How often should you switch chest compressions to avoid fatigue?

Chest Compression Rotation During CPR

Rescuers should switch chest compressions every 2 minutes to prevent fatigue and maintain high-quality compressions. 1

Evidence-Based Rationale

The 2010 International Consensus on Cardiopulmonary Resuscitation clearly recommends changing chest compression providers approximately every 2 minutes to prevent rescuer fatigue and deterioration in compression quality 1. This recommendation is based on multiple studies showing that compression quality—particularly depth—deteriorates over time due to rescuer fatigue.

Compression Quality Deterioration

Research demonstrates that chest compression quality begins to deteriorate within the first few minutes of CPR:

• An in-hospital patient study showed mean compression depth deteriorated between 90-180 seconds 1
• Multiple manikin studies revealed time-related deterioration in chest compression quality, especially depth, during continuous compressions by healthcare providers 1
• Medical students showed better quality compressions during the first 2 minutes, with noticeable deterioration after this point 1

Optimal Rotation Timing

The 2-minute interval aligns with the recommended rhythm check cycle in cardiac arrest algorithms, allowing for a natural transition point that minimizes interruptions to compressions 1. When switching compressors:

• The change should be accomplished as quickly as possible (ideally in less than 5 seconds) 1
• The switch should be coordinated with other mandatory pauses (like rhythm checks) to minimize interruption time 1

Alternative Rotation Strategies

While 2 minutes is the standard recommendation, some research suggests alternative approaches:

• A 2020 randomized cross-over manikin study found significantly higher mean compression depth and lower rescuer fatigue with 1-minute rotations compared to 2-minute rotations 2
• A 2015 study demonstrated superior compression quality when rotations occurred every minute rather than every two minutes, with significant differences in compression depth and percentage of appropriate depth compressions (76% vs. 54%) 3
• However, a 2009 study found no significant difference in effective compressions between 1-minute and 2-minute rotations, suggesting that compressions lost due to fatigue in the 2-minute scenario are approximately offset by compressions lost during the changeover process 4

Monitoring for Earlier Fatigue

The American Heart Association recommends that the team leader monitor compressors for signs of fatigue 1. If there is evidence of inadequate compressions that cannot be corrected with feedback or positioning adjustments, responsibility for chest compressions should be transferred to another team member immediately, even if 2 minutes has not passed 1.

Practical Considerations

To optimize compression quality:

• Ensure compressions are performed on a firm, hard surface 1
• Consider using adjustable-height surfaces, lowering the height of the surface, or using a step stool to enable rescuers to achieve optimal compression depth 1
• Monitor for leaning after compressions and ensure complete chest recoil 1
• Consider individual rescuer factors such as height, weight, and gender, as these may affect compression quality and fatigue onset 5

Pitfalls to Avoid

• Delaying rotation despite signs of fatigue: If a rescuer shows signs of fatigue before 2 minutes, don't wait to switch 1
• Prolonged interruptions during rotation: Practice quick transitions to minimize pauses in compressions 1
• Ignoring individual rescuer capabilities: Some rescuers may fatigue more quickly than others based on physical characteristics 5
• Focusing only on compression rate: While rate may be maintained despite fatigue, depth often deteriorates significantly 1, 5

By adhering to the 2-minute rotation guideline while remaining vigilant for earlier signs of fatigue, rescuers can maintain high-quality chest compressions throughout resuscitation efforts, optimizing the chance for patient survival.