Cardiopulmonary Resuscitation (CPR) is a life-saving technique used when someone’s heart stops beating. Delivering high-quality chest compressions is paramount for effective CPR and improves survival chances. However, continuous chest compressions are physically demanding, and rescuer fatigue can quickly compromise their quality.
Why Rescuer Switching Matters
Chest compressions require substantial physical effort, leading to rapid fatigue in rescuers, particularly in their arms and shoulders. Studies show that physical exhaustion can affect compression quality within 90 seconds to two minutes. This decline can manifest as shallower compressions, slower rates, and incomplete chest recoil, reducing blood flow to vital organs.
Maintaining proper hand placement, compression depth (at least 2 inches or 5 cm for adults), and a consistent rate (100-120 compressions per minute) becomes challenging when fatigue sets in. Incomplete chest recoil, where the chest does not fully return to its normal position between compressions, can impede the heart’s ability to refill with blood, reducing the effectiveness of each compression. Regular switching helps ensure compressions are delivered with necessary force and technique, optimizing blood flow and improving patient outcomes.
Recommended Switching Timelines
To counteract rescuer fatigue and maintain high-quality compressions, guidelines from organizations like the American Heart Association recommend switching rescuers every two minutes. This timeframe is based on research indicating that compression depth begins to degrade significantly after 90 seconds to two minutes of continuous chest compressions. For two-rescuer CPR, this interval translates to switching roles after about five cycles of 30 compressions and 2 breaths.
Adhering to this two-minute guideline is important, even if the rescuer performing compressions does not yet feel fatigued. Fatigue can impact compression quality before it is consciously perceived. Proactive switching ensures a fresh rescuer takes over before quality declines, maintaining continuous, effective blood flow. Consistent adherence to guidelines improves outcomes for cardiac arrest victims.
Seamless Rescuer Transition
A smooth, efficient rescuer switch is essential to minimize interruptions in chest compressions, as any hands-off time can reduce blood flow to the brain and heart. The goal is to complete the switch within five seconds or less. Clear communication between rescuers is important throughout this process.
Before the two-minute mark approaches, the rescuer performing compressions should verbally alert the team that a switch is imminent, by saying “Switching soon” or “Ready to switch.” The incoming rescuer should then position themselves to take over immediately, whether kneeling or standing opposite the current compressor. As the current rescuer finishes their compression cycle, they should announce “Last compression” or “Switching now,” and the new rescuer should begin compressions without delay.
The transition should involve a swift exchange of roles, with the new rescuer immediately taking over compressions while maintaining the correct rate and depth. The person managing the airway and ventilations can monitor the timer or provide verbal cues for the two-minute interval. Regular practice of these switching techniques during training helps teams develop coordination and muscle memory, ensuring transitions are seamless and compressions remain uninterrupted.