ASHI and MEDIC First Aid Blog

October 2, 2018

Why Should You Know About High-Performance CPR?

By guest blogger Bill Rowe,  Director of Content Development, Emergency Care

In honor of Sudden Cardiac Arrest Awareness Month, let’s explore the concept and practice of high-performance CPR, and why adding HPCPR to bystander training can significantly impact incident outcomes.

The Basics

Hanging a person upside down. Placing hot ashes on someone’s bare abdomen. Blowing smoke through a tube into the rectum. Rolling someone over a barrel. Manipulating a person’s arms as if rowing a boat. The pursuit of resuscitation from sudden cardiac arrest (SCA) has been a long and remarkable journey. Unfortunately, we still have a long way to go. The national survival rate for SCA in the U.S. remains very low, generally around 5-10%

For the past 50 years or so, we have settled on the use of cardiopulmonary resuscitation, or CPR, as a specific treatment of SCA. Using a combination of external compression of the chest and forced breaths into the mouth, CPR is designed to artificially provide a limited distribution of oxygen to body tissue when the heart and lungs are not able to do so.

Other than a few unique situations, CPR does not cure SCA. It buys time. Time for defibrillation.

Defibrillation, an electrical shock delivered through the heart tissue using a defibrillator, is the definitive treatment, or cure, for most SCAs. The earlier defibrillation can be done, the greater the chance for survival. Minutes count. For each minute a person is in cardiac arrest, there is about a 10% decrease in the chance for survival.

Automated external defibrillators, or AEDs, have provided a much needed solution to getting defibrillation done earlier. They can be used virtually by anyone, even untrained lay bystanders.

Quality Matters

In areas where a higher focus is made on the quality of resuscitation, survival rates can go up remarkably, even as high as 40-60%. Geographical areas like Seattle and King County, Washington, along with facilities such as casinos and airports that have focused on quality, lead the way in improving survival rates.

Improving survival from SCA is clearly localized. An individual or small group may not have much influence on improving the national survival rate, but they can have enormous influence on improving survival in a community, company, building, or even at home!

For the past decade, the consensus expert view on resuscitation is that we are pretty dialed in on how to do it, but not as dialed in in the way we deliver it. There is a clear gap between what providers know about how to do CPR and their actual ability to perform it well. Narrowing this gap should be the goal of all CPR providers.

Practice Matters

Hands-on skill practice is essential to improve CPR quality, both for individual skills, such as compressions and breaths, and in scenario practices that simulate real-world conditions. Shorter, more frequent practice sessions are recommended to maintain a high level of competency.

Details Matter

Research indicates that higher-quality skills, especially chest compressions, provide a higher chance for surviving SCA.

  • Peak survival for SCA occurs at a compression rate of around 100-120 compressions per minute.

  • The deeper the compression, the higher the survival rate. Compressions of at least 2 inches are recommended. Minor injury can occur with deeper compressions, but that should not prevent getting the deepest compression possible.

  • Full chest recoil to normal position on the upstroke of compressions is critical. The effect of recoil on blood flow and SCA survival is significant and should not be underestimated.

  • Blood pressure is created and maintained with ongoing compressions. When compressions stop, even for a short time, blood pressure is lost and has to slowly be built back up. Minimizing interruptions to compressions improves quality and survival.

  • Excessive air volume in rescue breaths can result in complications that reduce the quality of the effort.

Instead of taking turns doing CPR when there are multiple providers, the use of a coordinated team approach can improve the efficiency and quality of the care provided.

  • Minimizing the interruption time of compressions before and after defibrillation can improve survival. With a team, the integration of using an AED when one arrives can go much more smoothly and without interrupting compressions. Compressions can be started immediately after a defibrillation shock is delivered.

  • Performing chest compressions is tiring. It is unlikely a provider can maintain high-quality compressions for more than a few minutes. Seamlessly switching compressors every few minutes can help maintain compression quality.

  • A team approach allows for the use of tips and tricks to improve CPR performance.

    • Counting compressions out loud helps to keep all team members focused and on track.

    • The use of interposed rescue breaths, that do not interrupt compressions, can maintain blood pressure and quality.

    • Anticipating and beating AED voice prompts can eliminate interruptions to care.

    • Hovering hands over the chest while defibrillating can minimize the time it takes to resume compressions.

    • Hovering a finger over a shock delivery button can eliminate delay when shock is indicated.

High-Performance CPR

So what is high-performance CPR (HPCPR)?  Simply put it is an organized approach to significantly improve the quality of resuscitation for SCA and the chance for survival of the affected person. HPCPR protocols that reflect the concepts above are rapidly being adopted by hospitals, EMS agencies and fire departments with great results.

A key part of HPCPR is the use of a device, such as the LOOP from HSI, which can provide real-time feedback on the quality of CPR skills. Real-time feedback allows providers to continuously adjust performance to maintain the maximum quality possible.

The HPCPR approach can also be used by pre-EMS providers such as law enforcement officers, correctional officers, lifeguards, emergency response team members, and workplace first aid providers. Any organization can incorporate some or all of the HPCPR concepts into their emergency plans.

The High-Performance CPR Programs from ASHI and MEDIC First Aid

The ASHI and MEDIC First Aid High-Performance CPR training programs bring the proven HPCPR concepts and skills used in EMS to those most likely to initiate resuscitation in an emergency, prior to the arrival of EMS.

Use the HPCPR programs with any CPR or BLS program to create more comprehensive training, or as standalone training for those already trained in CPR.

Just like our other great instructor-led training programs, the HPCPR programs use low-cost instructor and student training materials for use in the classroom. If you are already a CPR or BLS instructor, you are eligible to purchase and use the instructional materials… no additional instructor training required.

Take a look at the HPCPR programs today to see how they can help your organization improve survival from sudden cardiac arrest.  Don’t forget our Sudden Cardiac Arrest Awareness Month weekly promos: this week, get an ASHI or MEDIC First Aid High-Performance CPR program package and a LOOP Learning System for only $149. See our Facebook page or log into Otis for details.


MEDIC First Aid HPCPR Program




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