Chest compressions rate - if you're not at 100 per minute, is it better than you're over or under?

[tcripp]

Yes, Stayin' Alive is one. (And, cute Hutsy...) Another One Bites the Dust is another. Just be careful which one you choose to sing out loud in the little bathroom where your patient is wedged between the tub and toilet...

AHA is now teaching "at least 100" which tells you better is more. But, if you are watching and you see the compressor going all SVT on the patient, slow them down. Let's give the patient the best care possible.

[crotchitymedic1986]

It really does not matter, every 2-4 years AHA changes the algorythm to sell more books and keep themselves relative, but the truth is despite all those changes, out of hospital survivability has not significantly improved. So go through the motions to put on a good show for the family, then transport the body to the ER to be pronounced.

[chbare]

Every 2-4 years? Where did you pull that number from?

[crotchitymedic1986]

This took about 5 minutes, I am sure if I spent the night googling I would find more

ACLS:

http://en.wikipedia....ac_life_support shows the major changes 1980, 86,92, 2000, 2005, 2010.

http://circ.ahajourn...ppl_1/I-86.full discusses 2000

http://circ.ahajourn...12/24_suppl.toc 2007

http://media.america...r-updates.shtml 2010

BLS:

http://www.amazon.co...13960767&sr=1-1 iscusses 2000 and 2005 changes

http://www.msnbc.msn...-new-cpr-rules/ 2008

http://www.heart.org.../ucm_317350.pdf 2010

Edited August 21, 2011 by crotchitymedic1986

[paramedicmike]

Five to eight years isn't two to four years.

[chbare]

AHA re-examines the guidelines and recommends changes if needed every 5 years. The last changes occurred in 2005. Typically, it takes about a year or so for said changes to proliferate.

[croaker260]

The new 2010 ECC guidelines and supporting evidence clearly show that FASTER is better than SLOWER. Specifically, it states " To provide effective chest compressions, push hard and push fast. It is reasonable for laypersons and healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute (Class IIa, LOE B " This is different than the 2005 guidelines that recommended a rate of about a 100.

The guidelines also state: "The number of chest compressions delivered per minute is an important determinant of return of spontaneous circulation (ROSC) and neurologically intact survival. "

The studies that support this are:

Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder

HN, Hoffman P, Tynus K, Vanden Hoek TL, Becker LB. Chest compression

rates during cardiopulmonary resuscitation are suboptimal: a

prospective study during in-hospital cardiac arrest. Circulation. 2005;

111:428–434.

and

Wolfe JA, Maier GW, Newton JR Jr, Glower DD, Tyson GS Jr, Spratt

JA, Rankin JS, Olsen CO. Physiologic determinants of coronary blood

flow during external cardiac massage. J Thorac Cardiovasc Surg. 1988;

95:523–532.

The first study showed the following ROSC rates based on compression rate

• 40-72 compressions/minute : 40% ROSC
  
• 72-87 compressions.minute: 58% ROSC
  
• 87-94 compressions/Minute: 76% ROSC
  
• 94-138 Compressions/Minute: 75% ROSC
  

Considering that this is the total compressions delivered in a minute, not compression RATE (as in, this is the total compressions delivered even accounting for pauses, ventilation, scratching ass, etc) When you count the ventilation pauses and a goal of 20% hand off time or less each minute...if you screw up at all you will drop below 87/minute total compressions each minute.

The take home message is this: You will not decrease ROSC by going to fast, but you will significantly drop it if you go to slow. So.. a little fast (up to 138 min) is perfectly OK.

I hope this helps.

It really does not matter, every 2-4 years AHA changes the algorythm to sell more books and keep themselves relative, but the truth is despite all those changes, out of hospital survivability has not significantly improved. So go through the motions to put on a good show for the family, then transport the body to the ER to be pronounced.

Could not disagree more. Respectfully, the evidence is more compelling that ever supporting the change, and with the stuff I have seen being done, expect even more changes coming out in 2015. Oh , and FWIW, the updtates are every 5 years.

And for what its worth.... the evidence is clear that WE (Health care providers of all levels in and out of the hospital) are as much at fault for the poor outcomes as anyone. WE became to focused on toys, and not on quality CPR. And for what its worth, ROSC rates are improving. Both in places like Seattle, but in smaller services too. Seattle just broke the 50% ROSC mark for VF arrest (the holy grail for the past 50 years of resuscitation science).

I have a large portion of the science documents if you are interested. Or you can look at my science behind CPR lecture if you want too. Its on slideshare.com.

Edited August 23, 2011 by croaker260

[JakeEMTP]

Queen's "Another one bites the dust" is will also provide about 100cpm if you can remember. Not only the rate is important while doing CPR, the depth is equally important.

[Vorenus]

Queen's "Another one bites the dust" is will also provide about 100cpm if you can remember. Not only the rate is important while doing CPR, the depth is equally important.

As is releasing all of the depth on the thorax before doing another compression.