3.4 Two-Rescuer Adult BLS

When two trained rescuers are available, they should work together to maximize CPR effectiveness. One rescuer performs chest compressions, while the second manages airway and ventilations.

Assigning Rescuer Roles

Rescuer 1: Chest Compressions

• Positions at the victim’s side and delivers high-quality compressions.
• Compression rate: 100-120 per minute.
• Compression depth: At least 2 inches (5 cm).
• Minimizes interruptions and switches roles every 2 minutes to prevent fatigue.

Rescuer 2: Airway & Ventilations

• Positions at the victim’s head.
• Uses head tilt-chin lift
  ×

  head tilt-chin lift

  
  (or jaw thrust
  ×

  jaw thrust

  
  if spinal injury suspected).
• Provides rescue breaths using a bag-mask device (BVM) or mouth-to-mouth.
• Delivers 2 breaths after every 15 compressions.

Compression-to-Ventilation Ratios

• Adults: 30:2 (same as single rescuer).
• Children & Infants: 15:2 (increased ventilation support).
• With an advanced airway (e.g., endotracheal tube
  ×

  endotracheal tube

  
  ):
  • Continuous compressions (no pauses).
  • 1 breath every 6 seconds (10 breaths per minute).

Switching Roles to Prevent Fatigue

To maintain high-quality compressions, rescuers should switch roles every 2 minutes (or 5 cycles of 30:2).

Step-by-Step Role Switch

1. Rescuer 2 (airway) signals: “Switch after this cycle.”
2. After the 30th compression, Rescuer 1 moves to the head to take over ventilations.
3. Rescuer 2 immediately begins compressions.
4. The switch should take less than 5 seconds to minimize interruptions.

Key Benefits of Two-Rescuer CPR

• Reduces rescuer fatigue, ensuring consistent high-quality compressions.
• Allows better airway management, especially with a bag-mask device.
• Minimizes hands-off time, maximizing survival outcomes.