Cardiopulmonary resuscitation (CPR) manually circulates blood and oxygen when a person’s heart has stopped beating. Not all CPR is equally effective in sustaining life. High-Quality CPR (HQC) refers to a precise set of actions and measurable metrics designed to maximize the flow of oxygenated blood to the brain and heart. Adhering to these standardized actions increases the chance of survival. The success of resuscitation efforts depends on the rescuer’s ability to execute these specific components.
Achieving Optimal Compression Depth
The goal of chest compressions is to physically squeeze the heart between the sternum and the spine, creating the pressure necessary to pump blood out to the body. Compressing the chest to the correct depth is paramount for achieving adequate blood circulation to vital organs. For adults, current guidelines recommend pushing down at least 2 inches (5 centimeters) with each compression.
It is important not to compress the chest too deeply; the maximum recommended depth is 2.4 inches (6 centimeters). Inadequate depth fails to create the pressure needed for proper blood flow, while excessive depth increases the risk of injury. Rescuers should use their body weight, keeping their arms straight and shoulders directly over their hands, to achieve the necessary force.
Maintaining the Correct Compression Rate
Maintaining the right rate for chest compressions ensures that blood is circulated continuously and consistently. Pushing too slowly provides insufficient blood flow, but compressing too quickly prevents the heart from filling adequately between pushes. The recommended compression rate for all age groups is a steady tempo of 100 to 120 compressions per minute.
This numerical range optimizes the balance between generating adequate pressure and allowing for heart refill. Consistently maintaining this rate is a measurable metric of HQC, and rates outside this narrow window are associated with decreased survival rates.
Ensuring Complete Chest Recoil
Complete chest recoil is allowing the chest wall to fully return to its normal, uncompressed position after each push. This movement is physiologically essential for creating a vacuum-like effect inside the chest. This negative pressure draws deoxygenated blood back into the heart, a process known as venous return, which is necessary for the heart to refill.
Failing to allow full recoil, often caused by the rescuer “leaning” on the chest, significantly limits the amount of blood the heart can draw back in. Allowing the chest to fully spring back ensures that each subsequent compression maximizes the stroke volume.
Minimizing Breaks in Compressions
Continuous blood flow is crucial during cardiac arrest, and interruptions in chest compressions cause a rapid drop in coronary perfusion pressure. This pressure supplies blood to the heart muscle itself. Minimizing the “hands-off” time is a defining feature of HQC.
The goal is to achieve a Chest Compression Fraction (CCF) of at least 60%, meaning that 60% or more of the total resuscitation time is spent actively performing compressions. All interruptions, including those for rhythm checks or rescue breaths, should be limited to less than 10 seconds. In a two-person rescue, one rescuer should prepare equipment while the other continues compressions until the moment an intervention is required.
Delivering Effective Rescue Breaths
For adult victims receiving combined CPR, the standard ratio of compressions to ventilations is 30 compressions followed by 2 rescue breaths. These breaths serve to oxygenate the blood that the compressions are circulating. The air should be delivered over approximately one second to avoid forcing air into the stomach, which can cause complications like vomiting.
Each breath should be just enough to cause a visible rise of the chest. Excessive ventilation can increase pressure within the chest, which reduces the blood return to the heart and lowers the effectiveness of the compressions. After delivering the two breaths, the rescuer must immediately return to chest compressions to minimize the pause in circulation.