Anesthesia Experts

Homing in on Optimal Compression Rate and Depth for CPR

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Authors: Duval S et al.

JAMA Cardiol 2019 Aug 14

Compression at a rate of 86 to 129 per minute and depth of 3.8 to 5.6 cm was associated with higher survival to discharge.

Adult cardiac arrest guidelines recommend delivery of chest compressions at a rate of 100 to 120 per minute and a depth of 5 to 6 cm. This guidance is primarily based on evaluation of each of these variables in isolation, even though depth and rate are thought to be related.

To better define the optimal combination of compression rate and depth, researchers performed a secondary analysis of data collected during a randomized trial of 8718 patients with out-of-hospital cardiac arrest across the U.S. and Canada from 2007 to 2009 (NEJM JW Emerg Med Oct 2011 and N Engl J Med 2011; 365:798). The analysis includes 3643 patients with 5 minutes of compression rate and depth data from a cardiac monitor. Compressions at a rate of 107 per minute and depth of 4.7 cm were associated with the highest survival, regardless of patient characteristics (e.g., age, sex, initial rhythm). When compressions were delivered within 20% of this optimal point, patients had higher survival to hospital discharge (6.0% vs. 4.3%; odds ratio, 1.44). In patients with optimal compressions, use of an impedance threshold device was associated with improved survival compared with use of a sham device.

COMMENT

Only the first 5 minutes of compressions were evaluated, making it difficult to extrapolate these findings across prolonged resuscitations. While these findings will not change clinical practice, I am somewhat reassured that there is more evidence to support what we have been doing. There are too many limitations to the study to support use of an impedance threshold device until more direct evidence of benefit is available.

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