Making the transition to high quality CPR: implications for paramedic practice

Out of hospital cardiac arrest (OHCA) continues to be a major public health challenge, despite increased scientific knowledge about prevention, cardiac arrest pathophysiology, and acute resuscitation. Many changes have occurred in recommendations and guidelines over the last 50 years of modern-era CPR. Recently, there has been more emphasis placed on the importance of providing high quality CPR, especially in the early phases of resuscitation, with a relative de-emphasis on administering drugs and establishing an early advanced airway. Interestingly, recent data has shown that OHCA patients who received ACLS drug administration had no statistically significant improvement in survival to hospital discharge, or long-term survival compared to patients who received no ACLS drugs. (Olasveengen et al, 2009; Jacobs et al, 2011)

It is becoming more apparent that a key to improving survival may depend on high quality CPR. The challenge we currently face is to define the important components of high quality CPR and how CPR can be best integrated into the full resuscitation effort, including delivery of shocks (Cheskes et al, 2011). Many components of good quality CPR such as chest compression depth, compression rate, and full chest recoil that can potentially affect survival are well appreciated. (Abella et al, 2005; Wik et al, 2005). More recently, newer metrics of high quality CPR have been developed which have also been shown to be associated with increased survival. These new metrics include hands-off time, peri-shock pause and chest compression fraction (CCF). The goal of this paper is to define and discuss the clinical perspectives of these newer CPR metrics including how evolving developments in defibrillator technology can assist paramedics in being able to achieve high quality CPR during resuscitation efforts.