From the Research
CPR should be continued until emergency medical services arrive or until the person shows signs of life, which can vary from minutes to over an hour. The American Heart Association recommends performing CPR in cycles of 30 chest compressions followed by 2 rescue breaths, at a rate of 100-120 compressions per minute 1. For an adult, compress the chest at least 2 inches deep; for children, compress about 2 inches; and for infants, compress about 1.5 inches. High-quality CPR involves minimal interruptions in compressions, allowing complete chest recoil between compressions, and avoiding excessive ventilation. CPR works by manually pumping blood to vital organs, particularly the brain, when the heart cannot do so effectively. Even if CPR doesn't restart the heart, it can significantly increase the chances of survival by maintaining blood flow until advanced medical care arrives. The duration of CPR depends on the situation, the victim's condition, and the availability of advanced medical care.
Some key points to consider when performing CPR include:
- The use of epinephrine, which is a core component of guidelines and recommended to be administered as soon as feasible in nonshockable rhythms 1
- The potential benefits of combining vasopressin, steroids, and epinephrine to improve return of spontaneous circulation (ROSC) among those with in-hospital cardiac arrest 1
- The lack of evidence to support the use of antiarrhythmics, such as amiodarone and lidocaine, in improving short-term or long-term survival or neurologic outcomes 2, 3
- The importance of high-quality CPR, including minimal interruptions in compressions and avoiding excessive ventilation 4
It's also worth noting that recent studies have compared the effectiveness of amiodarone and lidocaine in treating in-hospital cardiac arrest, with one study finding that lidocaine was associated with higher rates of ROSC, 24-hour survival, survival to hospital discharge, and favorable neurologic outcome 4. However, the most recent and highest quality study should be prioritized when making a definitive recommendation. In this case, the study from 2023 provides the most up-to-date evidence on the comparative effectiveness of amiodarone and lidocaine 4.
Overall, the key to successful CPR is to perform it correctly and consistently, with a focus on high-quality compressions and minimal interruptions. By following the American Heart Association's guidelines and prioritizing the most recent and highest quality evidence, healthcare providers can provide the best possible care for patients in cardiac arrest.