Cardiopulmonary resuscitation: difficulty in maintaining sufficient compression depth at the appropriate rate

Abstract

Over the last 50 years, the recommended chest compression for cardiopulmonary resuscitation (CPR) has become faster and deeper, but maintaining deep compressions may be difficult at higher rates. Our study aimed to determine whether adequate compression (chest compression at an appropriate depth and rate) is being performed in emergency departments (ED). We also investigated the effect of adequate compression performance on the return of spontaneous circulation (ROSC). This prospective observational study was conducted at the EDs of two urban academic medical centers. We included adult patients (age ≥18 years) with cardiac arrest who underwent CPR in the ED between May and November 2020. We excluded patients with cardiac arrest related to trauma, repeated arrest except the first, and those for whom a monitor-defibrillator (ZOLL X-series) was not used. The following data were obtained from the monitor-defibrillator devices: compression depth, rate, chest compression fraction, CPR time, and percentage of compressions at the recommended rate and, at the recommended depth, at over and below rates, and depth, and at the appropriate depth and rate. Our study included 50 patients, from whom 441 chest compression sequences were obtained and analyzed. The mean compression depth, rate, and fraction were 6.48 ± 0.87 cm, 117 ± 5/min, 92.1 ± 3.70%, respectively. As the compression rate increased, the depth decreased, and most compressions were over-depth. Adequate compression (appropriate depth at recommended rate) was observed in 97 of the 441 compression sequences (21.9%). Below-depth and below-rate percentages were higher in the deceased group than that in the ROSC group (9.7 ± 15.2% vs. 3.3 ± 3.5%, p = 0.27; 2.7 ± 2.6% vs. 1.2± 0.9%, p = 0.06). The global ratio of chest compression showed low compliance with the recommended rate and depth, even when performed by skilled ED staff.