High-Quality CPR: Are We There Yet?

If you haven’t noticed, there has been a big push recently to improve the quality of CPR delivered to victims of sudden cardiac arrest. EMS professionals are being encouraged to do “high-performance CPR,” a highly-choreographed team-centered approach to CPR designed to assure that no moment is wasted in delivering chest compressions. In addition, anyone trained in CPR is instructed with the most recent CPR standards which emphasize proper chest compressions and CPR technique.

The High-Quality CPR Movement
The goal of this high-quality CPR movement is to improve survival from sudden cardiac arrest by doing letter-perfect CPR with only minor interruptions in chest compressions. Recent scientific evidence shows the importance of effective chest compressions along with defibrillation in successful resuscitation. Not only does it improve the chances for those patient when you use an AED, it also helps people in cardiac arrest who cannot be treated with a defibrillatory shock.1

Although national survival rates have yet to tick up from the current 5 - 10% survival figure but that should change as more and more communities begin embracing high-quality CPR. Here are some the things you can do to deliver high-quality CPR and give your patients a fighting chance at living:

• Minimize interruptions of chest compressions
• Push hard and fast on chest (at least 2 in depth, at least 100/min)
• Allow full recoil of chest
• Avoid excessive force in rescue breaths

Minimize Interruption of Chest Compressions
The American Heart Association recommends not interrupting compressions for more than 10 seconds even to deliver rescue breaths. Is that possible? Yes. By delivering just a quick breath in which you can see the chest rise. Pay attention to not let chest compressions stop even for a short time. This reduces the effectiveness of CPR considerably.

Keep chest compressions going except for brief pauses during rescue breaths and AED analysis and shocks.

Push Hard and Fast
CPR provides increased pressure in the chest that prolongs the time when a fibrillating heart is receptive to defibrillation. Research shows that most rescuers do not push hard enough or fast enough when doing chest compressions. It has been documented that professional rescuers push less than 1.5 inches up to 70% of the time while the recommended depth is 2 inches.2 Keep the rate of at least 100 compressions per minute. In addition to rate, another focus for high-quality CPR is compression depth.

Follow the recommended chest compression rate of at least 100 per minute and the recommended depth of at least 2 inches.

Let the Chest Come Back Up
Allow the chest to recoil completely during compressions. This means letting the chest come back up to its normal position after each compression. This generates a negative pressure in the chest and draws blood back into the heart. It fills the heart more completely and thus improves the flow of blood on your next compression.

Avoid Excessive Force in Rescue Breaths
Give two short breaths in which you see the chest rise. Avoid excessive force when giving rescue breath---give just enough air to see the chest rise. Delivering an excessive volume of air into the victim can force air into the stomach that can result in vomiting.

Rescue breaths are a quick puff of air. Give a rescue breath over the course of one second. Don’t attempt to totally fill the lungs with air. AHA guidelines call for two rescue breaths after every 30 compressions. The key is to watch for the chest to rise. That way you’ll know the breath was effective.

Summary
High-quality CPR is a movement based the importance of maintaining proper compression depth and rate and reducing interruptions in chest compressions. By following the most current guidelines you will be delivering high-quality CPR: minimize interruption of chest compressions, push hard and fast, let the chest fully recoil and avoid excessive force in rescue breaths.

References

1. Kudenchuk PJ, Redshaw JD, Stubbs BA, Fahrenbruch CE, Dumas F, Phelps R, et al. Impact of changes in resuscitation practice on survival and neurological outcome after out-of-hospital cardiac arrest resulting from nonshockable arrhythmias. Circulation. 2012;125:1787-94

2. Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, Vanden Hoek TL, Becker LB. Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest. JAMA. 2005;293(3):305-310.