How to Perform Chest Compressions: Techniques for Effective Lifesaving

This article explores the vital role of chest compressions in CPR, how they restore blood flow, improve defibrillation success, and help sustain the function of vital organs. You will learn the chest compression techniques for adults, children, and infants. By understanding the importance of chest compressions, you can respond effectively during emergencies, potentially saving lives in the process.

Chest compression techniques are crucial components of CPR (cardiopulmonary resuscitation) aimed at restoring blood circulation during cardiac arrest. Proper hand placement, compression depth, and compression rate are essential for effective chest compressions. Here's a comprehensive guideline of these chest compression techniques:

• Hand placement: Proper hand placement ensures that the force is applied to the right area, directly over the sternum
• Compression Depth: Proper compression depth ensures that the heart is effectively squeezed, helping to pump blood out of the heart's chambers and into the arteries.
• Compression Rate: Maintaining an appropriate compression rate and minimizing interruptions can optimize blood circulation, improve oxygen delivery, and enhance the overall effectiveness of CPR.

Hand Placement

Placing the hands correctly on the chest is essential for delivering effective chest compressions. Proper hand placement ensures that the force is applied to the right area, directly over the sternum. This allows for optimal transfer of force to the heart, maximizing the efficiency of each compression.

In addition, proper hand placement ensures effective coordination with other CPR techniques, such as rescue breaths or defibrillation. When the hands are positioned correctly, it allows for seamless transitions between compressions and other necessary interventions, promoting optimal patient care.

• Hand Placement for Adults: For adults, place the heel of one hand on the center of the person's chest, right between the nipples. Ensure that the hand is positioned on the lower half of the sternum, avoiding the tip.
• Hand Placement for Children: For children aged 1 to puberty, the hand placement is similar to adults. Place the heel of one hand on the center of the child's chest, between the nipples. Position your other hand on top, interlocking your fingers. Adjust the force applied based on the child's size and build.
• Hand Placement for Infants: For infants up to 1 year old, use the two-finger technique. Place two fingers (index and middle finger) on the lower half of the infant's breastbone, just below the nipple line. Avoid applying pressure to the tip of the sternum.

Depth of Chest Compressions

Achieving adequate compression depth during CPR is crucial for optimal outcomes and improving the chances of survival. Sufficient compression depth helps create enough pressure to generate blood flow and circulate oxygen to vital organs, especially the brain and heart. Insufficient compression depth may result in inadequate blood circulation, reducing the effectiveness of CPR and potentially compromising the person's chances of recovery.

Proper compression depth ensures that the heart is effectively squeezed, helping to pump blood out of the heart's chambers and into the arteries. This promotes oxygen delivery to the organs, preventing further damage and increasing the likelihood of a positive outcome.

Recommended Depth for Chest Compressions in Different Age Groups

• Adults: For adult victims, the recommended compression depth is at least 2 inches (5 centimeters) but not more than 2.4 inches (6 centimeters). This depth allows for effective blood circulation and optimal outcomes during CPR.
• Children (1 to puberty): When performing chest compressions on children, aim for a compression depth of about one-third of the depth of the chest, which is approximately 2 inches (5 centimeters). Adjust the force to the size and build of the child.
• Infants (up to 1 year old): For infants, the recommended compression depth is about 1.5 inches (4 centimeters). Apply enough pressure to compress the infant's chest by this amount while performing CPR.

By adhering to the recommended compression depths specific to each age group, rescuers can provide effective chest compressions during CPR and improve the person's chances of survival. Regular training and certification in CPR techniques are essential to gain proficiency and confidence in performing compressions at the appropriate depths for different age groups.

Chest Compression Rate

The recommended number of chest compressions per minute during CPR in all age group is 100 to 120 compressions. This rate ensures an adequate circulation of blood and oxygen to the vital organs.

By rigorously adhering to a consistent compression rate, which falls under the broader category of CPR techniques, and curtailing interruptions, you can optimize circulatory efficacy, augment oxygen transport to vital organs, and thereby elevate the overall success rate of cardiopulmonary resuscitation.

Understanding the Purpose of Chest Compressions

The purpose of chest compressions in CPR is to manually pump the heart and restore blood circulation in a person experiencing cardiac arrest. When someone goes into cardiac arrest, their heart stops pumping effectively, leading to a lack of blood flow and oxygen to the brain and other vital organs. Chest compressions play a crucial role in maintaining blood circulation and delivering oxygenated blood to these organs until advanced medical help can be provided.

