Technique for chest compressions in adult CPR

Chest compressions have saved the lives of countless patients in cardiac arrest since they were first introduced in 1960 [1]. Cardiac arrest is treated with cardiopulmonary resuscitation (CPR) and chest compressions are a basic component of CPR. The quality of the delivered chest compressions is a pivotal determinant of successful resuscitation [2]. In spite of this, studies show that the quality of chest compressions, even if delivered by healthcare professionals, is often suboptimal [2]. Therefore it is important that providers carefully familiarize themselves with this technique.Chest compressions are generally indicated for all patients in cardiac arrest. Unlike other medical interventions, chest compressions can be initiated by any healthcare provider without a physician's order. This is based on implied patient consent for emergency treatment [3]. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate the emergency response system and immediately start chest compressions [4]. The risk of serious injury from chest compressions to patients who are not in cardiac arrest is negligible [5], while any delay in starting chest compressions has grave implications for outcome. Due to the importance of starting chest compressions early, pulse and breathing checks were de-emphasized in the most recent CPR guidelines [4]. Thus, healthcare providers should take no longer than 10 seconds to check for a pulse. The carotid or femoral pulses are preferred locations for pulse checks since peripheral arteries can be unreliable.In certain circumstances it is inappropriate to initiate chest compressions. A valid Do Not Resuscitate (DNR) order that prohibits chest compressions is an absolute contra-indication. DNR orders are considered by the attending physician on the basis of patient autonomy and treatment futility.The principle of patient autonomy dictates that competent pat