Thursday, 28 March, 2024
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CPR guidelines mistaken on depth of compressions

The depth of chest compressions and the rate at which they were applied make a significant impact on survival and recovery of patients, a review of research by UT Southwestern Medical Centre emergency medicine physicians shows.

Contrary to popular belief, the reviews showed that cardio-pulmonary resuscitation (CPR) compressions deeper than 5.5cm resulted in decreased survival, possibly because of collateral damage to other internal organs.

Previously, investigations and guidelines indicated that deeper compressions were better. The American Heart Association's 2010 CPR guidelines recommend compressing the chest at least 5cm without providing any upper limit.

"Most people do not recognise that it takes quite a bit of thrust to compress the chest 5cm," said Dr Ahamed Idris, professor of emergency medicine and internal medicine at UT Southwestern and director of the Dallas-Fort Worth Centre for Resuscitation Research. "About 60 lbs of pressure are required to reach this depth. But in some cases a burly fireman or well-intended volunteer can go way past that amount, which can harm the patient." Idris’ group also found that the rate at which chest compression was applied was most important. Compression rates of 100 to 120 per minute were optimal for survival when other factors were considered.

"Survival depends on the quality of the CPR," said Idris. "Both the depth of chest compressions and the rate at which they are applied can have important results for patients in the first moments of cardiac arrest."

In the findings, from two independent studies, about half of responders are giving chest compressions too fast, with about a third above 120 compressions per minute, and 20% above 140 per minute, said Idris, section chief of research in emergency medicine and a trainer of paramedics. Most emergency responders find the beat of the children’s song "Row, Row, Row Your Boat" to be a good measure to reach 100 to 120 beats per minute, the "sweet spot" for resuscitation and survival. American Heart Association guidelines call for a two-step procedure: Call 911, and start chest compressions immediately. "And don’t stop until the paramedics arrive," Idris said.

[link url="http://www.utsouthwestern.edu/newsroom/news-releases/year-2015/feb/cpr-chest-compressions.html"]UT Southwestern Medical Centre release[/link]
[link url="http://circ.ahajournals.org/content/130/22/1962.abstract?sid=43e56f53-e4e3-4504-95c9-9da411b4e631"]Circulation abstract[/link]
[link url="http://journals.lww.com/ccmjournal/Abstract/publishahead/Chest_Compression_Rates_and_Survival_Following.97363.aspx"]Critical Care Medicine abstract[/link]

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