Perhaps you give CPR (cardiopulmonary resuscitation) almost every shift, and you consider yourself a code blue champion. Maybe you work on a med-surg unit or in a surgery center that rarely has to code a patient. Despite the ACLS (Advanced Cardiac Life Support) certification card in your wallet, you may find your skills need brushing up on. Below are some tips for ensuring that you are providing excellent CPR.

1. Get your hands on the chest quickly.
As soon as you notice that a patient is pulseless, place your hands on the chest to start compressions while yelling for others to help. Minimize interruptions to CPR.

2. Use your equipment.
If possible, use a stool so that the compressor is at the proper height, and also place a backboard or use the backboard setting on a mattress to get the proper resistance for compressions.

3. Go fast, but not too fast.
Occasionally compressors get so full of adrenaline that they compress at a rate of 120-150, which is too fast to allow for ventricular filling. The rate should be between 100-120. Tip: Music services such as Spotify actually have entire playlists created for the ideal rate of CPR!

4. Depth is important.
Get the proper depth to allow full recoil of the chest. The recommended depth for adults is 2 to 2.4 inches. Sometimes this may mean lifting your hands completely off the chest after each compression.

5. Too much of a good thing.
Pause for breaths without an advanced airway, but also be careful not to “overbag” the patient. Excessive ventilation can increase intrathoracic pressure and decrease coronary perfusion pressure.

6. Use end tidal to measure your compressions.
End tidal carbon dioxide monitoring can reveal the quality of your compressions. End tidal greater than 20 is associated with greater survival outcomes. Values of less than 20 indicate that you need to adjust your rate and depth. If end tidal suddenly jumps into the 40s, you likely have return of spontaneous circulation.

7. Switch compressors to combat fatigue.
Proper CPR is exhausting. Switch every two minutes, and you can give epi every two compressors.

8. Designate a CPR coach.
If you have extra eyes or hands, designate a CPR coach who will monitor the depth and rate of compressions and who will help ensure that compressors are switching appropriately and end tidal is appropriate.

High quality compressions lead to greatly improved patient outcomes.

Laura Kinsella

Laura Kinsella, BSN, RN, CEN, is an emergency room nurse in Washington, DC.

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