Recommended Chest Compression Frequency During CPR
The recommended chest compression rate during cardiopulmonary resuscitation is 100 to 120 compressions per minute for adult victims of cardiac arrest. 1, 2
Evidence-Based Recommendation
The American Heart Association strongly recommends a manual chest compression rate of 100 to 120 compressions per minute (strong recommendation, very-low-certainty evidence). 1
This represents an evolution from the 2010 guidelines, which recommended a rate of "at least 100/min" without specifying an upper limit. 1 The 2015 guidelines established the upper threshold of 120/min based on emerging evidence showing potential adverse effects at higher rates. 1, 2
Why This Specific Range Matters
Rates Below 100/min Are Inadequate
Compression rates below 100/min are associated with decreased return of spontaneous circulation (ROSC) and reduced survival. 2
Studies comparing mean compression rates of 87-95/min versus 40-72/min showed a 33% increase in ROSC with the higher rates. 1
Rates Above 120/min Cause Problems
Compression rates exceeding 120/min lead to deterioration in compression quality, particularly decreased depth. 2, 3
At rates of 140/min, systolic blood pressure decreased to 74% of baseline, and the fraction of compressions with complete chest recoil and sufficient depth significantly deteriorated. 1, 3
Rescuer fatigue occurs significantly sooner at 140 compressions/min compared to 120/min. 3
Studies demonstrate that as compression rate increases beyond 120/min, compression depth tends to decrease in a dose-dependent manner. 1, 2
The Optimal Target: 120 Compressions Per Minute
Research suggests that 120 compressions per minute may represent the optimal rate within the recommended range. 4, 3
A manikin study found that the number of high-quality CPR compressions was highest at 120/min, with significantly more compressions fulfilling quality criteria compared to 100/min. 4
At 120/min, the rate of incomplete chest recoil remained low while maintaining adequate compression depth. 4, 3
Integration with Other CPR Quality Metrics
High-quality CPR requires attention to multiple components simultaneously, not just rate: 2
- Compression depth: At least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm) 1, 2
- Complete chest recoil: Allow full chest wall recoil between compressions 1, 2
- Minimize interruptions: Maintain chest compression fraction >60%, ideally >80% 1, 2
- Compression-to-ventilation ratio: 30:2 for adults 1
Critical Implementation Considerations
Use of Feedback Devices
Audiovisual feedback devices may be reasonable for real-time optimization of compression rate and other quality metrics (Class IIb recommendation). 1, 2
These devices help rescuers maintain the target rate of 100-120/min and adequate depth simultaneously. 2, 5
Rescuer Rotation
Rotate the chest compressor role approximately every 2 minutes to maintain high-quality compressions. 1, 2
Compression depth begins to decrease after 90-120 seconds of CPR, even though compression rates may remain stable. 1
This rotation should coincide with rhythm analysis to minimize interruptions. 1
Common Pitfalls to Avoid
Compressing too fast (>120/min): This is a frequent error that compromises compression depth and chest recoil. 2, 3
Focusing solely on rate while ignoring depth: Studies show that evaluating a single CPR quality metric in isolation can be misleading, as rate and depth interact significantly. 1, 2
Failing to rotate compressors: This leads to fatigue and progressive deterioration in compression quality, particularly depth. 1, 2
Excessive pauses: Transport CPR quality is significantly worse than on-scene CPR, with median correct depth proportions dropping from 41.9% on-scene to 8.7% during transport. 6
Special Population Considerations
Pediatric Patients
- For simplicity in training and in the absence of sufficient pediatric-specific evidence, it is reasonable to use the same compression rate of 100-120/min for infants and children (Class IIa recommendation). 1