High-quality CPR in out-of-hospital cardiac arrest is vital for increased survival and improved neurological outcomes.

What is Chest Compression Fraction: CFF or Chest Compressions Fraction refers to measuring the proportion of resuscitation time during a cardiac emergency.

How can you achieve a high chest compression fraction:

  • Compressing the chest at a rate of 100–120 compressions per minute.
  • Chest compression depth of 2–2.4 inches
  • Allowing for full chest wall recoil after each chest compression.
  • Minimizing pauses in compressions

Key Takeaway

  • Chest compression fraction will help increase cardiac arrest victims' survival rate.
  • A low CCF can indicate that the heart is not pumping effectively and may be a sign of heart failure.
  • High CCF can indicate that the heart is overworking and may be a sign of heart disease.
  • Improving an average chest compression fraction is vital to achieving an 80% threshold and has increased the chances of survival by 200% to 300%.
  • Increasing CCF during bystander cardiopulmonary resuscitation with ventricular fibrillation is an independent determinant of survival to hospital discharge.
  • Implementing strategies to improve CCF is likely to result in an increase in survival from cardiac arrest and survival to hospital discharge.

What is Chest Compression Fraction?

The Chest Compression Fraction measures the amount of blood pumped out of the heart with each compression. A low CCF can indicate that the heart is not pumping effectively and may be a sign of heart failure, while high CCF can indicate that the heart is overworking and may be a sign of heart disease. Targeting a CCF of at least 60% is intended to limit interruptions in compressions and maximize coronary perfusion during resuscitation. This was calculated by automated external defibrillator analytic software that permitted identification of all interruptions greater than 2 seconds or 3 seconds. CCF can also be measured using various methods, including

  • Echocardiography
  • Cardiac MRI
  • Cardiac CT

Chest Compression Fraction should be monitored closely in people with heart conditions and those taking medications that can affect heart function. The CCF can be affected by several factors, including the following:

  • Heart's size
  • Heart muscle's strength
  • Amount of blood in the heart
  • Heart rate
  • Blood Pressure
  • Medications

Why is chest compression fraction important?

Improving an average chest compression fraction is vital to achieving an 80% threshold and has increased the chances of survival by 200% to 300%. It may be reasonable to perform Cardiopulmonary Resuscitation with a chest compression fraction of at least 60% in adults and children during out-of-hospital cardiac arrest. To better resuscitation outcomes, compression pauses for ventilation should be as short as possible.

How can chest compression fraction be improved?

Chest compression fraction is often poor and thus provides a considerable opportunity for improvement. Interruptions in chest compressions during cardiopulmonary resuscitation have long been thought to impact the outcomes of out-of-hospital cardiac arrest patients negatively. Continuous chest compressions should be more effective in improving the CCF than conventional 30:2 cardiac arrest resuscitation. Few data exist on the effectiveness of a higher CCF on clinical outcomes.

These data suggest that increasing the CCF effectively improves outcomes from sudden cardiac arrest. This is an important finding that is relatively easily implemented and widely generalizable. The optimal level of chest compression fraction defines a practical goal for emergency medical services training and quality improvement. Implementing strategies to improve CCF is likely to result in an increase in survival from cardiac arrest and survival to hospital discharge. The American Heart Association currently recommends minimizing the frequency and duration of interruptions in chest compressions to maximize the number of compressions delivered per minute.

What are the benefits of chest compression fraction?

CCF is an important measure of heart function and can be used to help diagnose and treat heart conditions. CCF is often used in conjunction with other measures of heart function, such as ejection fraction, to assess the heart's overall health. In addition, it may be used to help assess the risk of heart conditions and to guide treatment decisions. It is crucial because it determines the chances of survival in patients with out-of-hospital ventricular fibrillation.

How can chest compression fraction be measured?

The Chest Compression Fracture is measured by dividing the duration of compression by the total time of cardiac arrest observed. To better resuscitation outcomes, compression pauses for ventilation should be as short as possible. High-performing Emergency Medical systems target at least 60%, with 80% or higher being a frequent goal.

