CPR requires undertaking multiple steps that work together to save the patient’s life. The best CPR approach is systematic but flexible and may need to be adapted to the patient and situation. Regardless, CPR should be provided early and in an effective manner.

Related Video: CPR for Adults with 2 Rescuers

Related Video: Single Rescuer CPR for Adults

Systems-based approach

Effective CPR for adults is based on the Chain of Survival. It differs slightly based on whether the cardiac arrest occurs inside or outside of the hospital.

Adult Chain of Survival

Effective CPR relies on care systems that incorporate team building, information sharing, and a focus on improving the quality of resuscitation. Effective leadership is key, as well as personal responsibility. To improve CPR quality, the team must provide:

• Evaluation of resuscitations and their outcomes
• Assessment of attained goals and feedback
• Systemic strategies to improve effectiveness

Hospitals often establish medical emergency teams (METs) and rapid response teams (RRTs) to quickly identify patients at risk for cardiac arrest and improve their outcomes. Almost 80% of cardiac arrest patients had vital signs outside the normal range within 8 hours of the event. By recognizing these early signs, IHCAs can be prevented.

Multidisciplinary Teams: Multidisciplinary teams are called upon urgently to manage the patient in an emergency. This allows integration of the range of skillsets to provide the best treatment for the patient. 

Measures

To ensure improved CPR quality, accurate assessment tools should be used that evaluate effectiveness and outcomes. An example is the Utstein-style guidelines,² which evaluate the critical performance measurements:

• CPR rate
• Time elapsed before defibrillation
• Survival to discharge

Information must be shared among the links of the chain, from the emergency medical staff, to the emergency department, and to hospital medical personnel.

Assessment of attained goals

To ensure quality, information must be shared within the system as well as externally with other systems that provide the same type of care. External systems may be registries, such as

• The resuscitation outcomes consortium for OHCAs
• Get with the Guidelines ®³ for IHCAs
• Mission: Lifeline®⁴ for CPR.

Making Changes

It is crucial to make the necessary changes after resuscitation reviews and assessments are completed. These allow for improvement in:

• Rates of bystander CPR
• Improved CPR quality
• Decreased time before defibrillation
• Public awareness
• Community member and professional training

There is still work to be done to improve the quality of CPR. While it continues to save lives, CPR has the potential to have an even greater impact when the care systems are prioritized. By doing this, the large disparities in survival rates that still exist will be overcome.