Cardiopulmonary resuscitation (CPR) is an intervention that can sustain life during a cardiac arrest. A common question arises regarding the optimal surface for performing CPR, particularly when a person is found on a soft surface like a bed. Understanding the importance of effective chest compressions is important, as these actions are designed to circulate blood to vital organs. The choice of surface directly impacts the quality and efficacy of these compressions.
Why a Firm Surface Matters for CPR
Effective chest compressions manually pump blood through the body when the heart cannot. Guidelines recommend compressing the chest by at least 2 inches (5 centimeters) but no more than 2.4 inches (6 centimeters) for adults, and at a rate of 100 to 120 compressions per minute. This depth and rate are important for maintaining blood flow to the brain and other vital organs.
When CPR is performed on a soft surface, such as a mattress, a significant portion of the force applied during compressions can be absorbed by the mattress itself. Studies show that up to 57% of the compression force may be absorbed by a soft surface, which can reduce the effective compression depth delivered to the person’s chest. This absorption makes it difficult to achieve the recommended compression depth, potentially leading to inadequate blood circulation. A soft surface also increases the effort required from the rescuer, potentially leading to earlier fatigue and a decline in compression quality.
A firm surface, like the floor or a backboard, provides the necessary resistance, ensuring that the force of compressions is directed towards the chest and heart. This allows for proper compression depth and full chest recoil, which is when the chest returns to its normal position after each compression. Full recoil is important because it allows the heart to refill with blood between compressions, maximizing the amount of oxygenated blood circulated.
Deciding Whether to Move the Person
When faced with the need to perform CPR on a person on a bed, the primary consideration is the quality of chest compressions. While a firm surface is ideal for effective CPR, the immediate initiation of compressions is even more important. Delaying CPR to move a person can reduce their chances of survival.
Moving an unresponsive person carries inherent risks, including potential injury to the person or the rescuer, and loss of time during which compressions could be delivered. If a mattress is very soft and compressions are clearly ineffective, or if the bed is unstable, moving the person might be considered. However, if any delay would occur or if the move poses a risk of further injury, it is advised against.
If moving is deemed necessary and feasible, it should be done quickly and safely with minimal interruption to compressions. One method involves log rolling the person onto a sheet and then using the sheet to drag them onto the floor. This technique can help minimize spinal movement and facilitate the transfer. If additional rescuers are available, they can assist in a coordinated move to ensure safety and speed.
Performing CPR When Moving Isn’t Possible
There are situations where moving a person to a firm surface is not feasible, too risky, or would cause significant delay in starting CPR. In these instances, initiating CPR immediately on the bed, even if it is soft, is still important. Any compressions are better than no compressions at all.
Strategies can be employed to improve the effectiveness of compressions on a soft surface. Placing a firm object, such as a large book or a CPR backboard, under the person’s back can provide some of the necessary resistance. For hospital beds, some models have a “CPR mode” that increases mattress stiffness or allows for rapid deflation, which can enhance compression quality.
Another approach is to position the person at the very edge of the bed. This allows the rescuer to use the floor for support under their knees, potentially enabling a more stable and forceful compression. Even on a less-than-ideal surface, maintaining proper hand placement in the center of the chest and striving for the recommended compression depth and rate remains the goal.
Prioritizing Immediate Chest Compressions
The most important takeaway in any cardiac arrest scenario is the immediate initiation of high-quality chest compressions. While a firm surface is preferred for optimal CPR effectiveness, the priority is to begin compressions without delay. Rapid action can increase the chances of survival. Always call emergency services immediately before or while starting CPR.