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CPR: Quality Makes a Difference

According to the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, there are 5 critical components of performing high quality cardiopulmonary resuscitation (CPR): minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. 

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CPR Quality – Minimize Interruptions

For tissue oxygenation, it is essential that healthcare providers minimize interruptions in chest compressions and maximize the amount of time chest compressions generate blood flow. The duration of arrest is defined as the time cardiac arrest is first identified until time of first return of sustained circulation. To maximize perfusion, the 2010 AHA Guidelines for CPR and ECC recommend minimizing pauses in chest compressions.

CPR Quality – Chest Compression Rate of 100 to 120/min

The 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC) recommend a chest compression rate of ≥ (greater than or equal to) 100/min. Data provides the best evidence of association between compression rate and survival and suggest an optimum target of between 100 and 120 compressions per minute. Consistent rates above or below that range appear to reduce survival to discharge.

CPR Quality – Chest Compression Depth of ≥50 mm in Adults

Compressions generate critical blood flow and oxygen and energy delivery to the heart and brain. The 2010 AHA Guidelines for CPR and ECC recommend a single minimum depth for compressions of ≥ 2 inches (50 mm) in adults. A recent study suggested that a depth of ≥44 mm in adults may be adequate to ensure optimal outcomes.  Another recent study examined chest compression depth and survival in out-of-hospital cardiac arrest in adults and concluded that a depth of < (less than) 38 mm was associated with a decrease in ROSC (return of spontaneous circulation) and rates of survival.

CPR Quality – Full Chest Recoil: No Residual Leaning

Incomplete chest wall release occurs when the chest compressor does not allow the chest to fully recoil on completion of the compression. This can occur when a responder leans over the patient’s chest, impeding full chest expansion. Leaning is known to decrease the blood flow throughout the heart and can decrease venous return and cardiac output.

CPR Quality – Avoid Excessive Ventilation

Although the delivery of oxygen is essential during CPR, the appropriate timeframe for interventions to supplement existing oxygen in the blood is unclear and likely varies with the type of arrest. Studies in animals and humans suggest that compressions without ventilations may be adequate early in nonasphyxial arrests. When asphyxia is the cause of the arrest, the combination of assisted ventilation and high-quality chest compressions is critical to ensure sufficient oxygen delivery. Animal and human studies of asphyxial arrests have found improved outcomes when both assisted ventilations and high-quality chest compressions are delivered.