Here are the key purposes of chest compressions in CPR:

1. Restoring Blood Flow: Chest compressions are performed by applying rhythmic pressure to the chest, which helps to manually pump the heart. The compressions squeeze the heart's chambers, forcing blood out into the arteries and restoring blood flow to the body. This circulation is critical for delivering oxygen and nutrients to vital organs and tissues.
2. Creating Artificial Circulation: During cardiac arrest, the heart's natural pumping mechanism fails. Chest compressions act as a substitute, creating artificial circulation by externally compressing the chest and pushing blood through the blood vessels. This sustained circulation helps maintain a minimal blood flow, preventing organ damage and increasing the chances of successful resuscitation.
3. Delivering Oxygen: Chest compressions facilitate the delivery of oxygen to the body's tissues. Even without the heart pumping effectively, the compressions help to move blood through the blood vessels, ensuring a minimal flow of oxygenated blood. This is particularly vital for organs such as the brain, heart, and kidneys, which require a constant supply of oxygen to function properly.
4. Enhancing Defibrillation Success: If a defibrillator is available, it delivers an electric shock to the heart to restore a normal rhythm. Chest compressions play a significant role in enhancing the success of defibrillation. By providing continuous compressions, blood circulation is maintained, making the heart more likely to respond positively to the shock and restore its regular beating pattern.
5. Sustaining Vital Organ Function: Chest compressions during CPR help sustain vital organ function by ensuring a minimal blood flow. Organs like the brain are highly sensitive to oxygen deprivation, and continuous chest compressions help provide oxygenated blood, preventing irreversible brain damage. Sustained circulation supports the overall function of vital organs until the underlying cause of the cardiac arrest can be addressed.

Chest Compressions for Adults

Performing effective chest compressions is crucial when providing CPR to adults in cardiac arrest. Here are the key steps to follow for chest compressions in adults:

1. Ensure the person is lying on a firm, flat surface. Kneel beside them and expose their chest.
2. Place the heel of one hand on the center of the person's chest, between the nipples. Position your other hand on top, interlocking your fingers. Keep your fingers off the chest, allowing for full compression depth.
3. With straight arms, position your shoulders directly over your hands. Using your upper body weight, push straight down on the chest. Compress the chest at least 2 inches (5 centimeters) but not more than 2.4 inches (6 centimeters). Allow the chest to fully recoil between compressions, but try to minimize interruptions.
4. Aim for a compression rate of 100 to 120 compressions per minute. To maintain a steady rhythm, you can think of it as performing compressions to the beat of the song "Stayin' Alive" by the Bee Gees.
5. Ensure sufficient compression depth by pushing hard enough to compress the chest and allow it to return to its normal position. Adequate compression depth promotes blood circulation and oxygen delivery to vital organs.

Chest Compressions for Children

When performing CPR on children aged 1 to puberty, there are specific considerations to ensure effective chest compressions:

1. Place the heel of one hand on the center of the child's chest, between the nipples. Position your other hand on top, interlocking your fingers.
2. For smaller children, use two fingers (index and middle finger) to compress the chest. Place the fingers on the lower half of the child's breastbone, just below the nipple line.
3. Aim for a compression depth of about one-third of the depth of the child's chest, approximately 2 inches (5 centimeters). Adjust the force applied based on the size and build of the child.
4. Maintain a compression rate of 100 to 120 compressions per minute. Use a consistent rhythm to ensure effective circulation.

Chest Compressions for Infants

When providing CPR for infants (up to 1 year old), the following steps are essential for chest compressions:

1. Place two fingers (index and middle finger) on the lower half of the infant's breastbone, just below the nipple line. Avoid applying pressure to the tip of the sternum.
2. Compress the infant's chest to a depth of about 1.5 inches (4 centimeters). Apply enough pressure to achieve this depth while being cautious not to exert excessive force.
3. Maintain a compression rate of 100 to 120 compressions per minute. Maintain a consistent rhythm to ensure effective circulation.

Remember, the recommended techniques for chest compressions in adults, children, and infants are based on general guidelines. It is important to receive proper training and certification in CPR specific to each age group to ensure proficiency and responsiveness in real-life emergency situations.

Guidelines for Maintaining an Appropriate Compression Rate

To ensure high-quality CPR and high-quality chest compressions, you should maintain an appropriate compression rate by following these guidelines:

1. Maintain a steady rhythm: Deliver chest compressions at a consistent pace to maintain a regular flow of blood. It helps to synchronize compressions with a metronome or the beat of a song like "Stayin' Alive" by the Bee Gees, which has a rhythm close to the recommended compression rate.
2. Avoid excessive speed: While it is important to achieve the recommended rate, avoid compressing too rapidly. Compressions that are too fast may compromise the quality and depth of each compression, reducing their effectiveness.
3. Allow for full chest recoil: After each compression, allow the chest to fully recoil before starting the next compression. This ensures that the heart refills with blood, optimizing blood flow during CPR.
4. Minimize interruptions: It's essential to minimize interruptions in compressions, especially when transitioning between different aspects of CPR, such as providing breaths or preparing for defibrillation. Timely resumption of compressions after interruptions helps maintain consistent circulation and enhances the chances of successful resuscitation.

