Improving compressions
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Delivering High-Quality CPR: Position, Depth, Rate, and Technique
Providing high-quality CPR is one of the most important actions you can take during cardiac arrest. Small improvements in technique can significantly increase the amount of blood delivered to the brain and heart, improving survival.
Correct Position for CPR
The optimal position for delivering CPR is by the side of the casualty. This allows easier movement between chest compressions and rescue breaths and helps maintain good technique.
However, compressions can also be delivered from over the head if space is limited. This may be necessary in confined environments such as:
- Aircraft aisles
- Buses or coaches
- Trains or other restricted spaces
Compression Depth: Why It Matters
Fear of causing harm, fatigue, or limited upper-body strength often leads rescuers to compress too shallowly. This is one of the most common CPR errors.
Current guidance recommends that adult chest compressions should be 5–6 centimetres deep.
Estimating compression depth is difficult, and evidence shows that compressions are often too shallow. Importantly, compressions that are slightly too deep are far less harmful than compressions that are too shallow.
Priority: Ensure adequate compression depth every time.
Compression Rate: Finding the Right Speed
Large studies involving more than 13,000 patients have shown that the highest survival rates occur when chest compressions are delivered at a rate of:
100–120 compressions per minute
When compression rates exceed 120 per minute, compression depth often decreases. For this reason, it is important not to exceed two compressions per second.
Minimising Pauses in Chest Compressions
Every pause in chest compressions reduces blood flow to vital organs. Pauses commonly occur during:
- Defibrillation
- Rescue breaths
- AED rhythm analysis
All interruptions should be kept under 10 seconds wherever possible.
Clear communication between rescuers is essential to minimise these gaps and maintain effective CPR.
Chest Recoil: Just as Important as Compression
Allowing the chest to fully recoil after each compression is just as important as pushing down.
A common mistake is leaning on the chest, which prevents full recoil.
Full recoil allows better venous return to the heart, improving circulation and overall CPR effectiveness.
Think of compression and recoil as equal:
- Compression time = recoil time
Managing Fatigue During CPR
Compression quality can begin to fall after as little as two minutes.
If there are enough rescuers available:
- Swap the person delivering compressions every two minutes
- Ensure there is no pause while changing rescuers
This helps maintain correct depth, rate, and recoil.
Practice Improves Performance
Regular practice is one of the best ways to improve CPR quality.
- Use a CPR manikin whenever possible
- If practising at home, use a toy or stuffed animal to rehearse hand position and technique
Confidence comes from practice, and confident CPR saves lives.
- IPOSi Unit four LO3.1, 3.2 & 3.3
- IPOSi Unit two LO1.2, 1.3, 1.4, 2.1, 2.2 & 2.3
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