A review of chest compression interruptions during out-of-hospital cardiac arrest and strategies for the future

Abstract

Background: It has been known for many years that interrupting chest compressions during cardiopulmonary resuscitation (CPR) from out-of-hospital cardiac arrest (OHCA) leads directly to negative outcomes. Interruptions in chest compressions occur for a variety of reasons, including provider fatigue and switching of compressors, performance of ventilations, placement of invasive airways, application of CPR devices, pulse and rhythm determinations, vascular access placement, and patient transfer to the ambulance. Despite significant resuscitation guideline changes in the last decade, several studies have shown that chest compressions are still frequently interrupted or poorly executed during OHCA resuscitations. Indeed, the American Heart Association has made great strides to improve outcomes by placing a greater emphasis on uninterrupted chest compressions. As highly trained health care providers, why do we still interrupt chest compressions? And are any of these interruptions truly necessary?

Objectives: This article aims to review the clinical effects of both high-quality chest compressions and the effects that interruptions during chest compressions have clinically on patient outcomes.

Discussion: The causes of chest compression interruptions are explored from both provider and team perspectives. Current and future methods are introduced that may prompt the provider to reduce unnecessary interruptions during chest compressions.

Conclusions: New and future technologies may provide promising results, but the greatest benefit will always be a well-directed, organized, and proactive team of providers performing excellent-quality and continuous chest compressions during CPR.

Keywords: CPR; cardiac arrest; chest compressions; interruptions.