Lecture Notes: High-Quality CPR

Key Importance of CPR

• High-Quality CPR significantly increases survival rates in cardiac arrest patients.

Five Major Determinants of CPR Quality

1. Compression Rate

   • Aim for 100 to 120 compressions per minute.
   • Higher rates correlate with increased chances of return of spontaneous circulation (ROSC) and survival.

2. Compression Depth

   • Optimal depth: 2 to 2.5 inches (4 to 5 cm).
   • Any depth > 4 cm increases survival probability.
   • Depth around 5 cm is optimal for both ROSC and survival to discharge.

3. Continuity

   • CPR should be performed for at least 60% of the resuscitation time.
   • Aim for 80-90% if possible for maximal survival outcomes.

4. Chest Wall Recoil

   • Allow full chest recoil after compressions to enable heart refilling.
   • Leaning on the chest prevents normal filling and reduces cardiac output.

5. Hyperventilation

   • Avoid excessive ventilation as it can decrease cardiac output and worsen outcomes in arrest.

Compression Rate Research

• Studies indicate better outcomes with compressions in the range of 100 to 120 per minute.

Compression Depth Research

• Depth of just under 5 cm correlates with return of spontaneous circulation.
• Depth over 4 cm increases survival odds significantly.

Chest Compression Fraction (CCF)

• Higher CCF correlates with better survival rates.
• Data shows:
  • 60-80% CCF: highest survival odds.
  • Aim for minimum 60%, ideally in the 80% range.

Shockable Rhythms

• Shockable rhythms: Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT).
  • VF: disorganized squiggles, no pattern.
  • VT: wide, bizarre-looking QRS complexes but organized.
• Importance of early defibrillation for shockable rhythms.
• Significant decrease in survival odds after 1 minute of elapsed time without defibrillation.

Defibrillation Timing

• Immediate assessment and defibrillation is crucial; survival rates plummet after 6 minutes without defibrillation.

Advanced Support After Good CPR

• Once good CPR is established and rhythm assessed, initiate bag valve mask ventilation.
  • Coordinate: 30 compressions followed by 2 breaths.
• Establish vascular access if in a hospital setting.
• Regular rhythm reassessment every 5 cycles (2 mins).

Conclusion on Interventions

• Basic life support (BLS) and early CPR/defibrillation are more critical than advanced interventions (drugs, airway management).
• Studies show minor differences in outcomes with advanced life support vs. basic techniques.

Case Example: 58-Year-Old Male in Sporting Event

• Call for help and assess for a carotid pulse.
• Initiate chest compressions if no pulse is present.
• Use a defibrillator quickly to assess and shock if indicated.

[End of Lecture Notes]