Chest Compressions

Learning Outcomes
By the end of the session, students will be able to:

1. Describe how to perform chest compressions during

cardiopulmonary resuscitation
2. Understand the scientific principles behind delivery of high-quality
chest compressions during cardiopulmonary resuscitation
Definitions

Cardiac arrest – when the heart stops pumping

Background – The Problem
• In the UK only 8% of people suffering out of hospital cardiac arrest survive
to go home to their families (1)
• Bystander CPR before arrival of the ambulance service has been shown to
double 30-day survival rates from OOHCA (2)
• However, bystander CPR rates are as low as 39% in the UK (3)
• This is poor compared to other developed countries, such as Norway,
where bystander CPR rates are as high as 73% and OOHCA survival to
hospital discharge is 25% (4).
• A YouGov survey of 2,072 UK citizens in 2014, found that 40% of people
would be reluctant to perform CPR because they lacked training or were
afraid (5).
Science – Chest Compressions
• 1667 cardiac arrests
• Linear regression graph
• Time without CPR vs %
survival

• CPR helps to buy time

• Larsen et al. 1993 (6)

The Don’ts of CPR
• Don’t be afraid!
• You can’t hurt someone in cardiac arrest
• Broken ribs are better than being dead
How to do chest compressions
• DOWN for the brain

• UP for the heart

Science – Chest Recoil
9 swine instrumented to
measure pressure of blood
perfusing the heart

Standard CPR with 100%

recoil vs CPR with 75%
recoil

Significant decrease in
coronary perfusion
pressure with incomplete
recoil

Yannopoulos et al. (7)

The Don’ts of CPR
• Don’t lean!
How to do chest compressions
• Depth
• 5 – 6cm
• 2 inches (in old money)
• 1/3rd of the chest depth
Science – Compression Depth
• Data analyzed from 60
resuscitations with CPR
compression monitoring
• All arrests where a shock
was delivered
• Analysis of the average
depth of compressions in
the 30 seconds prior to 1st
shock
• Greater compression depth
= more chance of successful
defibrillation
• Edelson et al. 2006 (8)
The Don’ts of CPR
• Don’t be a lightweight!
How to do chest compressions
• How fast? > 120
• 100 – 120 beats per minute Too fast

• 2 compressions per second 100 – 120

Just right
< 100
• Stayin’ alive Too slow

• Another one bites the dust

• Baby shark
Science - Rate
3098 patients with out of hospital
cardiac arrest

All had monitoring of chest

compressions and recording of
successful resuscitation

Demonstrated an increase in successful

resuscitation at rates between 100 –
120

Idris et al. 2012 (9)

Main Learning Points
Main take home messages
• Don’t be afraid to do CPR

• The quality of CPR does matter

• 5-6cm
• Ensure full recoil
• 100 – 120 BPM
References
• 1. Perkins GD, Lockey AS, de Belder MA, Moore F, Weissberg P, Gray H, et al. National initiatives to
improve outcomes from out-of-hospital cardiac arrest in England. Emerg Med J [Internet]. 2016
Jul 23 [cited 2018 Oct 29];33(7):448–51. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/26400865
• 2. Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early
Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest. N Engl J Med [Internet]. 2015
Jun 11 [cited 2018 Oct 29];372(24):2307–15. Available from:
http://www.nejm.org/doi/10.1056/NEJMoa1405796
• 3. Hawkes C, Booth S, Ji C, Brace-McDonnell SJ, Whittington A, Mapstone J, et al. Epidemiology
and outcomes from out-of-hospital cardiac arrests in England. Resuscitation [Internet]. 2017 Jan
[cited 2018 Oct 29];110:133–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27865775
• 4. Lindner TW, Søreide E, Nilsen OB, Torunn MW, Lossius HM. Good outcome in every fourth
resuscitation attempt is achievable—An Utstein template report from the Stavanger region.
Resuscitation [Internet]. 2011 Dec [cited 2018 Oct 29];82(12):1508–13. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/21752524
• 5. British Heart Foundation. Creating a nation of lifesavers. 2014.
References
• 6. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital
cardiac arrest: a graphic model. Ann Emerg Med [Internet]. 1993 Nov [cited 2018 Nov
13];22(11):1652–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8214853
• 7. Yannopoulos D, McKnite S, Aufderheide TP, Sigurdsson G, Pirrallo RG, Benditt D, et al. Effects of
incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and
cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation [Internet]. 2005
Mar [cited 2018 Nov 13];64(3):363–72. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/15733767
• 8. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, et al. Effects of
compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest.
Resuscitation [Internet]. 2006 Nov [cited 2018 Nov 13];71(2):137–45. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/16982127
• 9. Idris AH, Guffey D, Aufderheide TP, Brown S, Morrison LJ, Nichols P, et al. Relationship Between
Chest Compression Rates and Outcomes From Cardiac Arrest. Circulation [Internet]. 2012 Jun 19
[cited 2018 Nov 13];125(24):3004–12. Available from:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.059535