Objective Measures of Good CPR
High quality CPR with minimal interruptions is a priority when running codes because (along with early defibrillation) it’s one of the two factors that has been shown to improve cardiac arrest survival-to-discharge outcomes. This is why (Ideally) the only time we should stop chest compressions is to analyze the rhythm and deliver a shock when V-Fib or pulseless V-Tach is present. Even then, interruptions to compressions should last no longer than 10 seconds to help us maintain a chest compression fraction of at least 80%. But how do we know if high quality, effective CPR is being performed? The objective measures of good CPR is today’s Pass ACLS tip topic.
How do we know if high quality, effective CPR is being performed?
From an Objective QA/PI perspective high quality CPR should meet these criteria:
- A compression rate of 100 – 120 per minute;
- A depth of at least 5 cm and allowing for full chest recoil as observed by a feedback device;
- An End tidal CO2 greater than 10 mm Hg; and
- Interruptions last less than 10 seconds so that we provide fast & deep compressions at least 80% of the time. This is called the Chest Compression Fraction or CCF.
Because high-quality, uninterrupted CPR is so important, code teams should assign a CPR Coach. The role of the CPR Coach on the code team is to ensure that CPR is being performed effectively and provide real-time critical feedback.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions. Many devices have a built in metronome to help compressors maintain their rate. Some devices connect directly to the crash cart monitor and will store data that can be reviewed during the post-code debrief to aid in continuous improvement and Quality Assurance.
The use of end tidal waveform capnography (ETCO2) to:
- Evaluate the effectiveness of CPR – good CPR will produce a peak wave > 10 mm Hg;
- Confirm placement of an advanced airway – if we hear bi-lateral breath sounds and see an ETCO2 wave, the ET tube is in the right position
If the CPR Coach, or any member of the team, sees the peak wave is less than 10 they should speak up. More about ACLS’s use of ETCO2 can be found in another Pass ACLS tip of the day.
A no-tech way to monitor effective CPR if a compression feedback device or ETCO2 capnography isn’t available is to check for a femoral or carotid pulse while CPR compressions are in progress. If you can feel a pulse that matches compressions… Good Job! For this reason remember, pulse checks to establish ROSC must be done while CPR compressions are paused and should last less than 10 seconds. Do not stop CPR because someone feels a pulse while compressions are in progress.
