How to Save Lives With CPR

The response to cardiac arrests is fundamental skill needed within the ambulance service, each year nationally responding to approximately 60,000 suspected arrests and attempting resuscitation in 28,000 (Perkins et al., 2018). As the survival rate from cardiac arrest is already very low in England, with only 8.6% of patients being fully discharged from hospital (Consensus Paper on Out-of-Hospital Cardiac Arrest in England, 2015), it is vital that every opportunity to increase the survival rate is taken. One of the factors with the biggest impact during resuscitation is the quality of the compressions given.

In order for there to be blood to pump around the body, the ventricles must be able to fully fill with blood. Therefore during compressions it is vital that the person comes fully up off of the chest, allowing it to completely recoil. By not coming off the chest the total volume of blood transported is reduced, reducing the chance of survival for the patient. As the chest rises during a compression the negative pressure draws blood into the ventricles allowing for maximum output each time. This greatly improves the chance of survival as more oxygenated blood is able to move around the body, reaching the organs in the patient. In a study done by Russell et al. (2017) it was shown that with a high compression rate there is less time for decompression, so less blood can be drawn into the heart.

In addition to this, the frequency of compressions is also vital to ensuring that the body receives enough oxygenated blood with the rate of compression being around 100 to 120 per minute (nhs.uk, 2016). However, the stressful nature of the event can often lead to rapid compressions, not only affecting decompression, but the overall quality of the compressions. In a study done by Zimmerman et al. (2015) it was found that the use of a metronome improved the accuracy of compression on a paediatric manikin. When using the metronome the percentage of compression with adequate rate rose from 50 to 72, whilst the percentage with adequate depth rose from 70 to 72. This has a massive impact in the overall quality of the compressions, which then helps to provide the optimal chance of survival.

One way this can be incorporated into practice is by using the metronome that is built into the defibrillator. This will allow the person doing chest compression to keep to the optimum rate of around 100 to 120 per minute. This means that no matter what the situation or level of skill, the person should be able to provide an accurate rate of compressions. To ensure that the overall quality of compressions are good the “pit crew concept” can be used. In this method there is a team leader who oversees the resuscitation. By having a overview of the resuscitation they can ensure that the compressions are of a high quality and give any advice to improve the quality of compressions if needed.