Back to the Basics of CPR

Start chest compressions immediately.
- Continuous, good quality compressions improve survival. Keep pauses to an absolute minimum and < 10 seconds.
Perform compressions at a rate of 100/min.
- Often compressions are too fast.
- Keep them between 80-100 per minute.
Switch rescuers every two minutes.
- No exceptions; everyone’s compressions deteriorate.
Do not stop compressions unless absolutely necessary.
- Train to start IV, intubate, during compressions.
- Use PETCO₂ to evaluate quality of CPR and to watch for ROSC.

Both pre- and post-defibrillation pauses are detrimental.
- Charge the defibrillator while providing chest compressions.
- Do not shock during chest compressions; despite what you’ve heard about gloves, it is dangerous.
Resume chest compressions immediately following defibrillation. Do not check pulse. Check for rhythm change if necessary after at least two minutes have passed.
- Successful defibrillation resets the heart to asystole before resuming a perfusing rhythm.
- Continued chest compressions may increase chance of developing a rhythm and won’t hurt the patient.

Ventilation is not needed in the first 2-4 minutes after a VF cardiac arrest.
- Agonal breaths signal a reflexive brainstem; these patients may have the best chance of survival.
Each breath given by positive pressure decreases blood flow to the brain.
- Air pushed into the chest temporarily prevents refilling of the heart.
Goal of ventilation is maximizing O₂ delivery.
- More ventilation/oxygen is NOT better.
Limit to two breaths after 30 compressions while patient is in arrest or has a SBP <70.
- Use the waveform to adjust ventilation to keep ETCO₂ between 35 and 45 mm Hg.
- Spikes in ETCO₂ may indicate ROSC.
- Low ETCO₂ may be from hyperventilation.
- Expect increased ETC0₂ following the administration of sodium bicarbonate.
- Ensure that no one ventilates > 6-8/min.