Chest compressions and basic life support–defibrillation

Part 4: Adult Basic Life Support

“…In 3 animal studies frequent or prolonged interruptions in chest compressions were associated with reduced return of spontaneous circulation (ROSC), reduced survival rates, and reduced postresuscitation myocardial function (LOE 6). 113,174,178,179 Some animal studies suggest that continuous chest compressions with minimal or no interruptions produce higher survival rates than standard CPR (LOE 6). 151,179 -181 These guidelines recommend that all rescuers minimize interruption of chest compressions for checking the pulse, analyzing rhythm, or performing other activities (Class IIa).…”

Cardiopulmonary resuscitation in patients with a Nuss bar—a case report and review of the literature

“…The bar was designed to apply outward pressure to the sternum, allowing it to retain its convexity, but the nature of CPR requires that the sternum be compressed inward at the precordial level to pump the heart and to circulate the blood manually. Studies that have not even accounted for bar presence have shown that conventional methods of CPR typically fail to generate the threshold CPP of 2000 to 2666 Pa that is associated with improved rates of resuscitation [3,11,15,16], and an inadequate rate of chest compression delivery may be the cause of this shortfall [5]. Thus, only slight resistance against compressions may be necessary to render any resuscitative effort futile.…”

“…The purpose of CPR is to prolong a patient's viability by oxygenating the blood and by circulating it through the body via external chest compressions. When CPR is deemed necessary by the rescuer, compressions should be delivered at the level of the lower half of the sternum in the midline of the chest to a depth of 4 to 5 cm at a rate of 100 compressions per minute [4,5]. However, CPR alone usually cannot defibrillate the heart of a patient in VF or ventricular tachycardia; its use sustains the patient long enough for a defibrillator to arrive so that restoration of spontaneous circulation may be achieved [4,[6][7][8][9].…”

Paramedics Manage the Airway Easier with Laryngeal Mask Airway Than with Intubation during Simulated CPR Scenarios

“…All participants managed to place a LMA in both scenarios, but only 85% (105 out of 124) of them managed to intubate the trachea using the Macintosh blade in the non-CPR and even less (80%, 99 out of 124) in the CPR scenario. The median time required for the first successful placement of LMA was 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) sec in the non-CPR scenario and 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) sec in the CRP scenario (P = 1) while intubation with the Macintosh blade was 15 (9-28) sec in the non-CPR scenario and 19 (10-29) sec in the CPR scenario (P = 0.002). Insertion of LMA was statistically significantly faster than intubation with the Macintosh blade in both scenarios (P < 0.001) (Figure 1).…”

“…The stomach contents sometimes lead to serious respiratory compromise by obstructing the upper airway, and the use of LMA does not protect against this. On the other hand, several animal studies have shown that frequent or prolonged interruption of chest compressions is associated with reduced coronary perfusion pressure, reduced return of spontaneous circulation, reduced survival rates, and reduced postresuscitation myocardial function [22][23][24][25]. This is the reason why the ERC guidelines stress that any placement of an advanced airway device should be achieved with the least possible interruption to chest compressions.…”