CPR question

[Sand_Dollar, BSN]

Hi there!

I am a student and was on the CVCU last week. I saw my first code and noticed the doctor doing compressions was going at least twice as fast as I thought we were supposed to (had the song Staying Alive going through my head). I asked a nurse about it later and she said we are supposed to give compressions of AT LEAST 100/minute.

I thought 100 bpm or so was optimal, was his 200 bpm appropriate or just off the charts? I attributed the increased speed to adrenaline, but maybe he was going that fast on purpose.

Thanks for taking the time to answer this, I want to have my facts straight for the time when I'm the one giving compressions.

~SD

[wooh, BSN, RN]

Well considering 200 bpm would be more than 3 compressions per second, I'm seriously doubting the compressions were that fast.

[One1, BSN, RN]

It should be AT LEAST 100 compressions per minute, like you said. The more the better, as long as the chest is allowed to recoil completely in between compressions. As long as a human is doing compressions I think it would be difficult to go too fast if you do compressions with appropriate recoil.

[dah doh, BSN, RN]

Probably just adrenaline. One of our doctors does CPR so hard that the patient flies off the bed with each recoil!

[Sand_Dollar, BSN]

Well considering 200 bpm would be more than 3 compressions per second, I'm seriously doubting the compressions were that fast.

I can only assume it was double the speed because he was, literally, making two compressions for every beat of the song going through my head. I started to sing it to myself when I saw how fast he was going just to figure out the pace. Not very reliable I know. He sure was sweating when left the room though!

[Do-over, ASN, RN]

I have never seen a physician do chest compressions... but I admittedly don't get out much. I'd rather they give orders and stuff. Maybe start a central line.

For myself, I get absolutely wiped out doing compressions and I cannot really imagine someone achieving 200 a minute - at least not for very long. Its hard to sustain the minimum, adequately, for very long.

[Sand_Dollar, BSN]

It should be AT LEAST 100 compressions per minute, like you said. The more the better, as long as the chest is allowed to recoil completely in between compressions. As long as a human is doing compressions I think it would be difficult to go too fast if you do compressions with appropriate recoil.

Unfortunately, I wasn't in a spot to see how much he let off between compressions. I was thinking the same, as long as he let the heart fill he should be OK. I wish I saw the recoil part of it but I stayed out of the room because there were already too many people in there just standing around.

Thanks for the help One1, I won't forget: compressions AND recoil.

[Dodongo, APRN, NP]

I have never seen a physician do chest compressions...

Haha. This. I have seen it once. We were letting a group of students get some experience during a code and they weren't going quite deep enough so one (LARGE) attending walked over and pushed them out of the way, did one big compression (we heard ALL the ribs break at once) and walked away letting them start again. Other than that, it's just the RNs and sometimes RTs that do compressions. And doing it to the beat of staying alive is more of an "at least do it this fast" pace. As fast as possible is best as long as the chest recoils allowing blood to fill the chambers. 200/min sounds impossible. It would be 3.3 per second like wooh said. I don't think he would have been compressing deep enough for it to be worthwhile. 2/second is about optimal. Once you do it a few times you'll get the feel for it... and be sooooo sore the next day. Haha.

[umcRN, BSN, RN]

Haha. This. I have seen it once. We were letting a group of students get some experience during a code and they weren't going quite deep enough so one (LARGE) attending walked over and pushed them out of the way, did one big compression (we heard ALL the ribs break at once) and walked away letting them start again. Other than that, it's just the RNs and sometimes RTs that do compressions. And doing it to the beat of staying alive is more of an "at least do it this fast" pace. As fast as possible is best as long as the chest recoils allowing blood to fill the chambers. 200/min sounds impossible. It would be 3.3 per second like wooh said. I don't think he would have been compressing deep enough for it to be worthwhile. 2/second is about optimal. Once you do it a few times you'll get the feel for it... and be sooooo sore the next day. Haha.

So interesting. I work in peds and I certainly have seen physicians do compressions. When the code is going we get "compressiors" lined up ready to go. We have two docs "running" it - usually the ICU fellow with the attending overseeing them and to step in if needed. One extra doc might be writing orders but otherwise they are compressing. And if the kid is going to get opened up for ecmo we prefer the physicians to do cardiac massage (though I've seen nurses do it and would do it myself if needed). Also in peds, especially the neonates, we aim for a rate of 120, once the person doing compressions starts to die out they are immediately changed out. We are very good at sticking to the two minute rule.

I've even been in codes where extra doctors just turned up out of the blue, from the cath lab, clinic, etc. If they were available they show up and the male physicians really try to help out, especially on our bigger patients. With kids I guess it's all about what we can do to preserve that neuro function, as soon as the code starts they head is packed in ice and we keep our compressiors rotating. The most recent code we had actually was a 21 minutes code, the surgeon had the knife to her little chest to cut in for ecmo when she returned. Two days later she went for MRI and she didn't have a SINGLE abnormality or area of damage. We even had the AD doing compressions on her! Pretty amazing we thought

[Do-over, ASN, RN]

Just one of the many differences between community hospitals and teaching ones.

[WoundedBird]

@umc - I'm very intrigued with the cooling of the coding ped pt. I understand it from a hyperthermia situation and for spinal cord injuries from my first career as an athletic trainer, but never thought of applying it in other situations. I'm going to keep an eye out when I start my program in June at a major teaching hospital and see / ask about it.

[dah doh, BSN, RN]

We have a hypothermia protocol for witnessed pre-hospital cardiac arrest with return of spontaneous circulation after resuscitation. Although our Intensivists have done the protocol on in hospital arrest as well.