What is the ideal rate for performing chest compressions during Cardiopulmonary Resuscitation (CPR)?

Optimal Chest Compression Rate for CPR

The most ideal rate to perform chest compressions during CPR is 100 to 120 compressions per minute. This recommendation is strongly supported by current guidelines and research evidence focused on optimizing survival outcomes.

Evidence-Based Recommendation for Compression Rate

• The American Heart Association (AHA) 2020 guidelines specifically recommend performing chest compressions at a rate of 100 to 120 compressions per minute for adult victims of cardiac arrest (Class IIa, Level of Evidence B-NR) 1
• This recommendation updates the previous 2010 guidelines which recommended a rate of at least 100 compressions per minute without specifying an upper limit 1
• The 2015 AHA guidelines update first established the 100-120/min range based on emerging evidence showing potential adverse effects of rates outside this range 1

Physiological Basis for the Recommended Rate

• Chest compression rates below 100/min are associated with decreased return of spontaneous circulation (ROSC) and reduced survival 1
• Rates above 120/min may reduce coronary blood flow and decrease the percentage of compressions that achieve target depth 1
• Data from the Resuscitation Outcomes Consortium (ROC) Epistry suggest an optimum target between 100 and 120 compressions per minute, with rates above or below this range appearing to reduce survival to discharge 1

Impact of Compression Rate on Other Quality Metrics

• As chest compression rates increase beyond 120/min, compression depth tends to decrease in a dose-dependent manner 1
• Studies show that at rates above 140/min, the proportion of compressions with adequate depth decreases significantly 2, 3
• Higher rates (>140/min) are associated with increased incomplete chest recoil, which reduces coronary perfusion 2, 4
• Rescuer fatigue occurs more quickly at higher compression rates, leading to deterioration in overall CPR quality 2, 3

Balancing Compression Rate with Other CPR Quality Metrics

• Five main components of high-quality CPR have been identified: chest compression fraction, rate, depth, chest recoil, and ventilation 1
• For optimal outcomes, chest compressions should be performed:
  • At a rate of 100-120/min 1
  • To a depth of at least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm) 1
  • With complete chest recoil between compressions 1
  • With minimal interruptions (chest compression fraction >80%) 1

Emerging Research and Controversies

• Some recent research suggests that rates slightly higher than the recommended range (121-140/min) may be associated with improved ROSC in certain settings 5
• However, this must be balanced against evidence showing that higher rates can compromise compression depth and increase rescuer fatigue 2, 3
• The current 100-120/min recommendation represents the best balance of factors affecting mortality and morbidity outcomes 1

Implementation Considerations

• Using metronome guidance can help rescuers maintain the recommended compression rate 6
• Audiovisual feedback devices may be reasonable to use during CPR for real-time optimization of compression rate and other quality metrics 1
• Rescuers should rotate the compressor role approximately every 2 minutes to maintain high-quality compressions, as compression depth (but not rate) begins to deteriorate after 90-120 seconds 1

Common Pitfalls to Avoid

• Focusing solely on compression rate without considering depth, recoil, and minimizing interruptions 1
• Compressing too fast (>120/min), which can lead to inadequate depth and incomplete recoil 2, 4
• Compressing too slowly (<100/min), which reduces blood flow and decreases chances of successful resuscitation 1
• Failing to rotate compressors regularly, leading to fatigue and deterioration in compression quality 1