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

From the Guidelines

To promote high-quality CPR during chest compression in an adult patient with cardiac arrest, it is essential to perform chest compressions at a rate of 100/min to 120/min, to a depth of at least 2 inches or 5 cm, and allow for full chest wall recoil by avoiding leaning on the chest between compressions. This technique is supported by the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1.

Key Techniques for High-Quality CPR

• Position hands on the lower half of the sternum in adults with cardiac arrest, as recommended by the 2015 guidelines 1
• Use a compression-to-ventilation ratio of 30:2 for adults in cardiac arrest, unless an advanced airway is in place, in which case continuous chest compressions with 1 breath every 6 seconds (10 breaths per minute) may be reasonable 1
• Minimize interruptions in chest compressions, with total preshock and postshock pauses as short as possible, and pause compressions for less than 10 seconds to deliver 2 breaths if an advanced airway is not in place 1
• Consider using audiovisual feedback devices during CPR for real-time optimization of CPR performance, as suggested by the 2015 guidelines 1

Importance of Proper Technique

Proper technique is crucial for effective CPR, as it directly impacts the patient's chance of survival. The 2015 guidelines emphasize the importance of high-quality chest compressions, minimal interruptions, and proper hand positioning 1. Additionally, the use of CPR boards or activation of the bed's CPR mode can help ensure a firm surface for effective compressions, as demonstrated in previous studies 1.

Real-World Application

In real-world practice, these techniques can be applied by positioning oneself to maximize compression force and minimize fatigue, using body weight rather than arm muscles to deliver compressions, and adjusting the bed height or using a secure step stool to achieve an appropriate working height. By following these guidelines and techniques, healthcare providers can deliver high-quality CPR that maximizes the patient's chance 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:

• Continuous chest compressions with minimal interruptions, allowing for complete chest recoil 2, 3
• Compressions at a rate of 100-120 per minute, with a depth of 2-3 inches in adults 2, 4
• Avoiding excessive ventilation, with a ratio of 30:2 for chest compressions to rescue breaths 2, 5
• Use of physiologic monitoring, such as coronary perfusion pressure, arterial diastolic blood pressure, and end-tidal carbon dioxide, to guide resuscitation efforts 6
• Implementation of a comprehensive, structured, integrated, multidisciplinary system of care for post-cardiac arrest patients 2

Importance of CPR Quality

High-quality CPR is crucial for optimizing outcomes beyond return of spontaneous circulation (ROSC) 2. The quality of CPR can be affected by various factors, including:

• Adherence to advanced cardiac life support guidelines 4
• Availability of automated external defibrillators (AEDs) and their use in CPR 3
• Rescuer training and experience 5, 4
• Use of audiovisual feedback systems to guide compressions 4

Monitoring and Feedback

The use of physiologic monitoring and feedback systems can help improve CPR quality by:

• Providing real-time feedback on compression rate and depth 4
• Allowing for adjustments to be made to optimize coronary perfusion pressure and other physiologic targets 6
• Enhancing the precision and effectiveness of CPR efforts 6