30 - Manual cardiopulmonary resuscitation techniques

Summary

The standard technique of external chest compression in cardiopulmonary resuscitation (CPR) has changed little since the landmark paper of Kouwenhoven et al. in 1960 (Fig. 30.1). This is despite the fact that a variety of alternate techniques have been proposed as providing an advantage over the standard method. The rhythmic application of force to the body of the patient is fundamental to the process of generating blood flow in CPR, but there is little agreement as to the optimal technique for applying that force. There is a great need for improved external chest compression techniques since only an average of 15% of patients treated with standard CPR survive cardiac arrest, and it is widely agreed that increasing the blood flow generated by chest compression will improve survival.

This chapter will review the standard external chest compression technique as it is currently taught, including its origins and its rather scant scientific basis. It will also explore in detail the origins, physiology, and applicability of some alternate manual techniques that have been proposed.

Standard external chest compression

According to the most recently published guidelines of the Emergency Cardiac Care Committee of the American Heart Association, external chest compressions are applied by the rescuer who places the heel of one hand over the victim's sternum. The second hand is placed on top of the first in such a way that the fingers do not touch the chest. The fingers may be interlocked if desired. Force is applied straight down with the elbows locked and the shoulders in line with the hands.