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The latest CPR guidelines are the 2015 UK and European Resuscitation Council guidelines. The next scheduled update will not be until October 2020. The 2015 Resuscitation Council guidelines gave some pointers on delivering CPR.
The optimum position for providing CPR is by the side of the victim to allow for easier movement between the compression and the breaths but compressions could be given over the head if the victim is in a confined space, for example, in the aisle on a plane or bus, where it is not possible to get to their side.
Fear of doing harm, tiredness and limited muscle strength frequently result in CPR providers failing to compress the chest as deeply as recommended. Following case studies, the 2010 guidelines recommendation is that adult chest compressions should be at a depth of 5cm to 6cm. This remains the same in the new 2015 guidelines, however, it has been recognised that it can be very difficult to estimate chest compression depth and that compressions that are too shallow are more harmful than compressions that are too deep.
Therefore we need to prioritise achieving adequate compression depth.
Regarding the speed of compression, there have been two studies with a total of 13,469 patients, found higher survival among patients who received chest compressions at a rate of 100–120 minute.
It was also found that where the chest compression rates were higher than 120 per minute, there were an associated declining chest compression depths. So it is important to not exceed 2 compressions per second.
The next important thing to remember is to minimise the pause in chest compressions. When delivering compressions, defibrillation shocks, ventilation and AED units analysing the heart all can give pauses between compressions. These gaps need to be reduced to less than 10 seconds to maximize the amount of blood that is pumped around the body.
It is important to communicate well with rescuers to ensure that interruptions are kept to a minimum when delivering CPR.
It is just as important to allow the chest to recoil and to deliver the compression. It is common with CPR for people to lean on the chest and not allow it to fully come back to normal.
Allowing complete recoil of the chest after each compression results in the better venous return to the chest and may improve the effectiveness of CPR. When delivering compressions, think about the recoil as just as important as the compression itself. Therefore the compression time is equal to the recoil time.
It has been found that chest compression depth can decrease in as little as two minutes so if there are sufficient rescuers, CPR should change to a second rescuer every two minutes which will improve the quality of compression, however, there should be no interruption in chest compressions while changing rescuer.
Finally, practice on a manikin will help you develop your CPR skills. If you’re at home and have no manikin, practice on a toy or a stuffed bag to practice compressions.