It may be reasonable to perform Cardiopulmonary Resuscitation with a chest compression fraction of at least 60% in adult and child cardiac arrest. It is reasonable to pause chest compressions for 10 seconds to deliver two rescue breaths.

The chest compression fraction values for all minute intervals were averaged for each patient. Trained research staff reviewed the automated calculation of chest compression fraction at each site before entering chest compression fraction values.

What are the techniques for chest compression fraction?

Chest compressions techniques include the following:

  • Positioning the patient supine
  • Pushing hard and fast over the center of the victim's chest
  • A compression rate of at least 100 compressions per minute
  • Rescuers should minimize any interruptions to achieve a CCF of 60.
  • Aggressive rotation of compressors prevents the decline of chest compression quality due to fatigue.
  • Chest compressions are terminated following the return of spontaneous circulation.
  • Unconscious victims with normal breathing are placed in the recovery position.
  • If there is no return of spontaneous circulation, the decision to terminate the resuscitation is based on the clinical judgment that the patient's cardiac arrest is unresponsive to the treatment.

What are the guidelines for chest compression fraction?

According to the American Heart Association guideline and adult Basic Life Support recommendations, chest compressions during High-quality CPR should be performed at 100 - 120 per minute, with a Chest Compression fraction of ≥80%. Compression depth of 2-2.4 inches in adults and at least 1/3 the AP dimension of the chest in infants and children.

High-quality CPR performance metrics include:

  • Chest compression fraction >80%
  • Compression rate of 100-120/min
  • Compression depth of at least 2-2.4 inches in adults and at least 1/3 the AP dimension of the chest in children and infants
  • Avoid excessive ventilation

What are the contraindications for chest compression fraction?

A DNR or valid Do Not Resuscitate order prohibiting chest compressions is a contra-indication. The attending physician considers DNR orders based on patient autonomy and treatment futility. Guidelines of treatment futility dictate that healthcare providers are not obliged to provide treatment if this is futile. Therefore a "Do Not Resuscitate" order prohibiting chest compressions should be documented if chest compressions would be unlikely to save the victim's life.

However, few criteria can reliably predict the futility of starting chest compressions. If there is any uncertainty regarding the "Do Not Resuscitate" status, the rescuer should start chest compressions immediately while the uncertainties are addressed. Compressions may be stopped after a valid DNR order is produced.

Another contraindication of chest compression is when patients with implantable left ventricular assist devices, adult patients with total artificial hearts, or biventricular assist devices suffer cardiac arrest from device failure. If available, the patient must be resuscitated using a backup pump rather than chest compressions.

What are the complications of chest compression fraction?

Life-threatening complications due to CCF are infrequent and occur less frequently than 1%. If hypotension is noted following ROSC, then cardiogenic shock and chest injuries are the most important complications that you should consider. Chest injuries related to chest compressions were classified as rib fracture, sternal fracture, and other uncommon complications, such as:

  • Lung contusion
  • Lung hemorrhage
  • Pneumothorax
  • Haemothorax
  • Retrosternal hematoma
  • Mediastinal hematoma

Rib fractures are the most frequent complication of chest compressions, with an incidence of 1/3 at autopsy. However, only 2% of non-arrest patients who received bystander CPR noted rib fractures.

Conclusion

Bystander cardiopulmonary resuscitation quality contributes to cardiac arrest survival and survival to hospital discharge. The chest compression fraction is the proportion of time spent performing chest compressions during out-of-hospital cardiac arrest, and a CCF of above 80% has been recommended. Rescuers should try to perform high-quality chest compression rates of at least 100–120 per minute and a compression depth of at least 2 inches, avoiding excessive depths >2.4 inches, according to the new American Heart Association guidelines.

Adding a target compression fraction of at least 60% is intended to limit interruptions in compressions and maximize blood flow and coronary perfusion during high-quality CPR. Quantifying CPR by calculating the CCF helps improve the quality of resuscitation of patients.

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