High-Quality CPR
Objective: Run CPR as a measurable skill — rate, depth, recoil, short pauses, and ventilation discipline — not as background noise while someone stares at the monitor.
Why This Is Hard
Everyone “knows CPR.” On the bedroom floor the rate drifts, the recoiler leans, and someone stops compressions to argue about the strip. AHA 2025 still says the same foundation: adequate rate and depth, complete recoil, minimized interruptions, no excessive ventilation. Drugs and tubes do not outrank that.
- Two-person (or three) crew: one compresses, one bags/airway, switch every two minutes before the compressor dies.
- Moving to the stretcher is the pause that kills coronary perfusion. Plan the move; keep hands on the chest.
- A mechanical device is a logistics tool for transport or a tiny crew — not automatic “better CPR.” Protocol owns when it goes on.
- Do not freeze compressions to debate the monitor. Pulse checks stay short.
- 100–120/min — not 90, not 140
- At least 5 cm (2 in), not more than 6 cm (2.4 in) in adults
- Full recoil — get your weight off the chest
- Pauses under 10 seconds; switch compressor about every 2 minutes
AHA 2025 Adult Components (Education)
- Rate: 100–120/min.
- Depth: at least 5 cm; avoid >6 cm.
- Recoil: complete. Leaning kills coronary filling.
- Interruptions: keep pauses under 10 seconds. Chest-compression fraction goal at least 60%.
- No advanced airway: 30:2 for adults (1 or 2 rescuers).
- Advanced airway in place: continuous compressions and 1 breath every 6 seconds (10 breaths/min). Visible chest rise. Do not hyperventilate.
- Pulse but no breathing: 1 breath every 6 seconds (10/min).
- Mechanical CPR devices: routine use is not recommended. They are a logistics tool (transport, limited personnel) when protocol includes them — not a quality upgrade by default.
How Quality Dies on Scene
- Long peri-shock pauses (see shockable arrest).
- Staring at fine VF instead of compressing (see asystole vs fine VF).
- Bagging at 20+/min “because they look dead.” Excess ventilation raises intrathoracic pressure and drops venous return.
- One compressor for the whole code.
Kids Are Not a Copy-Paste
Pediatric CPR still wants 100–120/min and full recoil, but ventilation is different: with an advanced airway, AHA/AAP 2025 uses 20–30 breaths/min, not adult 10. Infant technique is 1-hand or 2-thumb-encircling — not two fingers. See pediatric airway.
Field Pitfalls
- Compressing on a mattress without a backboard or the floor.
- Hands too high (neck) or too low (xiphoid/abdomen).
- Calling “good CPR” without watching depth and recoil.
Practice
60-second drill
Metronome at 110. Partner watches recoil and counts pause time during a simulated rhythm check. Fail the round if the pause hits 10 seconds or anyone leans.
Related: Shockable Arrest, ROSC, Waveform Capnography.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — EMS companion: pulse, perfusion, and protocol still outrank a pretty strip
- AHA 2025 Part 7: Adult Basic Life Support
- AHA 2025 Part 9: Adult Advanced Life Support
- Rate 100–120, depth 5–6 cm, full recoil, short pauses, 30:2, 10 breaths/min with an adult advanced airway. Mechanical CPR is not routine.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.