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 (greater than 2.4 inches, or 6 cm) and at a rate of 100 to 120/min 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 positioning over the heart
- Adjust the bed height or use a secure step stool to achieve an appropriate working height, allowing you to use your body weight effectively
- Place one hand on top of the other and interlock your fingers to maintain proper hand position
- 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, minimize rescuer fatigue, and maximize blood flow to vital organs during CPR, which is critical for patient survival.
Importance of Proper Chest Compression Depth and Rate
Proper chest compression depth and rate are crucial for effective CPR, as they directly impact the patient's chances of survival and recovery. The American Heart Association recommends a compression depth of at least 2 inches (5 cm) and a rate of 100 to 120 compressions per minute 1. This is supported by previous guidelines, which also emphasize the importance of proper chest compression technique 2, 3, 4, 5.
Minimizing Interruptions in Chest Compressions
It is also essential to minimize interruptions in chest compressions, as this can significantly impact the patient's outcome. The goal is to achieve a chest compression fraction as high as possible, with a target of at least 60% 1. This can be achieved by avoiding unnecessary interruptions and using techniques such as continuous chest compressions with passive oxygen insufflation and airway adjuncts.
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:
- Initiating chest compressions sooner, before 2 ventilations, as emphasized by the new American Heart Association Guidelines 2010 6
- Modifying compression depth and rate, with a recommended rate of 100-120/min and depth as specified by guidelines 6, 7
- Abandoning the A-B-C steps for C-A-B (all age groups excluding newly born) to minimize delay in initiating chest compressions 6
- Using capnography for monitoring CPR quality, as recommended by Advanced Cardiovascular Life Support guidelines 6
- Minimizing pauses greater than 10 seconds during resuscitation, as this has been shown to impact survival 7
Comparison of CPR Techniques
Studies have compared the effectiveness of different CPR techniques, including:
- Mechanical chest compressions versus manual chest compressions, with no significant difference in survival to hospital discharge with good neurologic function 8
- Extracorporeal-CPR (ECPR) versus conventional-CPR, with ECPR appearing to be superior for improved neurological outcome and survival, although with increased risk of bleeding 9
Importance of Adherence to Guidelines
Adherence to resuscitation guidelines and patient severity of illness have been shown to be associated with patient survival in in-hospital cardiac arrest 7