What techniques promote high-quality CPR during chest compression in an adult patient with cardiac arrest?

From the Guidelines

To perform high-quality CPR on an adult patient in cardiac arrest, rescuers should perform chest compressions to a depth of at least 2 inches, or 5 cm, for an average adult while avoiding excessive chest compression depths, and at a rate of 100 to 120/min. This technique is supported by the most recent and highest quality study, which reaffirms the importance of chest compression quality 1.

Key Techniques for High-Quality CPR

• Position yourself so your shoulders are directly over your hands to maximize compression force
• Place a CPR board or activate the bed's CPR mode to ensure a firm surface for effective compressions
• Place your hands on the center of the patient's chest above the nipple line for proper compression location
• Place one hand on top of the other and interlock your fingers to maintain proper hand position
• Adjust the bed or use a secure step or stool to achieve an appropriate working height, allowing you to use your body weight effectively
• Keep your elbows straight and use your upper body weight rather than just arm muscles to deliver compressions

These techniques ensure adequate depth and rate of compressions, maximizing blood flow to vital organs during cardiac arrest, which is essential for improving the patient's chances of survival. The American Heart Association guidelines also emphasize the importance of minimizing interruptions in chest compressions and avoiding excessive chest compression depths 1.

Additional Considerations

• Total preshock and postshock pauses in chest compressions should be as short as possible 1
• It is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min 1
• During manual CPR, rescuers should perform chest compressions at a depth of at least 2 inches or 5 cm for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches or 6 cm) 1

By following these techniques and guidelines, rescuers can provide high-quality CPR and improve the patient's chances of survival.

From the Research

Techniques for High-Quality CPR

To promote high-quality CPR during chest compression in an adult patient with cardiac arrest, several techniques can be employed:

• Ensuring chest compressions are performed at the correct rate and depth, with a rate of 100-120/min and a depth of 2-3 inches 2
• Minimizing pauses in chest compressions, as pauses greater than 10 seconds can negatively impact survival 3
• Using feedback devices that provide real-time prompts or feedback to rescuers during CPR to improve adherence to guidelines for chest compression quality 4
• Employing a team approach to resuscitation, with briefing and debriefing of resuscitation teams to improve performance 4
• Considering the use of mechanical chest compression devices in settings where consistent, high-quality manual chest compressions are not possible or dangerous for the provider 5

Importance of CPR Quality

High-quality CPR is crucial for improving patient outcomes, including survival to hospital discharge and neurologically intact survival 6, 3

• Education of staff in both technical and non-technical resuscitation skills is essential for delivering high-quality CPR 4
• Collecting data during arrests and feeding back in real-time and post-event during debriefings can be used to improve delivery of high-quality CPR 4

Guidelines and Recommendations

The American Heart Association guidelines emphasize the need for high-quality CPR, with a focus on initiating chest compressions sooner and with slightly modified compression depth and rate 2

• The guidelines also recommend capnography for monitoring CPR quality and a team approach to resuscitation 2
• Advanced Cardiovascular Life Support guidelines emphasize good-quality CPR and recommend consideration of alternative treatments, such as chronotropic drug infusions, in certain situations 2