Emergency Medicine Book

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Chest Compressions

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  1. Indications
    1. Newborn Resucitation
    2. Pediatric Resuscitation
    3. Adult Resuscitation
  2. Technique: Newborns
    1. Sternal Compressions
      1. General
        1. Depress one third chest depth
        2. Do not lift fingers from chest between compressions
      2. Technique 1: Thumbs depress sternum
        1. Hands encircle torso
        2. Fingers support spine
        3. Preferred (less tiring)
      3. Technique 2: Two fingers depress sternum
        1. Use Index, Middle Finger placed below nipple level
        2. Preferred for larger newborns
    2. Compression rate >90 times per minute
    3. Compression to ventilation ratio: 3 to 1
    4. Sequence (2 sec): One and Two and Three and Breath
  3. Technique: Infants (age under 1 year)
    1. Sternal Compressions
      1. Use Index, Middle Finger placed below nipple level
      2. Depress 1/2 to 1 inch (1/3-1/2 chest depth)
    2. Compression rate > 100 times/minute
    3. Compression to Ventilation Ratio = 30:2 (one or two rescuer)
  4. Technique: Children (1 to 8 years)
    1. Sternal Compressions
      1. Use heel of one hand placed above center of chest (superior to xiphoid)
      2. Depress 1 to 1 and 1/2 inch (1/3-1/2 chest depth)
    2. Compression rate = 100 times/minute
    3. Compression to Ventilation Ratio = 30:2 (one or two rescuer)
  5. Technique: Adults
    1. Sternal Compressions
      1. Use heel of two hands placed above center of chest (superior to xiphoid)
      2. Depress 1.5 to 2 inches (1/3-1/2 chest depth)
    2. Compression rate = 100 times/minute
    3. Compression to Ventilation Ratio = 30:2 (one or two rescuer)
  6. Prognosis: Adults after CPR
    1. Criteria
      1. Witnessed arrest
      2. Initial rhythm
        1. Ventricular Tachycardia or
        2. Ventricular Fibrillation
      3. Pulse regained in first 10 minutes of compression
    2. Interpretation: Any of three criteria above met
      1. Predicts survival to hospital discharge
    3. References
      1. van Walraven (2001) JAMA 285:1602

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