AHA calls for renewed focus on CPR quality and monitoring

Cardiopulmonary resuscitation quality varies widely between systems and locations, prompting the American Heart Association to emphasize key components to improve resuscitative efforts, according to a consensus statement published in Circulation.

“There have been huge advances in CPR and there’s no question that high-quality CPR saves lives,” Peter Meaney, MD, MPH, lead author of the statement and assistant professor of anesthesia and critical care at Children’s Hospital of Philadelphia, said in a press release. “However, right now there is wide variability in the quality of CPR — and we can do better.”

Currently, survival rates vary from 3% to 16% for cardiac arrests that occur outside of hospitals and from 12% to 22% for those that occur in hospitals, Meaney and colleagues wrote.

In the statement, the AHA emphasizes five critical areas of high-quality CPR:

Minimize interruptions to chest compressions. Compressions generate blood flow and should be delivered more than 80% of the time the patient doesn’t have a pulse.
Provide the right rate of compressions — 100 to 120 per minute are optimal for survival.
Ensure compressions are deep enough — at least 2 inches for adults and at least one-third the depth of the chest in infants and children.
Do not lean over the patient’s chest and allow the chest to fully recoil so as not to decrease blood flow.
Avoid excessive ventilation, giving no more than 12 rescue breaths per minute, with the chest just visibly rising, so pressure from the breath does not slow blood flow.

The statement also advises that health and emergency care providers gather data on the quality of CPR delivery and patient response at the scene. If possible, an experienced team leader should oversee and evaluate the quality of CPR. Furthermore, providers, managers, institutions and systems of care should conduct debriefings, follow CPR delivery checklists and assess patient response measurements. The statement also recommends frequent refresher courses be offered, and that providers, managers, institutions and systems of care participate in CPR data registries.

“Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future,” the expert panel wrote.

For more information:

Meaney PA. Circulation. 2013;doi:10.1161/CIR.0b013e31829d8654.

Disclosure: Meaney receives money for serving as a medical expert reviewer for medical issues not pertaining to CPR. Meaney reports no other relevant financial disclosures. See the consensus statement for a full list of the writing group’s disclosures.