From the Guidelines
To promote high-quality cardiopulmonary resuscitation (CPR) for an adult patient in cardiac arrest, it is essential to compress the chest at a depth of at least 2 inches (5 cm) and a rate of 100 to 120/min, allowing for complete chest recoil between compressions, as recommended by the 2020 American Heart Association guidelines 1.
Key Techniques for High-Quality CPR
- Compress the chest to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches or 6 cm) 1
- Perform chest compressions at a rate of 100 to 120/min 1
- Allow for complete chest wall recoil between compressions by avoiding leaning on the chest 1
- Minimize interruptions in chest compressions, aiming for a chest compression fraction of at least 60% 1
- Rotate compressors every 2 minutes to prevent fatigue and maintain compression quality
- Use real-time feedback devices if available to monitor compression depth and rate
- Ensure high-quality ventilations with a 30:2 compression-to-ventilation ratio if no advanced airway is in place 1
Importance of Proper Technique
Proper technique is crucial to maximize blood flow to vital organs during CPR, increasing the chances of successful resuscitation and neurologically intact survival. The 2020 guidelines emphasize the importance of avoiding excessive chest compression depths and allowing for complete chest wall recoil between compressions 1. By following these guidelines and using the techniques outlined above, healthcare providers can provide high-quality CPR and improve patient outcomes.
From the Research
Techniques for High-Quality Cardiopulmonary Resuscitation (CPR)
The technique that promotes high-quality CPR when compressing the chest of an adult patient in cardiac arrest includes:
- Maintaining a compression rate of more than 100/minute 2
- Ensuring compression depth of more than 2 inches (or 50 mm) 2
- Allowing for adequate (full) chest recoil between compressions 2, 3
- Using a high impulse and palm lift (HIPL) technique, which involves rapid forceful compression with disconnection of the rescuer's palm from the patient's sternum during the recoil phase 3
- Continuous chest compression CPR without rescue breathing, which has been shown to improve survival to hospital discharge compared to interrupted chest compression with pauses for rescue breathing 4
Factors Affecting CPR Quality
Factors that can affect CPR quality include:
- Rescuer fitness, with higher anaerobic power and muscular strength associated with higher quality CPR 2
- Sex, with female rescuers showing better chest compression recoil percentages 2
- Use of mechanical devices, such as the LUCAS device, which can provide more consistent chest compressions and improve CPR quality 5
- Variability in chest compression depth and rate, which can increase during transport and in the emergency department 6