ACLS Provider: Course

High-Quality CPR

High-quality cardiopulmonary resuscitation (CPR) is a cornerstone of Advanced Cardiovascular Life Support (ACLS) and a critical intervention for improving survival rates after cardiac arrest. Effective chest compressions and ventilations can significantly increase the chances of survival, potentially doubling or tripling them, by maintaining vital blood flow to the brain and heart until definitive treatment, such as defibrillation, can be administered.

Key Components of High-Quality CPR:

Compression Depth

For adults, chest compressions should be performed to a depth of at least 2 inches (5 cm), but not exceeding 2.4 inches (6 cm). Compressing too shallowly may not generate sufficient blood flow, while compressing too deeply can increase the risk of injuries, such as rib fractures. Proper hand placement and body positioning are essential for achieving the correct compression depth.

Compression Rate

The recommended compression rate is 100–120 compressions per minute. This rhythm should be maintained consistently throughout the resuscitation effort. Using a metronome or a device with a built-in metronome can help rescuers maintain the correct pace.

Chest Recoil (Release)

Allowing complete chest recoil (also known as chest release) after each compression is crucial. This allows the heart to refill with blood between compressions, maximizing blood flow during subsequent compressions. Leaning on the chest between compressions or not allowing full recoil can significantly reduce the effectiveness of CPR.

Minimal Interruptions

Minimizing interruptions in chest compressions is paramount. Any pause in compressions, even for a few seconds, can significantly reduce blood flow to vital organs. Interruptions should be limited to 10 seconds or less, ideally only for pulse checks, rhythm analysis (during defibrillation), or when switching compressors to avoid rescuer fatigue.

Ventilations (Rescue Breaths)

When providing CPR with rescue breaths (mouth-to-mouth or using a bag-valve-mask), the recommended compression-to-ventilation ratio for a single rescuer is 30:2 (30 chest compressions followed by 2 breaths). Each breath should be delivered over approximately 1 second, with enough volume to produce visible chest rise. Excessive ventilation can cause gastric inflation, which can lead to complications. If the rescuer is unwilling or unable to provide rescue breaths, compression-only CPR is recommended.

Why High-Quality CPR Matters:

During cardiac arrest, the heart is unable to effectively pump blood. High-quality CPR mimics the heart's pumping action, maintaining circulation to the brain, heart, and other vital organs. This buys crucial time until advanced medical interventions, such as defibrillation or the administration of medications, can be performed. Effective CPR can significantly improve the chances of successful resuscitation and survival with good neurological outcomes.