Kilgannon JH et al., Resuscitation 2016 Sep 22;
Compression rates of 120–140 per minute increased odds of return of spontaneous circulation relative to the guideline-recommended rate of 100–120.
For patients with cardiac arrest, quality cardiopulmonary resuscitation (CPR) should be the first priority for providers. In 2015, American Heart Association/European guidelines changed the recommendation for chest compression rate from “at least” 100 compressions per minute to 100–120 compressions per minute (NEJM JW Emerg Med Dec 2015 and Circulation 2015; 132:Suppl 2:S315).
To determine the optimal chest compression rate, researchers conducted a single-center, prospective, observational study of 222 adult patients with in-hospital cardiac arrest. Compression rate was measured using defibrillation electrodes; pauses in CPR were not included in the rate calculation. Multivariable models were used to measure the association between compression rate and return of spontaneous circulation (ROSC), survival, and neurological function.
Overall CPR quality was excellent, with median time from collapse to CPR initiation <1 minute and median chest compression fraction 91%. Overall, chest compression rates were high (median, 140 per minute) and remained high as the resuscitation continued. The mean compression rate was 100–120 per minute in 10% of patients, 121–140 in 43%, and >140 in 47%. Relative to patients who received compressions at the currently recommended rate of 100–120 per minute, patients with average rates of 121–140 were significantly more likely to have ROSC (odds ratio, 4.48). However, there was no significant improvement in survival to hospital discharge or neurological function.
Based on this study and the preponderance of other recent evidence, I’m going to aim near 120 for my compression rate, and I’ll keep my eye on the guidelines to see if even higher rates are recommended. Nonetheless, the single most important priority remains high-quality CPR, with adequate chest recoil and minimal compression interruptions.