When someone suffers sudden cardiac arrest (SCA), lay rescuers should feel confident they can provide high-performance CPR immediately to help the victim survive. High-performance cardiopulmonary resuscitation (CPR) involves performing chest compressions at the optimal depth and rate, minimising compression interruptions, and avoiding leaning on the victim's chest. High-performance CPR is also referred to as high-quality CPR, and the terms are interchangeable.

How we practice resuscitation has come a long way. In the past, rescuers used different methods such as mouth-to-mouth to help restore regular breathing and heartbeats. In the 1960s, BHF Professor Desmond Julian pioneered the "closed chest cardiac massage," which would later become known as CPR.

A stringent analysis of survival rates prompted rescuers and medical professionals to further refine their approach to CPR. This concentrated approach to improve survival rates resulted in the development of high-performance CPR.

Ultimately, the goal of high-performance CPR is to improve the circulation of oxygen and blood in the victim's body while emergency medical personnel are on the way. CPR must be performed, and use of an automated external defibrillator (AED) with CPR feedback technology can maximise effectiveness.

Why High-performance CPR Is Important

High-performance CPR can boost survival outcomes significantly by ensuring that victims receive enough blood to their heart and brain. Bystanders can deliver high-quality CPR immediately while they wait for emergency medical services to arrive onsite. This improves survival rates considerably and provides better outcomes than outdated forms of CPR:

• High-performance CPR can deliver a survival rate as high as 40—60%
• Without high-performance CPR, the likelihood of survival falls by an estimated 5—10% each minute

You don't need to be a trained professional to rescue SCA victims with CPR. High-performance CPR can be taught to everyone and is the best way to stabilise the victim until an AED is found and administered.

Guidelines for Administering High-performance CPR

When to Administer High-performance CPR

The first step of administering high-performance CPR is identifying when an individual requires rescue. There are several scenarios that may indicate or precede the need for CPR, including:

• No pulse
• Sudden collapse
• Unconsciousness
• Breathing problems
• Drowning

A person in need of CPR must receive care as quickly as possible. It is generally advised that bystanders should perform CPR if somebody seems to need rescue and stop only if the victim's pulse is restored or if the regain consciousness. If a victim does not need CPR, monitor their pulse every two minutes.

Best Practices for Delivering High-performance CPR

When administering high-performance CPR, compression depth and rate play a key role in survival outcomes. The Resuscitation Council UK recommends delivering compressions at a rate of 100—120 per minute at a depth of 5—6 centimetres (2—2.4 inches), pushing hard and fast in the middle of the chest. Research shows that when rescuers compressed at depths less than 3.8 cm (1.5 inches), out-of-hospital cardiac arrest survival rates dropped by 30%.

In addition to maintaining the correct compression rate and depth, follow these seven recommendations for administering high-performance CPR:

1. Immediately call for an ambulance, or have a bystander call: 9-9-9 for UK, 1-1-2 for Europe, or your local emergency number
2. Locate and attach an AED, or ask a bystander to do so
3. Start chest compressions within 10 seconds of SCA. Follow instructions provided by AED when applicable
4. Push hard and fast — the Resuscitation Council UK recommends a compression depth of 5—6 centimetres (2—2.4 inches) and a rate of 100—120 beats per minute
5. Allow complete chest recoil between compressions
6. Minimise compression interruptions
7. Lift the victim's chin and provide two rescue breaths for every 30 compressions

Common Questions About High-performance CPR

Even after receiving the proper guidance and training, there may be uncertainties about high-performance CPR. Here are some answers to frequently asked questions about this practice:

What Medical Equipment Is Needed for High-performance CPR?

While specific medical equipment is not required to provide high-performance CPR, technology can make it significantly easier. An AED that provides CPR feedback on compression depth and rate is particularly helpful.

ZOLL^® monitor/defibrillators have cutting-edge Real CPR Help^® technology that provides audio and visual feedback to ensure rescuers' compressions are at the optimal rate and depth.

Should I Perform CPR if There Is a Pulse?

No. If a pulse is present, do not perform CPR. Instead, continue to monitor the victim's pulse and breathing until a medical professional arrives. If the victim loses their pulse at any point, begin high-performance CPR and continue with CPR until a medical professional is ready to intervene.

Read the 2021 ERC Guidelines

The most recent European Resuscitation Council (ERC) guidelines can be found here.