Paramedic as Educator: Citizen Ready
High Quality, High Performance CPR
While Cardiopulmonary Resuscitation (CPR) has changed many times over the years with new research and technology, the desired outcome from CPR efforts has not.
The evolution of CPR has included an increased focus not only on WHAT we are doing or HOW we are doing, but also on the WAY we are doing it to achieve the most effective result. While the mechanics of CPR have remained relatively the same, greater focus is given to ensuring these mechanics are effective and not detrimental to our efforts. The more we know about why we are doing what we are doing or teaching, the greater likelihood these treatments will be successful in improving outcomes from sudden cardiac arrest.
Whether referred to as “High Quality” CPR (for lay rescuers) or “High Performance” CPR (for healthcare providers), it is the critical component in the success of survival from a sudden cardiac arrest and often focuses on similar elements. Simply put, it is an organized approach to significantly improve the quality of resuscitation for Sudden Cardiac Arrest (SCA) and the chance for survival of the affected person. CPR practices that reflect the concepts below are rapidly being adopted by healthcare providers and organizations and filtering into the public to lay-rescuers in modified applications where appropriate.
In areas where a higher focus is made on the quality of resuscitation, survival rates can go up remarkably, even as high as 40-60%, compared to 10–14% for outdated CPR practices. Without high-performance CPR, the likelihood of survival falls by an estimated 5–10% each minute.
For the past decade, the consensus expert view on resuscitation is that we are pretty dialed in on how to do it, but not as dialed in in the way we deliver it. There is a clear gap between what providers know about how to do CPR and their actual ability to perform it well. Narrowing this gap should be the priority.
• Research indicates that higher-quality skills, especially chest compressions, provide a higher chance for surviving Sudden Cardiac Arrest (SCA).
• Peak survival for SCA occurs at a compression rate of around 100-120 compressions per minute.
• The deeper the compression, the higher the survival rate. Compressions of at least 5 cm or 2 inches are recommended. Minor injury can occur with deeper compressions, but that should not prevent getting the deepest compression possible.
• Full chest recoil to normal position on the upstroke of compressions is critical. The effect of recoil on blood flow and SCA survival is significant and should not be underestimated.
• Blood pressure is created and maintained with ongoing compressions. When compressions stop, even for a short time, blood pressure is lost and has to slowly be built back up. Minimizing interruptions to compressions improves quality and survival.
• Excessive air volume in rescue breaths can result in complications that reduce the quality of the effort.
• Minimizing the interruption time of compressions before and after defibrillation can improve survival. With a team, the integration of using an AED when one arrives can go much more smoothly and without interrupting compressions. Compressions can be started immediately after a defibrillation shock is delivered.
• Performing chest compressions is tiring. It is unlikely a provider can maintain high-quality compressions for more than a 2 minutes. Seamlessly switching compressors every 2 minutes can help maintain compression quality.
With the science of resuscitation practices is ever-evolving, the more we know the more effective we can be educating the public to be “Citizen Ready” for when they are needed.