When multiple rescuers are present during a cardiac arrest, they must work as a coordinated team to deliver high-quality cardiopulmonary resuscitation (CPR). This team approach, known as multi-rescuer CPR, ensures the patient receives continuous, effective chest compressions and ventilations. The primary objective is to maintain a consistent flow of oxygenated blood to the brain and heart, which is the most important factor influencing survival. Achieving this requires managing the physical demands of the procedure and preventing any decline in compression quality. The strategy for rotating personnel is a planned component of the overall resuscitation effort.
Why Rescuers Must Switch Roles
The physical act of performing chest compressions is extremely demanding, and rescuer fatigue sets in rapidly, often within the first two minutes of continuous CPR. This exhaustion immediately compromises the quality of life-saving compressions. When a rescuer becomes fatigued, the compression depth often decreases significantly, falling below the recommended two inches. This reduction means less blood is pumped to vital organs, decreasing the perfusion pressure necessary for survival.
Fatigue also causes the rescuer to struggle with maintaining the correct compression rate of 100 to 120 beats per minute. They may also fail to allow for complete chest recoil between compressions. Reduced recoil prevents the heart from fully refilling with blood before the next compression, reducing the overall effectiveness of the procedure. Studies show a significant reduction in correct compressions after just the first minute of effort. To counteract this inevitable physical decline, rescuers must be rotated preemptively before their performance drops below acceptable standards.
The Standard Time Limit for Switching
Major resuscitation guidelines recommend a definitive, scheduled timing for the switch to prevent fatigue from affecting compression quality. The standard time interval for rotating the rescuer performing chest compressions is approximately every two minutes. This two-minute period is timed to coincide with other scheduled events, such as a pulse check or the analysis of the heart rhythm by an automated external defibrillator (AED).
The two-minute timing is chosen as a preventative measure, initiating the switch before the onset of noticeable fatigue. For conventional CPR involving both compressions and ventilations, this interval typically equates to five cycles of 30 compressions followed by two breaths. Rescuers should adhere to this two-minute cycle regardless of whether they feel tired, as the goal is to maintain peak compression efficacy throughout the entire resuscitation effort.
Minimizing Interruptions During the Transition
When the time comes to switch, the transfer of the compression role must be executed with speed and precision to ensure continuous blood flow. The primary focus during this transition is to minimize the “hands-off” time—the period when no compressions are being delivered—to less than 10 seconds, and ideally, less than five seconds. Any significant pause in compressions can cause a drop in coronary perfusion pressure, which is detrimental to the patient’s outcome.
Effective communication is paramount for a smooth transition. The rescuer responsible for the timing typically calls out a cue, such as “Switching soon” or “Prepare to take over.” The incoming rescuer should already be positioned next to the patient, ready to take over compressions immediately as the current rescuer moves away. The new compressor begins compressions the moment the former compressor stops, aiming for a seamless handover.