Two-Rescuer & Team-Based CPR

Healthcare providers often work in teams, which allows for more efficient and effective resuscitation. Unlike single-rescuer CPR, two-rescuer and team-based approaches involve coordinated roles, role-switching, and communication to optimize patient care.

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Two-Rescuer CPR: Dividing Responsibilities

When two trained rescuers are available, the workload can be shared to minimize fatigue and improve efficiency.

Rescuer 1: Chest Compressions

• Positions at the patient’s side
• Provides high-quality chest compressions at 100-120 per minute
• Minimizes interruptions, switching roles every 2 minutes (or 5 cycles) to prevent fatigue

Rescuer 2: Airway & Ventilation

• Positions at the patient’s head
• Maintains an open airway using head tilt-chin lift or jaw thrust (if trauma suspected)
• Uses a bag-mask device (BVM) to deliver breaths
• Ensures ventilations are 1 second per breath and produce visible chest rise

Compression-to-Ventilation Ratios:

• Adults: 30:2 (unchanged from single rescuer)
• Children & Infants: 15:2 (increases ventilation support for pediatric patients)

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Switching Roles to Reduce Fatigue

Rescuers should switch roles every 2 minutes (or 5 cycles of compressions) to avoid fatigue. The switch should occur as quickly as possible (within 5 seconds) to minimize interruptions.

Step-by-Step Role Switch:

1. At the end of a cycle, Rescuer 2 signals: “Switch after this cycle.”
2. After the 30th (or 15th) compression, Rescuer 1 moves to the head and takes over ventilation.
3. Rescuer 2 immediately starts compressions.
4. Switch occurs with no delay in chest compressions.

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Team-Based Resuscitation in a Clinical Setting

When more rescuers arrive, CPR transitions from two-rescuer to a fully coordinated team response. Each team member should have a designated role to optimize efficiency.

Roles in a Team-Based Resuscitation

• Compressor: Performs high-quality chest compressions.
• Airway Manager: Maintains an open airway, provides ventilation.
• AED/Monitor Operator: Applies defibrillator pads, analyzes rhythm, and delivers shocks.
• Team Leader: Oversees resuscitation, assigns roles, ensures closed-loop communication.

Having a clear structure allows the team to work efficiently with minimal delays.

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Closed-Loop Communication in Resuscitation

Effective resuscitation teams use closed-loop communication to prevent errors and ensure clarity.

Closed-Loop Communication Steps:

1. Team leader gives a clear order:
   “Apply the AED pads and prepare for rhythm analysis.”
2. Rescuer repeats the instruction:
   “Applying AED pads now.”
3. Team leader confirms completion:
   “Pads are in place. Continue compressions.”

This prevents miscommunication and delays during critical situations.

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Minimizing Interruptions for Maximum Survival

To maximize survival chances, hands-off time must be minimized. Key strategies include:

• Preloading AED pads before stopping compressions
• Performing chest compressions while the AED charges
• Using the hover technique—anticipating role switches to avoid unnecessary delays

Every second counts! Team-based CPR ensures continuous, high-quality compressions with minimal interruptions.