From the Guidelines
To promote high-quality cardiopulmonary resuscitation (CPR) for an adult patient in cardiac arrest, chest compressions should be performed at a depth of at least 2 inches (5 cm) and a rate of 100 to 120 compressions per minute, with minimal interruptions and a target chest compression fraction of at least 60%. When compressing the chest, it is essential to allow for complete chest recoil between compressions to maximize blood flow to vital organs [ 1 ]. The American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care recommends a compression depth of at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm) to avoid excessive chest compression depths [ 1 ].
Key Considerations for High-Quality CPR
- Positioning: Ensure the patient is on a firm surface, with the rescuer directly over the patient and shoulders above the sternum.
- Compression technique: Compress the chest to the recommended depth and rate, allowing for complete chest recoil between compressions.
- Minimizing interruptions: Aim for a chest compression fraction of at least 60% by minimizing pauses in compressions, including preshock and postshock pauses [ 1 ].
- Ventilation: Ensure high-quality ventilations with a 30:2 compression-to-ventilation ratio if no advanced airway is in place.
- Feedback devices: Use real-time feedback devices if available to monitor compression depth and rate [ 1 ].
Importance of Adhering to Guidelines
Adhering to these guidelines is crucial for maximizing the effectiveness of CPR and improving patient outcomes, including survival to hospital discharge and neurological recovery [ 1 ]. By following these recommendations, rescuers can help ensure that adult patients in cardiac arrest receive high-quality CPR, increasing their chances of successful resuscitation.
From the Research
Technique 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:
- Positioning the patient supine and pushing hard and fast over the center of the chest with outstretched arms perpendicular to the patient's chest 2
- Maintaining a rate of at least 100 compressions per minute and minimizing interruptions to achieve a minimum of 60 actually delivered compressions per minute 2
- Providing compressions of adequate rate and depth, avoiding leaning on the chest between compressions, and avoiding excessive ventilation 3
- Aggressive rotation of compressors to prevent decline of chest compression quality due to fatigue 2
Key Components of High-Quality CPR
The key components of high-quality CPR include:
- Minimizing interruptions in chest compressions 4, 3
- Providing compressions of adequate rate and depth 5, 3
- Avoiding leaning on the chest between compressions 3
- Avoiding excessive ventilation 3
Metrics for Measuring CPR Quality
The metrics that can be used to measure CPR quality include: