If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of 100 to 120 a minute (details described below). Start CPR with 30 chest compressions before giving two rescue breaths. ![]() If there is no pulse or breathing within 10 seconds, begin chest compressions. If you're well-trained and confident in your ability, check to see if there is a pulse and breathing. That means uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive (described in more detail below). If you're not trained in CPR or worried about giving rescue breaths, then provide hands-only CPR. Here's advice from the American Heart Association: The difference between doing something and doing nothing could be someone's life. If you’re involved with the resuscitation and you see someone going too fast, coach them to slow down if you see someone looking fatigued and going too slow, perhaps switch out providers.If you're afraid to do CPR or unsure how to perform CPR correctly, know that it's always better to try than to do nothing at all. Whether you count two compressions per second, sing “Staying Alive” by the Bee-Gees (to yourself), or practice during SIM sessions, getting that proper feel for a compressions rate of between 100 and 120 takes practice. Guiding our rate to between 100 and 120 compressions per minute will maximize cardiac output and provide adequate coronary perfusion pressure while still allowing for full chest recoil and compressions of appropriate depth. In fact, the European Resuscitation Council included an upper limit of 120 compression per minute in their 2010 guidelines. 12 By not allowing for full chest recoil or having shallow compressions, we lessen the chance of successful CPR. Chest recoil is increasingly incomplete at rates above 120 5 and there is an inverse relationship between rate and depth of compression. 11 So why add in an upper limit? Remember that successful CPR is not one component alone, but all working together, and hence one can affect another. 10īut isn’t faster always better? Animal models show cardiac output increases with rates of compression up to 150 3 and there is evidence to suggest rates of 120-140 lead to the greatest chance of return of spontaneous circulation (ROSC) for in-hospital cardiac arrest patients. 8 More recently, rates of between 100-120 have been shown to lead to the greatest chance of survival to discharge, 9 while chest compression rates were shown to be have a curvilinear association with ROSC, peaking at approx. 7 Early retrospective studies on in-hospital cardiac arrests showed higher compression rates improved chances of ROSC, even though the average compression rate was below the recommendation at that time. 5 Using end-tidal CO2 as a surrogate marker, since it correlates with cardiac output 6, a compression rate of 120 in humans provides significantly higher end-tidal CO2 compared to a compression rate of 80. In a recent manikin model, a rate of 120 was associated with the highest number of compressions that fulfilled criteria for high-quality CPR. To guide cardiac arrest resuscitation management we rely on animal data (as above), manikin studies and retrospective patient data. Performing a double-blinded, randomized clinical trial on cardiac arrest victims to identify the ideal rate of compressions would be extremely difficult to accomplish. A rate of 120 compressions per minute significantly elevated aortic peak pressure and the coronary perfusion gradient during cardiac arrest. 3 These same hemodynamic effects are seen in humans during CPR. In animal models, higher rates of compressions have been shown to improve 24hr survival 2 and increase total cardiac output while maintaining adequate coronary blood flow. This was updated from the 2010 guidelines which read: “It is reasonable for lay rescuers and health care providers to perform chest compressions at a rate of at least 100/min” “In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min” While the first set of guidelines suggested a rate of 60 compressions per minute, this has been revised multiple times, leading us to the most recent guideline published in 2015: 1 CPR recommendations for the compression rate have changed along with guidance from resuscitation literature. Friedrich Maass, a resident at that time, documented that chest compressions at a rate of 120 successfully resulted in palpable carotid pulses and successful resuscitation of two pediatric patients. Stu Netherton Follow along over the next 5 weeks as he covers Rate of Compression, Depth of Compression, Chest Wall Recoil, Minimizing Interruptions, and Avoiding Excessive Ventilation.Īs early as 1892 Dr. Editor’s note: This post marks the first in a series of posts outlining the evidence surrounding various aspects of CPR by Dr.
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