What is the maximum interval for pausing compressions during Cardiopulmonary Resuscitation (CPR)?

Maximum Interval for Pausing Compressions During CPR

Chest compressions during CPR should be paused for no more than 10 seconds to maximize patient survival. 1, 2

Guidelines for Minimizing Compression Interruptions

The American Heart Association (AHA) has established clear recommendations regarding pauses in chest compressions during CPR:

• For ventilation: Pauses should be less than 10 seconds when delivering 2 breaths in patients without advanced airways 2, 1
• For defibrillation: Pre-shock and post-shock pauses should be as brief as possible, with pre-shock pauses no longer than 10 seconds 2, 1
• For advanced airway placement: If endotracheal intubation is performed, any pause should be kept as short as possible, ideally <10 seconds 2

Rationale for Minimizing Pauses

Minimizing interruptions in chest compressions is critical because:

• Chest compressions generate blood flow to vital organs
• Interruptions lead to decreased coronary perfusion pressure
• After a pause, several compressions are needed to rebuild adequate perfusion pressure 3
• Higher chest compression fraction (percentage of time spent doing compressions) is associated with better outcomes 2

Specific Pause Recommendations by Procedure

Necessary Pauses (Keep Under 10 Seconds)

• Delivery of 2 rescue breaths without advanced airway
• Assessment for return of spontaneous circulation
• Transition to mechanical CPR or ECMO 2

Procedures That Generally Don't Require Pausing

• Application of defibrillator pads
• Uncomplicated advanced airway placement
• IV/IO placement 2

Optimizing CPR Performance

To minimize interruptions and maintain high-quality CPR:

• Target a chest compression fraction of at least 60%, with 80% being achievable in various settings 2, 1
• When an advanced airway is in place, do not pause compressions for ventilation (provide 1 breath every 6 seconds while continuing compressions) 2, 1
• Monitor compressors for signs of fatigue and switch providers quickly (can be done in <3 seconds with proper preparation) 2
• For pulse checks, have fingers ready on the pulse site before pausing and check only a single pulse site to minimize pause duration 4

Common Pitfalls to Avoid

• Prolonged pulse checks: These are a major source of unnecessary pauses and should be kept under 10 seconds 4
• Multiple simultaneous tasks during pauses: The more tasks performed during a pause, the longer the pause tends to be 4
• Uncoordinated team actions: "Coordinated pauses" that combine multiple necessary actions (pulse check, rhythm check, compressor change) are more efficient but require planning 4
• Unnecessary pauses: Some procedures like IV placement and pad application can be performed during ongoing compressions 2

While a recent study found that arterial blood pressure recovers quickly (within 2 compressions) after pauses with mechanical CPR 5, the strong consensus across guidelines remains that pauses should be limited to less than 10 seconds to optimize patient outcomes.