Cardiopulmonary Resuscitation (CPR) is a life-saving intervention performed during cardiac arrest, a sudden cessation of the heart’s pumping function. Effective chest compressions are the most important component of high-quality CPR, manually circulating blood to the brain and other vital organs. Maintaining continuous, uninterrupted compressions is important for maximizing blood flow.
Understanding Chest Compression Fraction
Chest Compression Fraction (CCF) represents the percentage of time during a cardiac arrest resuscitation attempt that chest compressions are actively being performed. This metric is important because continuous blood flow is necessary to deliver oxygen and nutrients to the heart and brain. A higher CCF directly correlates with improved outcomes due to sustained perfusion.
Foundation of High-Quality Compressions
Achieving a high chest compression fraction depends on the quality of each compression. For adult patients, compressions should reach a depth of at least 2 inches (5 centimeters) but no more than 2.4 inches (6 centimeters) and be delivered at a consistent rate, ideally between 100 and 120 compressions per minute. Allowing the chest to fully recoil after each compression is necessary, as this allows the heart to adequately refill with blood before the next compression. Leaning on the chest between compressions can prevent this refilling, diminishing the effectiveness of subsequent compressions.
Strategies to Minimize Interruptions
Minimizing pauses and interruptions during CPR is the direct path to achieving a high chest compression fraction.
Team Dynamics
Establishing efficient team dynamics with clearly defined roles and responsibilities helps ensure seamless transitions between tasks. For example, one team member can prepare the defibrillator while another continues compressions.
Defibrillation Pauses
Pre-shock and post-shock pauses must be as short as possible. Compressions should continue while the defibrillator charges, stopping only briefly before shock delivery. Immediately after the shock, compressions must resume without delay.
Ventilation During CPR
When an advanced airway is in place, ventilations can be delivered asynchronously (one breath every 6 seconds) without pausing chest compressions. If an advanced airway is not present, a 30:2 compression-to-ventilation ratio is recommended.
Compressor Changes and Overall Efficiency
Rapid and efficient compressor changes are necessary to prevent fatigue and maintain high-quality compressions. These changes should occur every two minutes or when the compressor shows signs of fatigue, taking no more than five seconds. Limiting scene time and minimizing transport delays further contributes to sustained compressions.
The Impact of High CCF
Maintaining a high chest compression fraction significantly influences patient outcomes during cardiac arrest. A higher CCF increases the likelihood of achieving return of spontaneous circulation (ROSC), which is when the patient’s heart begins beating effectively on its own. Studies consistently show a strong correlation between a higher CCF and improved survival rates to hospital discharge. The sustained blood flow provided by continuous compressions helps preserve organ function, underscoring why maximizing CCF is a primary goal in resuscitation efforts.