High-Performance CPR: What the Latest Evidence Says
Compression depth, rate, fraction, ventilation ratios, and pit-crew CPR roles — the components that consistently improve ROSC and neurologically intact survival.
June 28, 2026 · 8 min read
The AHA guidelines keep the fundamentals stable: push hard, push fast, minimize interruptions. What the data now emphasizes is compression fraction — the percentage of arrest time your patient is actually receiving chest compressions.
The measurable targets
- Rate: 100–120 per minute
- Depth: at least 2 inches (5 cm), no more than 2.4 inches (6 cm)
- Full recoil between compressions
- Compression fraction ≥ 80% of total resuscitation time
- Pre- and post-shock pauses < 10 seconds
Pit-crew roles
Assign roles before you arrive: compressor 1, compressor 2, airway, IV/med, monitor/defibrillation, team lead. Rotate compressors every 2 minutes to preserve depth. The team lead does not do a task — they watch the clock, the monitor, and the compression quality.
The ventilation question
Before an advanced airway: 30:2. After: continuous compressions with 1 breath every 6 seconds (10 per minute). Over-ventilation drops preload and hurts outcomes — count out loud.
When to consider termination
Most systems allow termination of resuscitation (TOR) when: unwitnessed arrest, no bystander CPR, no shockable rhythm, and no ROSC after adequate ALS. Follow your protocol — but know the four criteria.
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