Cardiopulmonary resuscitation (CPR) is a life-saving procedure performed when someone’s breathing or heartbeat has stopped. During cardiac arrest, the heart cannot effectively pump blood, leading to a cessation of blood flow to vital organs. Chest compressions are the most important part of CPR, as they manually circulate oxygenated blood to the brain and heart. Maintaining continuous, high-quality chest compressions is important for patient outcomes and increases the chances of survival until medical help arrives.
Impact of Fatigue on Compression Quality
Performing chest compressions is physically demanding, and rescuers can experience fatigue quickly. This exertion leads to a decline in compression quality, directly impacting CPR effectiveness. Studies indicate a decrease in quality can occur within minutes of starting the procedure.
Fatigue can manifest as shallower compressions, failing to meet the recommended depth of at least two inches (five centimeters) for adults. It can also lead to a slower compression rate, falling below the optimal range of 100 to 120 compressions per minute. Fatigued rescuers may also exhibit incomplete chest recoil, where the chest does not fully return to its original position after each compression, hindering blood refilling in the heart. Increased pauses during compressions also reduce continuous blood flow to vital organs, diminishing the overall effectiveness of CPR.
Optimal Switching Intervals
To maintain high-quality chest compressions and counteract rescuer fatigue, major resuscitation guidelines recommend regular switching of compressors. Organizations like the American Heart Association (AHA) and the European Resuscitation Council (ERC) advise switching roles approximately every two minutes. This interval is often equivalent to about five cycles of 30 compressions and two ventilations in a two-rescuer scenario.
The two-minute interval relates to the observed onset of significant fatigue. Research shows compression quality, particularly depth, can begin to degrade after 90 seconds to two minutes of continuous compressions. Switching before this decline becomes substantial helps ensure compressions remain within high-quality parameters. Making these transitions quickly, ideally in less than five seconds, minimizes interruptions to continuous compressions.
Recognizing the Need to Switch
While the two-minute interval provides a structured guide, rescuers should also observe practical signs indicating a switch is needed, even if the recommended time has not yet passed. Visible signs of fatigue include changes in posture, such as slouching or leaning heavily, or a noticeable decrease in compression depth and rate. The compressor might also show physical signs of exertion like sweating or labored breathing.
Verbal cues, such as grunts or strained sounds, can also signal increasing fatigue. In multi-rescuer situations, effective team communication is important to proactively identify these signs and facilitate a smooth transition. The goal is to switch before a significant drop in compression quality occurs.