- To provide external chest compressions in a patient with no pulse in order to create blood flow to vital organs and/or sustain a shockable rhythm
- Swap compressors every 2 minutes due to fatigue and degraded compression quality.
- Adopt correct posture (4) at patient’s left.
- Minimise interruptions and limit them to 3 seconds maximum wherever possible.
- Compressions on non-supine patients OR on non-rigid surfaces are usually ineffective.
- Position the patient supine on a firm flat surface. Prepare in line with IMPACT CPR principles:
- Create or move to a good working space with 360° access where possible in a timely manner
- Feedback and CPR quality devices MUST be used where available.
- Begin high quality, focused compressions with minimal interruptions immediately.
| Newborn or infant | The two thumb technique (1) is preferred with 2 rescuers. The hands encircle the chest and the thumbs compress the lower sternum. The two finger technique to minimise the transfer time between compressions and ventilations where only 1 rescuer. |
| Child | Compressions are to be performed with the heel of one hand (2) in the centre of the chest. |
| Adult | Utilise the two handed technique (3) with hands positioned in the centre of the chest. |
- Compression depth is approximately ⅓ the depth of the chest. CPR Feedback devices MUST be used where available.
| Infant | Approximately 4 cm |
| Child < 12 years | Approximately 5 cm |
| Adult | More than 5 cm |
- Allow the chest to fully recoil after each compression.
- Target compression rate is:
| Newborn < 3 hours | 3 : 1 (90 / minute) |
| Infant / Child < 12 years | 15 : 2 (100 - 120 / minute) |
| Adult | 30 : 2 (100 - 120 / minute) |
- The compression to ventilation radio (i.e. 15:2, 30:2) is best defined as 15/30 compressions to 2 seconds pause, to facilitate ventilation. Recommence CPR at 2-3 seconds regardless and do not wait for 2 breaths to be completed.
Focused Compressions
The compressor should never be distracted and must not try to co-ordinate events whilst performing this skill as this leads to degraded performance.- Rate: Compression rates are those advocated by the ARC. Use a metronome where available (Corpuls3 has this enabled). The St. John First Responder App has a metronome in the Toolbox, set at 110 beats per minute.
- Depth: The ARC recommends a depth > 5 cm in adults. In children, the recommended depth is 5cm and in 4cm in infants1. Superficial depth is associated with lower survival probability.
- Recoil: Also referred to as leaning or release, the chest MUST be fully released on the upstroke / decompression phase. Rapid release creates negative pressure that promotes blood return to the thorax, and coronary perfusion. This can prolong shockable rhythms, which improves likelihood of a successful defibrillation.
- Hand Position: The ARC recommend the centre of the chest. Too high is ineffective and too low may precipitate regurgitation.
- Minimal Interruptions: Maximising time on chest with excellent compressions ensures that the blood pressure created is sustained as best as possible. By pausing for as little as 3 seconds, perfusion pressure can be lost completely and it is estimated to take 15 – 20 chest compressions to re-establish adequate perfusion pressure again.
- CorPuls CorPatch CPR Feedback Device
- Philips Q-CPR CPR Meter
- Two-thumb / two-finger compression technique, centre of the chest on a newborn/infant
- Single-handed compression technique on a child, hand positioned in the centre of the chest
- Two-handed compression technique on an adult, hands positioned in the centre of the chest
- Correct position
- Refer to Post-Resuscitation Care (ROSC) Guidelines.
- Refer to Determination of Death Guidelines.
| Settings | |
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| Extended Care: | |
| Colour assist: | |
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