Depth Compression: How Deep Should CPR Chest Compressions Be?

Out-of-hospital cardiac arrest leads to an estimated 330 000 deaths each year in the United States. It is often caused by a primary cardiac event that can be the initial clinical indication of heart disease. It can occur to anyone, though most persons experiencing cardiac arrest are older, with an average age in the mid-sixties. Unless treated within minutes of onset, cardiac arrest can be fatal. CPR keeps the blood flow active and increases the chances of survival before trained medical staff arrives on site. In fact, in many cases, hands-only or compression-only CPR is recommended for untrained bystanders. This proves how important and effective chest compressions are in helping someone having an out-of-hospital cardiac arrest or any medical emergency.

There's a correct way to perform chest compressions. And if you are currently considering a career in the medical field, a deep, basic understanding of properly administering chest compressions is important. Not just for health care providers, laypeople should also know how deep to compress and at what rate it could mean the difference between life and death for someone experiencing a life-threatening emergency. Let's discuss these areas of consideration about Cardiac Arrest Resuscitation and go over some need-to-know information about chest compression.

Key Takeaway

Basic Life Support providers, among others working within Emergency Medical Services systems, contribute to successful Resuscitation from out-of-hospital cardiac arrest. The American Heart Association for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care's current guidelines continue to emphasize the importance of proper chest compressions technique. It is a critical step in the chain of survival. Chest compressions must be done over the lower half of the sternum. Avoid compressing the xiphoid process because it can cause trauma to the liver or stomach.

  • Out-of-hospital cardiac arrest leads to an estimated 330 000 deaths each year in the United States.
  • The method and depth of compressions in infants and children vary by age.
  • Chest compressions in infants and children must be accompanied by ventilation.
  • Compression depth for adults is now 2.4 inches deep.
  • The optimal depth for an infant is 1.5 inches using only two fingers.
  • For pre-teens, the optimal depth increases to 2 inches.
  • The current international guidelines recommend an optimal chest compression depth of one-third of the depth of the external chest diameter in neonates.
  • Recommended chest compression rates are 100-120 per minute.

What is the Role of Compression Depth during Out-of-Hospital Cardiac Arrest CPR?

Chest compression depth in Cardiac Arrest Resuscitation is crucial. Previous studies demonstrated that increased CPR compression depth is strongly associated with better survival to hospital discharge. The American Heart Association studied emergency medical services–treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis clinical trial and the Epistry-Cardiac Arrest database. They calculated adjusted odds ratios for survival to hospital discharge, 1-day survival, and any return of circulation. This study of out-of-hospital cardiac arrest patients demonstrated that increased compression depth is strongly associated with better survival.

How Deep Should CPR Chest Compressions Be?

Chest Compression Depth for Adults

Since 2015, the American Heart Association updated the CPR guidelines. As a result, the depth of chest compression for adults has changed from 2 inches to 2 to 2.4 inches deep. This is the updated recommended depth, whether the patient is male or female. In addition, rescuers must perform this at the optimal chest compression rate of 100-120 per minute. This optimal rate is achieved by ensuring that the compression and decompression phases are of equal duration. 

Before 2015, the recommended depth was greater. However, the American Heart Association guidelines and Emergency Cardiovascular Care revealed that compressions delivered beyond the maximum depth of 2.4 inches resulted in an increased risk of injury related to the resuscitation efforts, such as fractured ribs.

Chest Compression Depth for Child and Infant

Since 2015, the American Heart Association updated the CPR guidelines. As a result, the depth of chest compression for adults has changed from 2 inches to 2 to 2.4 inches deep. This is the updated recommended depth, whether the patient is male or female. In addition, rescuers must perform this at the optimal chest compression rate of 100-120 per minute. This optimal rate is achieved by ensuring that the compression and decompression phases are of equal duration. 

Before 2015, the recommended depth was greater. However, the American Heart Association guidelines and Emergency Cardiovascular Care revealed that compressions delivered beyond the maximum depth of 2.4 inches resulted in an increased risk of injury related to the resuscitation efforts, such as fractured ribs.

Before 2015, the recommended depth was greater. However, the American Heart Association guidelines and Emergency Cardiovascular Care revealed that compressions delivered beyond the maximum depth of 2.4 inches resulted in an increased risk of injury related to the resuscitation efforts, such as fractured ribs.

Neonatal Chest Compression Depth

The International Guidelines for Resuscitation during the neonatal period, usually defined as less than 28 to 30 days after birth, are applied to newly born infants during the first weeks after birth and any infants during initial hospitalization. Although extensive resuscitative efforts are required in less than 1% of newborns, a significant volume will require CPR.

High-quality CPR maintains vital organ perfusion and is related to the survival rate and favorable neurologic outcomes in cardiac arrest patients. Unlike adult patients, where chest compressions are the most essential element, ventilation is the most critical performance element in pediatric and neonatal Resuscitation. The current international guidelines recommend Neonatal Resuscitation with the two-thumb encircling method over the lower third of the sternum. Proper depth is approximately one-third of the anteroposterior diameter of the chest wall. This optimal chest compression depth in neonate cardiac arrest is based on the study by Meyer et al that demonstrated one-third of the external chest diameter to be more effective.

How to know if your compression is at the proper depth?

Compressions that are too strong may break the victim's ribs and cause other internal injuries. However, too light compressions won't pump blood to dying organs, leading to death. Of course, a few broken ribs are not ideal, but it's better for the victim than to die.

Healthcare professionals always advise practice because that is the only way to get an optimal chest compression depth in the event of out-of-hospital cardiac arrest. But if you're not in a healthcare setting, it can be challenging to get that practice in. The amount of force required to pump blood through the human body adequately is more than most people realize. Healthcare professionals typically perform CPR uninterrupted for two minutes before spelling each other to avoid fatigue.