac arrest scenario. The lack of oxygenated blood flow to vital organs is. Therefore, the decision to continue or pause CPR must be weighed against the immediate threat of death.

Airway Obstruction

The primary concern with vomiting during CPR is the risk of aspiration. If stomach contents enter the airway and lungs, it can create a severe obstruction, preventing effective oxygen exchange. This is where a calm and methodical approach is paramount.

Psychological Impact on Rescuer

For an untrained bystander, witnessing vomiting during CPR can be distressing. It is important to remember that the priority remains the patient’s survival. Training and preparation are vital to navigate these challenging circumstances without succumbing to panic.

When to Consider Pausing CPR

While the general rule is to continue CPR unless the patient shows definitive signs of life, there are specific circumstances related to vomiting where a temporary pause might be necessary.

Assessing Airway Patency

The most critical consideration when vomiting occurs is to ensure the airway remains open and clear. This requires a rapid assessment and decisive action.

Visible Vomitus in the Airway

If you can clearly see vomit obstructing the mouth or throat, you must act to clear it. This is a situation where a brief pause in compressions is justified.

Signs of Ineffective Ventilation

If, after attempting rescue breaths, you do not see chest rise, it could indicate an airway obstruction, potentially due to vomit. This is a signal that an intervention is needed.

The “Look, Listen, Feel” Technique in Context

The standard “look, listen, and feel” for breathing is a crucial step. However, when vomiting occurs, the assessment needs to be more focused on the airway itself.

Checking for Pulse and Breathing

While clearing the airway, it is essential to quickly re-assess for a pulse and spontaneous breathing. If signs of life return, CPR can be stopped, but this is rare immediately after vomiting begins.

The Importance of Speed

Any pause in CPR should be as brief as possible. Every minute without compressions significantly reduces the chance of survival. Think of it as a momentary pit stop to refuel the engine, not shutting it down completely.

Steps to Take When Vomiting Occurs

When a person vomits during CPR, the immediate priority shifts to managing the airway. This requires specific actions to prevent aspiration and allow for continued resuscitation.

Clearing the Airway

This is the most critical step and requires immediate attention.

Positioning the Patient

If possible and safe to do so without significant disruption, the patient should be gently rolled onto their side. This allows gravity to help drain the vomitus from the airway. This is often referred to as the “recovery position,” but in the context of CPR, it’s a maneuver to facilitate airway clearance.

Using a Barrier Device or Cloth

If vomit is visible in the mouth or throat, use a clean cloth or a barrier device (like a gauze pad) to wipe it away. Be careful not to push the vomit further down the airway.

Suctioning (If Available and Trained)

In more advanced settings, suction devices are available. If you are trained in their use and have access to one, it can be highly effective for clearing a compromised airway. However, for lay rescuers, manual clearing is the primary method.

Resuming CPR

Once the airway is as clear as possible, CPR should be resumed without delay.

Back to Compressions

Immediately after clearing the airway, return to performing chest compressions. The urgency here is paramount.

Reassessing Ventilation

After resuming compressions, attempt rescue breaths again. Observe for chest rise. If there is still no chest rise, the airway may still be obstructed, and the clearing process might need to be repeated.

When to Actually Stop CPR

There are very few scenarios where vomiting itself mandates stopping CPR permanently. The only valid reasons to stop CPR are when the patient shows definitive signs of life or when professional medical help arrives and takes over.

Signs of Life

If the person begins to move, cough, or breathe normally, you can stop CPR and monitor them closely until emergency services arrive.

Arrival of Emergency Medical Services

Once paramedics or other qualified medical professionals arrive, they will assess the situation and take over resuscitation efforts. You should provide them with a clear and concise handover of what has occurred, including the vomiting.

Preventing Vomiting During CPR

While vomiting can be an unpredictable event, certain techniques in CPR administration can help minimize its occurrence.

Proper Hand Placement and Compression Depth

The correct placement of hands on the lower half of the sternum and maintaining the recommended compression depth (approximately 2 inches for adults) are crucial.

Avoiding Excessive Force on the Abdomen

While the sternum is the target, excessive or misplaced pressure can inadvertently compress the abdomen, potentially leading to regurgitation. Focus on delivering compressions through the chest.

Mastering Rescue Breath Technique

The way rescue breaths are delivered significantly impacts the risk of gastric distension.

Delivering Breaths Slowly and Steadily

You should aim to deliver each rescue breath over one second, just enough to see the chest rise. If you blow too forcefully or too quickly, you are more likely to push air into the esophagus rather than the lungs.

Allowing for Full Exhalation

Ensure the person’s chest falls completely between breaths. This reduces the build-up of pressure in the airway and stomach.

Head-Tilt Chin-Lift Maneuver

This maneuver is essential for opening the airway. However, it needs to be performed correctly.

Ensuring Airway Patency

The head-tilt chin-lift effectively lifts the tongue away from the back of the throat. Ensure this is done before attempting to deliver breaths.

Avoiding Hyperextension

Overextending the neck can sometimes obstruct the airway in certain individuals. Aim for a neutral or slightly extended position.

Training and Preparation: Your Best Defense

The most effective way to handle any complication during CPR, including vomiting, is through proper training and ongoing practice.

The Importance of Certified CPR Training

CPR courses, offered by organizations like the American Heart Association or the Red Cross, provide hands-on experience with manikins. This allows you to practice the necessary skills in a safe environment.

Scenario-Based Training

Reputable CPR courses often include scenario-based training that simulates real-life emergencies. This helps build confidence and familiarity with various challenges.

Understanding the Nuances

Training goes beyond just chest compressions and rescue breaths. It teaches you how to assess, react, and adapt to unexpected situations that can arise during resuscitation.

Regular Refresher Courses

CPR guidelines are updated periodically. Participating in regular refresher courses ensures your knowledge and skills are current.

Staying Calm Under Pressure

While easier said than done, training instills a sense of preparedness. This preparedness is a powerful tool for staying calm and making rational decisions when faced with a life-threatening situation. Remember, your actions, even if imperfect, are infinitely better than inaction. The goal is to keep the spark of life flickering until professional help can fan it into a flame.

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FAQs

1. Should you stop CPR if the person vomits?

No, you should not stop CPR if the person vomits. Instead, clear the airway of vomit to prevent choking or aspiration, then continue performing CPR immediately.

2. How do you clear vomit from the person’s airway during CPR?

Turn the person’s head to the side to allow vomit to drain out. Use a cloth or your fingers (if trained) to gently remove any visible vomit from the mouth and throat before resuming CPR.

3. Why is it important to continue CPR after the person vomits?

Continuing CPR is crucial because it maintains blood circulation and oxygen delivery to vital organs. Stopping CPR can reduce the chances of survival, so clearing the airway quickly and resuming compressions is essential.

4. Can vomiting during CPR cause complications?

Yes, vomiting can increase the risk of airway obstruction or aspiration pneumonia. Proper airway management during CPR helps minimize these risks and ensures effective resuscitation.

5. When should you call for emergency medical help during CPR?

Call emergency services immediately when you find someone unresponsive and not breathing normally. Continue CPR until professional help arrives or the person shows signs of recovery.