Chest Compressions

Chest compressions consist of rhythmic applications of pressure over the lower half of the sternum. These compressions create blood flow by increasing intrathoracic pressure and directly compressing the heart. Although properly performed chest compressions can produce systolic arterial pressure peaks of 60 to 80 mmHg, diastolic pressure is low118 and mean arterial pressure in the carotid artery seldom exceeds 40 mmHg.118

Blood flow generated by chest compressions delivers a small but critical amount of oxygen and substrate to the brain and myocardium. In victims of VF SCA, chest compressions increase the likelihood that a shock (ie, attempted defibrilla-tion) will be successful. Chest compressions are especially important if the first shock is delivered >4 minutes after collapse.36,37,156

Much of the information about the physiology of chest compressions and the effect of varying compression rates, compression-ventilation ratios, and duty cycles (percent of time the chest is compressed versus time allowed for chest recoil) is derived from animal models. Researchers at the 2005 Consensus Conference,157 however, reached several conclusions about chest compressions:

1. "Effective" chest compressions are essential for providing blood flow during CPR (Class I).

2. To give "effective" chest compressions, "push hard and push fast." Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1V2 to 2 inches (approximately 4 to 5 cm). Allow the chest to recoil completely after each compression, and allow approximately equal compression and relaxation times.

3. Minimize interruptions in chest compressions.

4. Further studies are needed to define the best method for coordinating ventilations and chest compressions and to identify the best compression-ventilation ratio in terms of survival and neurologic outcome.

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