Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate that when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create High-Performance CPR (HP-CPR). HP-CPR utilizes a team method, or “pit crew” approach, that dictates tight coordination and communication. HP-CPR, in conjunction with other system changes, has the potential to improve the survival rate for patients experiencing witnessed ventricular fibrillation (v-fib) to 50-75%.
To dramatically increase survival rates, HP-CPR must be a fully coordinated approach. EMTs must take responsibility or “own” the CPR portion of the resuscitation. Paramedics perform the advanced life support measures of the resuscitation, and work in coordination with ongoing CPR. Additional resuscitative care such as defibrillation, medication therapies, or airway management should complement CPR. CPR should be the default action at all times. In order to have effective HP-CPR ALL involved must work as a team, not as separate entities. In order to achieve this goal, HP-CPR protocol must start at the top and be endorsed by the Medical Director, EMS agency director, dispatch, and receiving hospital. The value of HP-CPR must be communicated to the men and women who actually perform the resuscitation.
The priority of the resuscitation team needs to be HP-CPR. In many systems the EMT is directed to provide CPR. The EMT needs to provide CPR with the appreciation that it is their primary responsibility. Even though the EMT is providing CPR, paramedics need to recognize its critical importance and work to integrate ALS care in a way that enables the EMT to achieve consistent CPR. This partnership between EMTs and paramedics will provide the basis to achieve HP-CPR and in turn improve the chances of successful resuscitation.
10 Principles of HP-CPR
- EMTs own CPR
- Minimize interruptions in CPR at all times
- Ensure proper depth of compressions (>2 inches)
- Ensure full chest recoil/decompression
- Ensure proper chest compression rate (100-120/min)
- Rotate compressors every 2 minutes
- Hover hands over chest during shock administration and be ready to compress as soon as patient is cleared
- Intubate or place advanced airway with ongoing CPR
- Place IV or IO with ongoing CPR
- Coordination and teamwork between EMTs and paramedics
Michigan Model for HP-CPR
The intent of MiResCu is to systematically implement a Michigan model for resuscitation. This model has been adapted from the proven program designed by the Resuscitation Academy and implemented in Seattle/King County, which has seen survival rates from witnessed V-Fib up to 57%. This model centers around the core concepts of HP-CPR and supporting components which include dispatch assisted CPR, community initiatives, and cardiac registries. With the combined efforts of a statewide organization and local resuscitation teams, we anticipate that Michigan can meet or exceed the rates of survival experienced by Seattle/King County and other communities across the nation. We plan to work with a small number of other states that have adapted the Resuscitation Academy model, in order to benefit from lessons learned and ensure success.
- Aufderheide TP, Pirrallo RG, Yannopoulos D, Klein JP, von Briesen C, Sparks CW, Deja KA, Conrad CJ, Kitscha DJ, Provo TA, Lurie KG. Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression-decompression techniques. Resuscitation. 2005 Mar;64(3):353-62.
- Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, Merchant RM, Hoek TL, Steen PA, Becker LB. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006 Nov;71(2):137-45.
- Pytte M, Kramer-Johansen J, Eilevstjønn J, Eriksen M, Strømme TA, Godang K, Wik L, Steen PA, Sunde K. Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs. Resuscitation. 2006 Dec;71(3):369-78.
- Wik L, Kramer-Johansen J, Myklebust H, Sørebø H, Svensson L, Fellows B, Steen PA. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA. 2005 Jan 19;293(3):299-304.
- Yannopoulos D, McKnite S, Aufderheide TP, Sigurdsson G, Pirrallo RG, Benditt D, Lurie KG. Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation. 2005 Mar;64(3):363-72.
- Yu T, Weil MH, Tang W, Sun S, Klouche K, Povoas H, Bisera J. Adverse outcomes of interrupted
precordial compression during automated defibrillation. Circulation. 2002 Jul 16;106(3):368-72