Cardiovascular Critical Care II
iv.
All patients with SCA should receive chest compressions (Acta Anaesthesiol Scand 2008;
52:914-9).
Place patient on a hard surface, use backboard (unless it will cause interruptions in chest
compressions, delay in initiation of CPR, or dislodgment of lines/tubing), and/or deflate air-
50; Resuscitation 2004;61:55-61).
vi.
Perform high-quality chest compressions at a rate of 100–120 compressions per minute at
a depth of 2–2.4 inches, and allow chest recoil after each compression. High-quality chest
compressions optimize coronary perfusion, cardiac index, myocardial blood flow, and cerebral
2006;71:341-51; Circulation 2015;132(suppl 2):S315-S367).
vii.
Without the use of a compression feedback device, it may be difficult to judge compression
rate and depth. In a randomized study, compression feedback devices were shown to increase
adherence to CPR guidelines, increase CPR quality, increase rates of ROSC, and decrease
viii.
Actual number of chest compressions given per minute is a function of the compression rate and
proportion of time without interruption. Goal is to minimize interruptions to chest compressions.
| (a) | Increasing the number of compressions given per minute can increase the rate of ROSC, |
|---|
2008;299:1158-64; Circulation 2009;120:1241-7; Circulation 2005;111:428-34).
| (b) | Rescuer fatigue is common and may lead to inadequate compression quality (Resuscitation |
|---|
2009;80:918-4). It is recommended to change compressors every 2 minutes (or after five
cycles of compressions at a rate of 30:2 compressions/ventilations) with no more than 10
seconds between changes (Resuscitation 2009;80:1015-8).
| (c) | Pulse checks (including initial) should last no more than 10 seconds. |
|---|---|
| (d) | Duration of the single longest interruption to chest compressions (regardless of reason) is |
negatively associated with survival (Circulation 2015;132:1030-7), reemphasizing the need
to minimize interruptions to chest compressions.
| (e) | Compression-first (or “compression only” or “hands only”) CPR decreases time until first |
|---|
compression (Resuscitation 2004;62:283-9) and for suspected OHCA is acceptable for
nonmedical rescuers (Circulation 2015;132(suppl 2):S315-S367).
| (f) | A Cochrane review found that bystander-administered chest compression-only CPR |
|---|
(supported by telephone instruction) increases the number of people who survive to
hospital discharge (Cochrane Database Syst Rev 2017;3:CD010134). It is unclear how well
neurologic function is preserved in this population.
ix.
Mechanical chest compression devices have not been shown to be superior to conventional
CPR. They can be considered when prolonged CPR is necessary, or high-quality manual CPR
is not available, being mindful of interruptions in CPR during device deployment and removal
chest compressions are not superior to manual chest compressions (Cochrane Database Syst
Rev 2018;8:CD007260). Furthermore, in shockable rhythms, mechanical chest compression
devices may lead to longer times to first defibrillation and greater intervals between additional
defibrillations (Resuscitation 2017;115:155-62).
Data suggest that patients can have ROSC with meaningful neurological recovery even
after prolonged (>25 min) pre-hospital resuscitation efforts (Circulation 2016;133:1386-96;
Resuscitation 2016;105:45-51), so extended CPR efforts can be anticipated.