The following article is written by David Grovdahl, MS, NRP is an EMS director and advocate for rural EMS systems. He has been a paramedic for 18 years and lectures frequently on topics ranging from data analysis to system design and the integration of technology in rural areas.
The 5 Components of High Quality CPR
Not that long ago, professional rescuers were taught to push hard and fast when treating victims of cardiac arrest. That’s all you needed to ensure you were doing good chest compressions, or so you were taught. The 2015 American Heart Association (AHA) and European Resuscitation Council (ERC) Guidelines continue to raise the bar on what’s required to provide life-saving CPR. High-quality CPR Defined In the 2015 Guidelines, the AHA describes high-quality CPR as the combined impact of 5 factors:
1. • Depth: 2–2.4 inches (5–6 centimeters)
2. • Compression rate: 100–120/minute
3. • Recoil: Allow for full recoil after each compression. No leaning.
4. • Minimize pauses. Get the chest compression fraction (CCF), the percentage of time CPR is being delivered, as high as possible, with a target of at least 60%. It may be reasonable with a sufficient number of rescuers to achieve a CCF greater than 80%.
5. • Ventilation: 2 breaths after 30 compressions without an advanced airway; 1 breath every 6 seconds with an advanced airway.
These metrics represent our best description of the type of CPR that is likely to result in a good outcome for patients. Each factor contributes to patient outcomes and needs to be monitored, recorded, and reviewed for continuous quality improvement.
One of the significant changes in the 2015 Guidelines was establishing an upper limit of 2.4 inches for compression depth and more specific guidance on rate: 100 to 120 compressions per minute, compared with >100 in the 2010 Guidelines.