Back to the Basics of CPR

Chest Compressions


  • Start chest compressions immediately.
    • Continuous, good quality compressions improve survival. Keep pauses to an absolute minimum and < 10 seconds.
  • Perform compressions at a rate of 100/min.
    • Often compressions are too fast.
    • Keep them between 80-100 per minute.
  • Switch rescuers every two minutes.
    • No exceptions; everyone’s compressions deteriorate.
  • Do not stop compressions unless absolutely necessary.
    • Train to start IV, intubate, during compressions.
    • Use PETCO2 to evaluate quality of CPR and to watch for ROSC.



  • Both pre- and post-defibrillation pauses are detrimental.
    • Charge the defibrillator while providing chest compressions.
    • Do not shock during chest compressions; despite what you’ve heard about gloves, it is dangerous.
  • Resume chest compressions immediately following defibrillation. Do not check pulse. Check for rhythm change if necessary after at least two minutes have passed.
    • Successful defibrillation resets the heart to asystole before resuming a perfusing rhythm.
    • Continued chest compressions may increase chance of developing a rhythm and won’t hurt the patient.



  • Ventilation is not needed in the first 2-4 minutes after a VF cardiac arrest.
    • Agonal breaths signal a reflexive brainstem; these patients may have the best chance of survival.
  • Each breath given by positive pressure decreases blood flow to the brain.
    • Air pushed into the chest temporarily prevents refilling of the heart.
  • Goal of ventilation is maximizing O2 delivery.
    • More ventilation/oxygen is NOT better.
  • Limit to two breaths after 30 compressions while patient is in arrest or has a SBP <70.
    • Use the waveform to adjust ventilation to keep ETCO2 between 35 and 45 mm Hg.
    • Spikes in ETCO2 may indicate ROSC.
    • Low ETCO2 may be from hyperventilation.
    • Expect increased ETC02 following the administration of sodium bicarbonate.
    • Ensure that no one ventilates > 6-8/min.



    • Consider whether to use the defibrillator in the AED mode.
    • To allow CPR analytics, put monitor in paddles lead.