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 to allow full chest wall recoil by avoiding leaning on the chest between compressions 1. The most recent and highest quality study, published in 2015, provides guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, emphasizing the importance of proper chest compression technique to ensure adequate blood circulation during cardiac arrest. Some key techniques to achieve high-quality CPR include:

• Positioning hands on the lower half of the sternum in adults with cardiac arrest 1
• Performing chest compressions at a rate of 100/min to 120/min 1
• Compressing the chest 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) 1
• Allowing full chest wall recoil by avoiding leaning on the chest between compressions 1
• Minimizing interruptions in chest compressions, with total preshock and postshock pauses as short as possible 1 These techniques are crucial for maintaining perfusion to vital organs until advanced life support arrives. Additionally, the use of audiovisual feedback devices during CPR for real-time optimization of CPR performance may be considered 1. It is also important to note that dispatchers should instruct untrained lay rescuers to provide compression-only CPR for adults with sudden cardiac arrest, and that compression-only CPR is a reasonable alternative to conventional CPR in the adult cardiac arrest patient 1.

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:

• Emphasis on chest compressions with adequate rate and depth, allowing for complete chest recoil 2
• Minimizing interruptions in chest compressions 2, 3
• Avoiding excessive ventilation 2
• Use of continuous chest compression CPR without rescue breathing for untrained bystanders 4
• Utilization of audiovisual feedback systems to guide rescuers in performing compressions at optimal rate and depth 5

Physiologic Monitoring

Physiologic monitoring can be used to deliver precision CPR and improve outcomes after cardiac arrest:

• Coronary perfusion pressure and arterial DBP are associated with survival outcomes 6
• End-tidal carbon dioxide is a reasonable noninvasive alternative to invasive hemodynamic endpoints 6
• Cerebral oximetry and cardiac ultrasound are emerging physiologic indicators of CPR effectiveness 6

Education and Training

Education and training of staff are essential in both technical and non-technical resuscitation skills (human factors) to deliver high-quality CPR:

• Briefing and debriefing of resuscitation teams can improve team performance 3
• Use of feedback and prompt devices can help improve adherence to guidelines for chest compression quality 3