CPR: What to Strive For?

by Darin Abbey

I remember when we use to talk about providing CPR to our cardiac arrest patients.

Then it became clear that we were not doing it well enough and so the industry started to refer to the need to provide High Quality CPR. Since then we are challenged both by the difficulty in defining exactly what the appropriate details of care are that comprise this intervention and likewise we remain challenged by ways to demonstrate ongoing clinical competence.

Recent years have provided continued research on what makes “best practice” chest compressions. Below are some facets of the 2010 Guidelines and possible changes that may be coming in the 2015 Guidelines:

2010 Guidelines 2015 Guidelines
The right depth “at least 5 cm” Perhaps 4 to 5.5 cm
The right rate “at least 100 per/min” Perhaps 100 to 120 per/min
Minimize interruptions “10 seconds or less” Likely no change?

In addition to continued enthusiasm for assuring “full chest recoil during chest compressions”, what is also likely not to change is the focus on systems of care and quality improvement. As Resuscitationists, both at the macro and micro levels we must continue to measure our performance and identify areas for improvement and strategies to do so.

And what about during CPR? Lately journals have discussed cases when CPR has been so strong that patients have regained consciousness. Resuscitation reports now exist of patients with purposeful movements, eye opening, localizing to painful stimuli, communicating with rescuers, and a few patients even understanding and adhering to voiced requests.

Such reports suggest that in a cartoon unreal world, that perhaps our goal during CPR should be to provide such great cerebral perfusion that our patients look to us and say, “You are doing a great job! Please keep it up!” Now that would be a measure of High Quality CPR to strive for.

However in our real world, the patient with apparent consciousness during high quality CPR presents an emotional and clinical challenge. In the absence of current guidelines recommendations teams may benefit from being informed of this possibility and considering potential clinical and emotional responses.

 

Suggested reading and to learn more:

Meaney P. et al. (2013) AHA Consensus statement on CPR Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital. Circulation.

http://circ.ahajournals.org/content/early/2013/06/25/CIR.0b013e31829d8654

Steill I. et al. What is the optimum chest compression depth during out of hospital cardiac arrest resuscitation of adult patients? Circulation 2014 Nov 25; 130 (22) : 1962-70

Olaussen A. et al. Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review. Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.10.01

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