Cardiopulmonary Resuscitation (CPR) is a time-sensitive procedure involving chest compressions and ventilations to manually circulate blood and oxygen to the brain and vital organs when the heart has stopped. The effectiveness of this intervention relies entirely on the quality of chest compressions, which must be delivered at an adequate depth and rate. Because high-quality compressions are physically demanding, maintaining this standard requires a strategic approach to switching responders.
The Recommended Rotation Schedule
Major resuscitation bodies, such as the American Heart Association and the European Resuscitation Council, advise rotating the rescuer performing chest compressions approximately every two minutes. This interval is a proactive measure designed to prevent fatigue before it degrades compression quality. The two-minute mark often coincides with other planned interruptions, such as rhythm checks or the analysis phase of an automated external defibrillator (AED).
For rescuers using the standard ratio of 30 compressions followed by 2 ventilations, the two-minute rotation interval typically translates to changing positions after five complete cycles. This scheduled rotation is important for both lay rescuers performing bystander CPR and professional teams. Adhering to this interval ensures a fresh, non-fatigued person takes over, helping maintain the necessary compression depth and rate.
Recognizing Indicators of Rescuer Fatigue
While the two-minute timer provides a scheduled moment for rotation, switching responders sooner is necessary if compression quality declines. Fatigue compromises the procedure’s effectiveness and can set in earlier than two minutes. The most significant indicator of fatigue is a noticeable decrease in compression depth, which can begin to decay as early as 90 seconds into the cycle.
Even if the compression rate remains within the target range of 100 to 120 compressions per minute, reduced depth directly impairs artificial circulation. Other indicators prompting an immediate, unscheduled switch include visible signs of physical exhaustion, such as heavy breathing, profuse sweating, or the compressor verbally requesting relief. If compression quality is compromised, the switch must happen instantly, regardless of the clock, to restore high-quality CPR.
Executing the Switch with Minimal Interruption
The primary objective during a change of responders is to minimize the “hands-off” time, the period when chest compressions are paused. Current guidelines emphasize that this interruption should be kept to an absolute minimum, ideally less than 5 to 10 seconds, to preserve the patient’s coronary perfusion pressure.
To achieve this rapid transition, the incoming rescuer should be positioned and ready to take over before the switch is called. Clear and concise verbal communication is necessary, with the incoming rescuer confirming readiness and the outgoing rescuer announcing the exact moment they are stopping.
The smoothest transition often occurs during the brief pause scheduled for ventilations or during a rhythm check from an AED. The new compressor should immediately place their hands and begin compressions the moment the previous rescuer lifts their hands, ensuring the quickest possible resumption of the intervention.