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When Do Pauses in Compressions Typically Occur While Performing High-Quality CPR?

Performing high-quality cardiopulmonary resuscitation (CPR) is crucial for resuscitating someone in cardiac arrest emergencies. However, during this life-saving procedure, it’s important for the responder to know when brief pauses in chest compressions are appropriate to facilitate other life-saving interventions. In this article, we will discuss when do pauses in compressions typically occur to optimize CPR outcomes.

Why Pauses are Needed?

When someone’s heart stops unexpectedly, every second counts. The goal of CPR is to manually pump the heart and circulate oxygenated blood to vital organs until definitive medical treatment can restart the heart. To achieve this, the rescuer must perform uninterrupted chest compressions at a rate of 100-120 compressions per minute. However, pausing compressions briefly allows the responder to effectively perform other critical life-saving interventions.

The American Heart Association (AHA) CPR guidelines recommend pausing compressions only when absolutely necessary to allow things like rescue breathing, applying an AED, checking a rhythm, or changing rescuer positions. This ensures compressions remain continuous whenever possible but crucial interventions aren’t neglected either. Blood flow stops during any breaks from compressions, so responders should aim to limit pauses to under 10 seconds whenever feasible.

During Rescue Breaths

One of the main reasons a rescuer will pause chest compressions during CPR is to provide rescue breaths to the victim. According to AHA guidelines, after every 30 compressions, the responder should stop compressing, open the airway using head-tilt chin-lift maneuvers, and deliver two rescue breaths over one second each to quickly oxygenate the blood before resuming compressions.

This cycle of 30 compressions followed by 2 breaths should continue uninterrupted until emergency help arrives to manually circulate oxygenated blood to the brain and heart during the pause. Research shows that chest compressions are far more important than breaths for generating blood flow during cardiac arrest, so any pause here should be as brief as possible—no longer than 10 seconds.

Applying an AED

When an automated external defibrillator (AED) is available, the responder should immediately pause compressions after the first shockable rhythm analysis to allow the machine to administer the shock safely. The latest AHA guidelines state, “after electrode placement, do not touch the patient during rhythm analysis and shock delivery.” Rescuers should ensure everyone is clear of contact before the AED advises “Stand Clear, don’t touch the patient” and delivers a shock if needed.

Compressions then resume promptly after shock delivery to get blood flow going again as soon as possible. Rapid defibrillation is crucial for heart restart success, so minimizing downtime during AED use is critical. Aim to keep the pause under 10 seconds.

Checking Rhythm

Another scenario where pausing compressions may occur is when emergency medical services (EMS) providers arrive on scene and want to interpret the patient’s cardiac rhythm. When responders assess the patient, a brief 5-10 second pause in compressions may be necessary to obtain an accurate interpretation of heart rhythm and properly attach monitoring leads and patches.

Fast action is key, so compressions should continue while setting up monitoring equipment if at all possible. Rescuers should resume compressions immediately after rhythm interpretation to optimize blood flow until advanced care and targeted therapy arrive.

Switching Responders

Sustaining high-quality CPR is extremely physically demanding and tiring. To prevent responder fatigue, international guidelines recommend switching rescuers approximately every two minutes to maintain adequate compression rates and depth.

When switching providers during a two-rescuer CPR scenario, it’s recommended to pause compressions momentarily to allow the new rescuer to move into position, and then smoothly resume compressions immediately by the replacement responder. This transition should be accomplished in under 5 seconds to minimize potential blood flow interruption.

In Summary,

Brief, well-planned pauses in compressions are necessary during CPR to allow for important interventions like ventilation, defibrillation, and emergency provider changes. However, pausing should be limited to under 10 seconds whenever possible to maintain vital blood flow to the heart and brain until a pulse returns. Responders should aim to keep compressions continuous whenever they safely can. Continuous chest compressions will ultimately enhance the effectiveness of CPR and lead to the best chance of survival for patients in cardiac arrest.

FAQs About CPR Pauses

How long can chest compressions be paused for defibrillation?

The recommended maximum time to pause compressions for defibrillation is 10 seconds. This allows for rhythm analysis without compromising circulation for too long. Resumption of compressions should be immediate upon shock or “no shock advised” prompt.

Can compressions continue during rhythm analysis with an AED?

No, AED algorithms require complete stillness during its rhythm interpretation period for accuracy. However, rescuer hands can remain on the chest until prompted to stop compressions to minimize delay between analysis and shock delivery if indicated.

 

Author

LT. Jeff Haughy

Owner Jeff Haughy has been providing high-quality care in the EMS industry since 1995 and started his Fire Service career with the Alameda Fire Department in 1991 as a Fire Explorer.

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