These factors significantly impact the chances of successful resuscitation and favorable outcomes for individuals experiencing cardiac arrest. Regular training and practice in CPR techniques are crucial for developing the necessary skills to deliver consistent and timely compressions.

Maximizing Compression Efficiency with AEDs

Automated External Defibrillators (AEDs) are invaluable devices that significantly improve survival rates during cardiac emergencies. Their integration with chest compressions is a pivotal aspect of CPR.

AEDs are designed to analyze the heart's rhythm and deliver a shock if necessary. However, this analysis is most effective when performed on a heart that is already being circulated with blood through chest compressions. Coordinating these actions ensures a seamless transition between compressions and AED intervention, creating a rhythm that enhances the chances of restoring a normal heartbeat.

What are the common mistakes to avoid while performing chest compressions?

Common Mistakes to Avoid While Performing Chest Compressions are:

1. Insufficient Compression Depth: Failing to achieve the recommended compression depth can compromise blood circulation. Rescuers should aim for proper depth (at least 2 inches for adults) to ensure effective chest compressions.
2. Incomplete Chest Recoil: Neglecting to allow the chest to recoil between compressions fully reduces blood return to the heart. Rescuers must ensure full chest recoil to optimize circulation.
3. Incorrect Hand Placement: Placing hands incorrectly on the chest can result in ineffective compressions. Hands should be positioned on the lower half of the sternum for adults, adjusting for different age groups accordingly.
4. Excessive Interruptions: Unnecessary pauses during chest compressions, whether for equipment setup or other reasons, can diminish the overall effectiveness of CPR. Minimizing interruptions is crucial for maintaining blood flow.
5. Inconsistent Compression Rate: Deviating from the recommended compression rate (100-120 compressions per minute for adults) can affect the quality of chest compressions. Consistency in rate is key for optimal circulation.

Interruptions and Maximum Interval

In the context of the entire CPR process, it is imperative to restrict pauses in chest compressions, a component of CPR, to maintain an uninterrupted flow of oxygenated blood. The ideal upper limit for these pauses is less than 10 seconds, as part of the holistic approach to maximize the chances of successful resuscitation.

To minimize interruptions and maintain high-quality CPR, the duration of chest compressions is a critical factor. Guidelines suggest compressing the chest at a rate of at least 100-120 compressions per minute.

What should a rescuer do right after giving chest compressions to an unconscious person?

After giving chest compressions to an unconscious person, the rescuer should assess the person's breathing. If the person is not breathing or only gasping, the rescuer should open the airway using the head-tilt, chin-lift technique. If trained and comfortable, the rescuer can provide two rescue breaths. If not trained or unwilling to provide rescue breaths, the rescuer should continue with chest compressions.

What is the Role of Full Chest Recoil?

Full chest recoil allows the chest to fully return to its natural position between compressions. This is essential for successful resuscitation as it maximizes the blood flow back to the heart. Inadequate recoil can compromise the effectiveness of compressions and reduce overall circulation.

Impact of Effective Compressions

Physiologically, effective chest compressions contribute to the circulation of oxygenated blood, maintaining perfusion to vital organs like the heart and brain. This is crucial for sustaining life during cardiac arrest.

‍

What is chest compression fraction?

Chest compression fraction is the percentage of time during a cardiac arrest scenario when chest compressions are actively performed. It is a critical metric in CPR quality, and a higher chest compression fraction is associated with improved outcomes.

To achieve a high chest compression fraction, focus on minimizing interruptions during CPR. Ensure prompt initiation of compressions, limit pauses between compressions, and coordinate seamlessly with other interventions, such as AED use or ventilation.

How can the effectiveness of chest compressions be improved during a resuscitation attempt?

Regular and effective CPR training is essential for responders to improve the effectiveness of Chest compressions. Familiarity with the correct techniques, compression depth, and rate enhances the likelihood of successful resuscitation.

In a healthcare setting, effective communication and coordination among team members can prevent unnecessary interruptions and ensure seamless transitions between chest compressions and other interventions. Utilizing feedback devices during CPR provides real-time information on compression depth, rate, and recoil. 

How do chest compression feedback devices work, and what do they monitor?

Chest compression feedback devices operate through sensor technology that monitors and analyzes key parameters of CPR in real time. These sensors, often embedded in the CPR manikin, defibrillator pads, or a separate device on the patient's chest, detect the motion and force applied during chest compressions. The data collected, including compression depth, rate, chest recoil, hand positioning, and compression fraction, undergoes immediate processing. Based on this analysis, rescuers receive instant audio and visual cues, guiding them to make adjustments and adhere to established CPR guidelines.

