Chest Compressions

UNCONTROLLED WHEN PRINTED

Indications

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

Contraindications

Patient Factors & Considerations

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.

Procedure

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.
Newborn or infant	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.