Evolving Rationale for Minimally-interrupted Chest Compressions during Cardiopulmonary Resuscitation

This past year marked the 50th anniversary of the first scientific presentation describing the technique and resulting survival benefit of cardiopulmonary resuscitation (CPR) as we know it today [1]. When first described, the directives for the chest compression component were to “push hard, deep and fast”. A half century later, the latest international guidelines for CPR have not only emphasized the timing, rate and quality of those chest compressions, but also the key notion of sustaining uninterrupted compressions whenever possible [1, 2, 3, 4, 5, 6]. Today, those early caveats of hard, fast and deep are now further supported by an accumulating body of compelling scientific data, including those that indicate that chest compressions can even be “too fast” or too uneven with insufficient chest wall recoil [6]. Moreover, recent research efforts also have encouraged a strategy of early and sustained provision of minimally-interrupted chest compressions [7, 8, 9, 10, 11]. In many cases, resuscitation specialists have de-emphasized rescue ventilation altogether [7, 12, 13, 14, 15]. Similarly, some investigators have recommended that the more invasive advanced life support (ALS) interventions (e.g., endotracheal intubation) should be deferred so that basic CPR (compressions) can be prioritized [7, 8, 9, 10]. Furthermore, in view of this new emphasis on chest compressions, there has arisen a renewed focus on the quality of CPR using feedback loops for prospective rescuers, both in follow-up and real-time remediation [4, 5, 6]. In the following discussion, we will review the data that support this evolving emphasis on minimally-interrupted chest compressions and also provide a perspective on why ‘compressions-only’ CPR is a very feasible strategy for the majority of persons likely to survive a cardiac arrest.