What is the ratio of chest compressions to rescue breaths in adults during CPR?

During CPR on adults, the recommended cpr adult ratio of chest compressions to rescue breaths is 30:2. This means you should perform 30 chest compressions followed by 2 rescue breaths. This cycle should be repeated until an automated external defibrillator (AED) is ready to use, emergency medical services (EMS) take over, or the person shows signs of life.

How does performing CPR on different surfaces (like a mattress or floor) impact chest compression depth?

Performing CPR on different surfaces can indeed impact chest compression depth. The American Heart Association (AHA) and other resuscitation organizations recommend performing CPR on a firm surface to ensure adequate chest compression depth. The reason for this is to allow for effective transfer of energy from the compressions to the heart and lungs, which is crucial for maintaining blood circulation.

When performing CPR on a mattress or a soft surface, there is a greater likelihood that the chest will not compress adequately. This is because the soft surface absorbs some of the force applied during compressions, making it more challenging for adults to achieve the recommended compression depth of 2-2.4 inches (5-6 centimeters).

What recent advancements have been made in the technology and techniques of chest compressions?

Recent years have witnessed notable advancements in the technology and techniques of chest compressions, aiming to enhance the effectiveness of CPR and improve outcomes during cardiac emergencies. Some key innovations include:

• Mechanical Chest Compression Devices: Mechanical devices, such as the LUCAS Chest Compression System, provide automated and standardized chest compressions. These devices consist of a piston that delivers compressions at a consistent rate and depth to reduce rescuer fatigue during prolonged CPR efforts and maintain high-quality compressions.
• Real-Time Feedback Devices: Advanced CPR manikins and external devices now offer real-time compression depth, rate, and recoil feedback. These feedback mechanisms guide rescuers during training and actual resuscitation.
• Smart Defibrillators with CPR Feedback: Modern AEDs often come equipped with features that provide feedback on the quality of chest compressions. These devices can analyze compression depth and rate, guiding rescuers to optimize their technique during resuscitation attempts. 
• Telecommunicator-Assisted CPR (T-CPR): Advances in emergency dispatch systems enable telecommunicators to provide real-time CPR guidance to bystanders over the phone. This technology assists in optimizing chest compression techniques and helps bystanders initiate CPR promptly while awaiting professional assistance.
• Novel Techniques for Special Populations: Research continues to explore specialized chest compression techniques for specific populations, such as obese individuals, pregnant women, and elderly patients. Tailoring CPR approaches to the unique characteristics of these groups aims to improve the overall effectiveness of resuscitation efforts.

These advancements collectively contribute to the ongoing efforts to increase survival rates during cardiac emergencies by ensuring high-quality chest compressions and facilitating more effective and accessible CPR training for individuals across various settings.

How does the presence of an advanced airway affect chest compression rate and technique?

The presence of an advanced airway, like an endotracheal tube, may necessitate a change in compression rate. It is often recommended to perform continuous compressions without pauses for ventilations. Rescuers should adapt compression technique to accommodate the presence of an advanced airway, ensuring minimal disruption in chest compressions.

Are there any specific guidelines for chest compressions in cases of drowning or choking?

1. Drowning: Begin chest compressions promptly if a drowned person is unresponsive. Focus on clearing the airway of any obstructions and perform standard chest compressions according to CPR guidelines.
2. Choking: For a choking victim who becomes unresponsive, initiate chest compressions after ensuring the airway is clear. The Heimlich maneuver may be necessary initially, but if the person loses consciousness, CPR should be started.

Integration with Other CPR Techniques

Chest compressions should seamlessly integrate with other CPR techniques, such as rescue breaths. Coordinating compressions and ventilations is essential to provide comprehensive care. Training and practice are crucial for healthcare professionals and bystanders to ensure a smooth transition between these components, minimizing interruptions and optimizing the chances of a positive outcome during resuscitation efforts.

Hands Only CPR

Hands only CPR, also known as compression-only CPR, is an alternative approach to conventional CPR that focuses solely on performing chest compressions without rescue breaths. It is recommended in specific situations where rescuers may be untrained or uncomfortable with rescue breaths, or when there is a concern about the transmission of infectious diseases, such as during a pandemic.

While hands-only CPR is an effective alternative, it is important to note that conventional CPR, which includes rescue breaths, is still considered the gold standard and may provide additional benefits, especially in cases of drowning or respiratory-related cardiac arrests.

Remember, receiving proper CPR training is highly recommended as it equips individuals with the knowledge and skills to confidently provide the most appropriate CPR technique based on the situation at hand. CPR Select offfers CPR group training to accommodate large groups.