# Why pause compressions during CPR?



## Cameljockey (Aug 10, 2012)

I was always curious about this but say you and your partner are on a full arrest and begin CPR. The ratio is 30:2 but whys the point of pausing compressions between the breaths and compressions? Why not continuously do compressions?


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## sweetpete (Aug 10, 2012)

Simply put, you won't be able to deliver effective ventilation to the lungs while your partner is delivering chest compressions. You need a et tube or King tube in place before you can deliver synchronus compressions and breaths. 

Hope this helps


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## Merck (Aug 10, 2012)

There's actually a study ongoing through the Resuscitation Outcomes Consortium (ROC) in North America analysing the difference between 30:2 and continuous compressions.  

If you consider the continous you have to realize that you will bag in very small volumes as the CPR at the proper rate of ~100 will just be countering your efforts to bag.  But in the 30:2 you can get more complete breaths.  The problem then is you've interrupted your CPR and increased your thoracic pressure.

So basically, there's not a good answer as to which is better - hence the study.

Further updates as events warrant....


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## Urbanems (Aug 10, 2012)

One ambulance service is Louisiana is doing a trial on what they call CPR HD.... Continuous compressions with just a NRB on at 15 lpm before intubation, so no pauses at all (except to place ETT or king/combi)


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## EpiEMS (Aug 11, 2012)

Urbanems said:


> One ambulance service is Louisiana is doing a trial on what they call CPR HD.... Continuous compressions with just a NRB on at 15 lpm before intubation, so no pauses at all (except to place ETT or king/combi)



Woah. It makes sense, certainly. Might even be better (if not, worst case, it's equal to the current standard of care).


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## Urbanems (Aug 11, 2012)

EpiEMS said:


> Woah. It makes sense, certainly. Might even be better (if not, worst case, it's equal to the current standard of care).



Yeah it makes sense I suppose, what really makes a difference is compression quality. Devices like the Lucas2 or any other automated CPR devices really make a difference. You put on the Lucas and it pumps away, and you actually stand around waiting for the next 2 min interval to push drugs/rhythm checks. Having that during a code makes the single most difference. You can really sit back and think about what's going on, and not have to worry about CPR rotations, compression rate and quality, and chest time. And on the move (like transporting the patient from the scene out to the unit and unit into the hospital) CPR by a human would be very ineffective because having someone do CPR while your carrying the patient out on a spine board is impossible (in my opinion) to do good compressions unless you want to slam the spineboard onto the ground. While the Lucas can do perfect CPR anytime anywhere


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## NomadicMedic (Aug 11, 2012)

Urbanems said:


> ... the Lucas can do perfect CPR anytime anywhere



Let's be perfectly honest, while the LUCAS device can certainly do effective compressions, it's not "perfect CPR everytime" and you certainly can't just sit back and watch.

It's our standard of care that we use a LUCAS on every arrest (provided the PT fits the LUCAS criteria) and I find that unless you're paying close attention to the placement of the LUCAS, even with all of the straps attached, the device will still migrate and the plunger will not be in the correct position during patient moves or during transport in a bumpy ambulance. 

I don't like moving active arrests with CPR in progress anyway, but on a busy code, the potential to forget about the LUCAS is there and unless the medic is keeping a close eye on things, including the quality of compressions and assuring correct device placement, the LUCAS may become ineffective quickly.


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## Christopher (Aug 11, 2012)

jadibrahim said:


> I was always curious about this but say you and your partner are on a full arrest and begin CPR. The ratio is 30:2 but whys the point of pausing compressions between the breaths and compressions? Why not continuously do compressions?



Basically, if you have the chest wall compressed and insufflate air via a BVM, you're going to put most of it in the stomach. 

30:2 is layperson at best and shouldn't be a part of a healthcare provider code. In a primary-cardiac etiology arrest, any priority given to ventilations is a focus on therapy proven to decrease survival to discharge.

100/min with interruptions only for AED or Cardiac Monitor use until the placement of a supraglottic airway or endotracheal tube. Airway delayed for at least 4 minutes, if not longer.

Makes the code far simpler, and sends more people home without deficit.


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## Cup of Joe (Aug 11, 2012)

n7lxi said:


> Let's be perfectly honest, while the LUCAS device can certainly do effective compressions, it's not "perfect CPR everytime" and you certainly can't just sit back and watch.
> 
> It's our standard of care that we use a LUCAS on every arrest (provided the PT fits the LUCAS criteria) and I find that unless you're paying close attention to the placement of the LUCAS, even with all of the straps attached, the device will still migrate and the plunger will not be in the correct position during patient moves or during transport in a bumpy ambulance.
> 
> I don't like moving active arrests with CPR in progress anyway, but on a busy code, the potential to forget about the LUCAS is there and unless the medic is keeping a close eye on things, including the quality of compressions and assuring correct device placement, the LUCAS may become ineffective quickly.



Anyone ever compare the LUCAS to the Zoll AutoPulse?

Looks like the AutoPulse might have less of a chance to move around in the back of an ambulance (seeing as its basically hugging the pt.).


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## MSDeltaFlt (Aug 11, 2012)

Since this thread is in a BLS section I'll go on the presumption basic airway in place.  Not sure of the official reason(s) why you pause compressions for ventilations during CPR, but from a RT point of view with BVM, it only takes about 20cmH2O pressure to dilate the cardiac sphincter.  That's not much.  Which is why they also stress manual ventilations to be smooth and easy. Because we all know what can and will happen if one ventilates too aggressively.


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## DrankTheKoolaid (Aug 11, 2012)

Someone correct me if i am wrong here.  If memory serves ILCOR actually wanted to go with continuous compressions without pauses for ventilations, but AHA felt rescuers would fatigue to quickly which would be more harmful then the brief pauses.


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## MSDeltaFlt (Aug 11, 2012)

I forgot to add something. Adding acute lung injury, even/especially aspiration pneumonia, you increase your pt's mortality by 50% on top of what is already going on. 

A 50% chance of dying to someone who is already clinically dead makes them even more dead. What do I mean by "more dead"?  Simple. That, simply put, gives them about 5 chances of surviving:

1. Slim

2. Fat

3. None

4. Outside

5. A snowball's chance in hell.


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## FR Wrath (Aug 11, 2012)

I work for the company in Louisiana that is doing the CPR-HD. The way it works is that the protocol runs off of an 18 minute script. Begin CPR right away while you attach the monitor. After analyzing rhythm you keep doing CPR for 2 minutes and place an OPA & NRB while paramedic gets the IO/IV and pushes drugs. It emphasizes more for ACLS drug interventions than a definitive airway. After about 6 minutes in you then place an airway, be it ET tube or Combitube (which is what we use in place of a King). But on the topic, we only cease CPR to analyze rhythm & shock if necessary.


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