Stay On The Chest

The American Heart Association recommendation is 5 seconds off-chest-time, MAX. That means there should never be more than five seconds that a patient in cardiopulmonary arrest is not getting chest compressions, and it's one of the biggest mistakes in performing good CPR.  The good news? It's really easy to fix - stay on the chest!

This graph illustrates the idea that in order for blood to be supplied to the body, a pressure-head must be built up. In fact, the first ten to fifteen compressions after every break in CPR works solely to get the blood moving from a standstill, and it is only after those first compressions get the blood moving does CPR actually provide perfusing blood flow to the organs. Every break in CPR leads to a sudden drop of pressure back to zero, and then the next 15 compressions build the pressure-head back up again. Limiting off-chest time is clearly paramount to survival.

This means when you are switching CPR performers, the new provider has their hands over yours and you are providing compressions together until you pull away from the patient’s chest. This also means that you should be performing chest compressions while the defibrillation paddles are being charged, and even while they are being placed on the chest. Only when the charger shouts, “clear!” should you stop compressions and step back.

Interesting side-note: A recently published article showed that bi-phasic defibrillators with sticky pads (rather than paddles) do not require the person performing chest compressions to stop during defibrillation. Attempt at your own risk.