High Performance CPR

Richmond Rescue recently joined four other services in Vermont to pilot a new initiative called High Performance CPR. This program has been developed in other parts of the country and has been shown to improve outcomes when CPR is performed. Nothing in the program is particularly high tech or revolutionary. It goes back to the basics and coordinates the efforts of all the responders.

First, the basics.

• Compress the chest 100 to 120 times per minute. Too fast is bad. Too slow is bad. 
• Compress the chest at least 2". 
• Allow the chest to fully recoil after each compression. Without full recoil, blood does not circulate to the heart itself even if the rest of the body is well perfused. 
• Minimize interruptions. You should be doing compressions at least 80% of the time. 

The video below goes into great detail about why the four items listed above are so important. If you have 15 minutes it is well worth watching.

You'll notice that ventilations are hardly mentioned. It turns out that quality compressions will make a greater difference in outcome than ventilations. Often, ventilations take away from the time we are doing compressions and don't greatly improve outcomes. As always, follow your local protocols regarding how CPR is performed.

Historically, Richmond Rescue averages about three cardiac arrests per year. This past year has been much busier than we expected. Below is a breakdown of our cardiac arrest calls from the past year. We have seen 25% of our cardiac arrest patients survive to hospital discharge with no deficits. Is High Performance CPR working? The State will be studying this in more detail and will hopefully be able to give us an answer when they use a larger data set.

A few notes on the chart:

• Most traumatic cardiac arrest victims are not going to be saved by CPR. They need a surgeon immediately. Being 25 minutes from the hospital, as we are in Richmond, generally leads to poor outcomes in traumatic arrests.
• ROSC is an acronym for Return Of Spontaneous Circulation. If ROSC is not achieved during CPR it often means that the patient went without CPR for too many minutes before we arrived. It could also be that the cause of the cardiac arrest was such a grave problem that it could not be corrected in the field, such as a pulmonary embolism, stroke or massive heart attack.

The High Performance CPR program has also improved our attitude going into a cardiac arrest call. We all fully believe that we can save the victim using what we have learned. So far it seems to be working. We are looking forward to this program being rolled out to the rest of Vermont in the next year and are interested to see the effect on patient outcomes.