High-Quality CPR

DSC_0049_CPRTo give victims of sudden cardiac arrest the best chance of survival, first aid providers must perform high-quality CPR (HQ CPR). HQ CPR is so important that it was a major theme in both the 2010 and 2015 American Heart Association (AHA) Emergency Cardiac Care (ECC) Guidelines. Learning to give HQ CPR is not as difficult as it might sound. In fact, there are only 5 characteristics of HQ CPR, and they are easy to learn and to practice.

Characteristics

The 5 characteristics of HQ CPR are:

  • Adequate compression rate: 100 to 120 compressions per minute (cpm). (Don’t confuse rate with ratio: the rate is 100 - 120 cpm; the ratio is 30 compressions to 2 breaths.)
  • Adequate compression depth: 2 to 2.4 inches (5 to 6 cm) for adults, 2 inches (5 cm) for children, and 1.5  inches (4 cm) for infants. Another method of measuring adequate depth of compressions is at least 1/3 the depth of the chest.
  • Full chest recoil between compressions: Allow the chest to recoil to normal in between each compression. Take all pressure off the chest without removing your hands from the chest.
  • Minimal interruptions of CPR: Start CPR as soon as possible. Once you begin CPR, do not stop to check pulse or breathing. Try for a compression fraction of 80%. This means that 80% of the time (e.g., 4 out of 5 minutes) helping the unresponsive patient was spent giving compressions.
  • No excessive breaths: Give each breath over 1 second to make the chest rise. Ventilating too long or too hard can push air into the stomach which can cause complications such as vomiting.

Do’s and Don’t’s of HQ CPR

Do Don’t
Rate of Compressions 100–120 compressions per minute (cpm). < 100 cpm or > 120 cpm.
Compression Depth Adult: At least 2 inches (5 cm).

Child: About 2 inches (5 cm) or ⅓ the depth of the chest.

Infant: About 1½ inches (4 cm) or ⅓ the depth of the chest.

 Compress to the depths listed:

Adult: < 2 inches (5 cm) or > 2.4 inches (6 cm).

Child: < > 2 inches (5 cm) or ⅓ the depth of the chest.

Infant: < > 1½ inches (4 cm) or ⅓ the depth of the chest.
Chest Recoil Full recoil between compressions without loss of hand contact. Apply pressure to the chest between compressions.

Lose contact with the chest between compressions.
Interruptions in CPR Reduce interruptions to 10 seconds or less. Strive for a compression fraction of 80%. Interrupt CPR for more than 10 seconds. Compression fraction below 60%.
Ventilations 2 breaths following each set of chest compressions. Each breath delivered over 1 second, each causing chest rise. More or less than 2 breaths. Inadequate breaths (no chest rise) or excessive breaths (over 1 second or causing signs of gastric distention).

Source: American Heart Association 2015 ECC Guidelines