From the Guidelines
A Cardiopulmonary Resuscitation (CPR) Performance program should prioritize high-quality chest compressions, minimal interruptions, and regular skill refreshers, as emphasized in the 2020 American Heart Association guidelines 1. The program should focus on training participants to perform chest compressions with a depth of at least 2 inches (5 cm) and a rate of at least 100 compressions per minute, allowing for full chest recoil after each compression, and minimizing interruptions in chest compressions, as recommended by the 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science 1. Key components of the program should include:
- Training on proper hand placement (center of chest)
- Compression depth (2-2.4 inches for adults)
- Rate (100-120 compressions per minute)
- Complete chest recoil between compressions
- The CAB sequence (Compressions, Airway, Breathing)
- Practice using automated external defibrillators (AEDs) The program should also incorporate regular practice sessions every 3-6 months to prevent skill decay, as CPR skills deteriorate rapidly without reinforcement, and simulation-based training with real-time feedback devices that measure compression quality is highly effective, as noted in the 2018 American Heart Association focused update on adult basic life support and cardiopulmonary resuscitation quality 1. For healthcare providers, the program should include advanced techniques like proper bag-mask ventilation (1 breath every 6 seconds) and medication administration (epinephrine 1mg IV/IO every 3-5 minutes), as outlined in the 2020 American Heart Association guidelines 1. Regular performance evaluation using metrics like chest compression fraction (target >80%) and perishock pause duration helps maintain quality, and this structured approach is essential because high-quality CPR significantly increases survival rates by maintaining blood flow to vital organs during cardiac arrest.
From the Research
Cardiopulmonary Resuscitation Performance Program
The importance of cardiopulmonary resuscitation (CPR) quality is a fundamental component of initial care for cardiac arrest victims 2. Several strategies have been evaluated to improve CPR performance, including:
- Real-time CPR sensing and feedback
- Physiologic monitoring such as end-tidal CO(2) measurement
- Metronome prompting
- Mechanical CPR devices
- Prearrest training (e.g. high-fidelity simulation education and CPR refreshers)
- Postarrest training (e.g. debriefing)
Automated External Defibrillators
Automated external defibrillators (AEDs) can significantly improve survival rates following out-of-hospital cardiac arrest 3, 4. The use of AEDs requires:
- Developing and implementing a program at sites where the cardiac arrest rate is high
- Training potential first responders
- Transferring patients to an advanced care facility after initiating resuscitation
- Identifying the essential components of an AED program that optimize its effectiveness
Training Programs
A novel quarterly CPR training program can improve hospital basic life support providers' CPR skill performance 5. This program uses quarterly, brief CPR training at a skills station, and staff nurse educators should consider incorporating innovative CPR education strategies that focus on spaced learning with immediate feedback.
Key Factors
Key factors that improve the effectiveness of an AED program include:
- Age of the patient
- Arrest witnessed by bystander
- CPR initiated by bystander
- CPR initiated by first responder
- Emergency medical service response within 8 minutes 4 These factors can be modified to improve the effectiveness of an AED program, and training community volunteers can improve bystander-initiated CPR rates.