HIGH-QUALITY CPR IN ACLS

 

High-quality cardiopulmonary resuscitation (CPR) is the foundation of successful resuscitation. Effective chest compressions and ventilations are critical to maintaining oxygenated blood circulation to vital organs, increasing the likelihood of return of spontaneous circulation (ROSC).

🚨 Why High-Quality CPR Matters:
✅ Increases perfusion to the brain and heart during cardiac arrest.
✅ Improves chances of successful defibrillation.
✅ Directly correlates with survival and neurological outcomes.

Even with advanced interventions like defibrillation and medications, poor CPR reduces survival rates—making high-quality CPR the most important factor in effective ACLS management.


1️⃣ COMPONENTS OF HIGH-QUALITY CPR

🔹 The goal of CPR is to maximize circulation while minimizing interruptions.

ComponentGuideline
Compression Rate100-120 compressions per minute (Keep the rhythm of “Stayin’ Alive” 🎶)
Compression DepthAt least 2 inches (5 cm) for adults
Full Chest RecoilAllow full recoil between compressions (avoid leaning on the chest)
Minimizing InterruptionsPause for less than 10 seconds for rhythm checks or defibrillation
Avoiding Excessive Ventilation10 breaths per minute with advanced airway
Compression-to-Ventilation Ratio30:2 (if no advanced airway)

🚨 CPR should be uninterrupted unless absolutely necessary—every pause reduces survival!

 

2️⃣ CHEST COMPRESSION TECHNIQUE

🔹 Hand Placement for Adult Chest Compressions

✅ Locate the lower half of the sternum (breastbone).
✅ Place the heel of one hand in the center of the chest.
✅ Place the other hand on top and interlock fingers.
✅ Keep elbows locked and shoulders directly over hands.
✅ Use your upper body weight—not just your arms—to apply pressure.

🚨 Common Mistake: Incorrect hand placement (too high or too low) can result in rib fractures or ineffective compressions.

🔹 Chest Compression Depth & Rate

✅ Compression Depth:

  • Adults: At least 2 inches (5 cm)
  • Children: At least one-third the chest depth (~2 inches or 5 cm).
  • Infants: At least one-third the chest depth (~1.5 inches or 4 cm).

✅ Compression Rate:

  • 100-120 compressions per minute
  • Use a metronome or music like “Stayin’ Alive” to maintain pace.

🚨 Common Mistake: Inadequate depth or rate reduces perfusion and survival rates.

🔹 Full Chest Recoil

✅ Why is recoil important?

  • Allows the heart to refill with blood, maximizing circulation.
  • Avoid leaning on the chest between compressions.

🚨 Failure to allow full recoil reduces cardiac output and the effectiveness of CPR.

🔹 Minimizing Interruptions in CPR

✅ Pauses should be limited to less than 10 seconds!

  • Defibrillation should be performed with minimal CPR interruption.
  • Advanced airway placement should be attempted without delaying compressions.
  • Medications should be given without disrupting compressions.

🚨 Each interruption in CPR significantly lowers survival rates!

 

3️⃣ VENTILATION IN CPR

🔹 Avoiding Excessive Ventilation

✅ With an advanced airway (ETT or supraglottic device):

  • Give 1 breath every 6 seconds (10 breaths per minute).
  • Do NOT pause compressions for ventilation.

✅ Without an advanced airway (Bag-mask ventilation):

  • Use a 30:2 compression-to-ventilation ratio.
  • Each breath should be delivered over 1 second, with visible chest rise.

🚨 Over-ventilation increases intrathoracic pressure, reducing venous return and cardiac output!

 

4️⃣ CPR SEQUENCE: C-A-B APPROACH

🔹 ACLS follows the C-A-B sequence:

1️⃣ C = Compressions

  • Start chest compressions immediately upon recognizing cardiac arrest.
  • Ensure high-quality compressions with minimal interruptions.

2️⃣ A = Airway

  • Open the airway using the head-tilt/chin-lift maneuver (unless trauma suspected → use jaw thrust).
  • Place an advanced airway if indicated (ETT, supraglottic airway).

3️⃣ B = Breathing

  • Provide ventilations at 10 breaths per minute (with advanced airway).
  • Ensure visible chest rise with each breath.

🚨 Why C-A-B instead of A-B-C?

  • Early compressions improve circulation and increase chances of survival.
  • Prioritizing compressions over ventilation reduces time to first chest compressions.
 

5️⃣ MONITORING EFFECTIVENESS OF CPR

🔹 Use real-time feedback devices when available:
✅ Capnography (ETCO₂ monitoring)

  • Normal ETCO₂ during CPR should be ≥10-15 mmHg.
  • ETCO₂ <10 mmHg suggests poor compressions—improve technique!
  • Sudden ETCO₂ rise (>40 mmHg) may indicate ROSC (Return of Spontaneous Circulation).

✅ Diastolic Blood Pressure (if arterial line present):

  • Aim for >20 mmHg diastolic pressure to ensure adequate coronary perfusion.

🚨 Real-time feedback improves compression quality and patient outcomes!

 

6️⃣ WHEN TO STOP CPR? (TERMINATION OF RESUSCITATION)

💔 Consider stopping CPR if:
✅ No ROSC after 20-30 minutes of high-quality CPR.
✅ Persistent asystole despite epinephrine and defibrillation (if shockable rhythm initially).
✅ No reversible causes (H’s & T’s) identified.
✅ Decision made in consultation with medical team and family.

🚨 Prolonged CPR can still lead to survival—cases exist where ROSC occurred after 30+ minutes!

 

7️⃣ COMMON PITFALLS IN CPR & HOW TO AVOID THEM


ErrorImpactCorrection
Slow compression rate (<100/min)Decreased circulationUse a metronome or pacing song
Inadequate depth (<2 inches)Reduced cardiac outputPush at least 2 inches deep
Excessive ventilation (>10 breaths/min)Increased intrathoracic pressure, reduced perfusionLimit to 10 breaths/min with advanced airway
Frequent interruptions in compressionsPoor perfusionMinimize interruptions to <10 sec
Incomplete chest recoilReduced cardiac outputAllow full chest recoil after each compression

🚨 Quality matters more than speed—poor CPR can be worse than no CPR!

 

8️⃣ FINAL TAKEAWAYS: MASTERING HIGH-QUALITY CPR IN ACLS

✅ Compression rate: 100-120 per minute (Stayin’ Alive Beat 🎶).
✅ Compression depth: At least 2 inches (5 cm) for adults.
✅ Full chest recoil: Avoid leaning on the chest between compressions.
✅ Minimize interruptions: Pause <10 sec for defibrillation, rhythm checks.
✅ Ventilation: 10 breaths per minute with advanced airway (avoid hyperventilation).
✅ ETCO₂ monitoring: >10-15 mmHg suggests effective CPR; sudden rise may indicate ROSC.

🚑 Takeaway: Mastering high-quality CPR is the single most effective skill in ACLS—compression quality directly correlates with survival!