When to Switch Rescuer Positions During CPR?

Cardiopulmonary resuscitation, commonly known as CPR, is a lifesaving procedure used during a cardiac arrest. Performing high-quality CPR is critical for improving the chances of survival. An essential part of effective CPR involves switching rescuer positions regularly during chest compressions. In this article, we will discuss the importance and timing of switching rescuer positions during CPR.

Why Switch Positions During CPR?

There are several important reasons why switching rescuer positions during CPR:

• Fatigue
• Compression Quality
• Motivation
• Compliance

1. Fatigue

Performing high-quality chest compressions during CPR is physically demanding work. Rescuers can experience rapid fatigue in their arms and shoulders. By regularly switching positions every 2 minutes or so, rescuers can avoid tiring which would compromise compression quality and depth. Keeping rescuers fresh is critical for optimizing blood flow to vital organs during a cardiac arrest.

2. Compression Quality

It can be difficult to maintain proper hand placement, compression rate, and full chest recoil between compressions over time. Switching positions allows another rescuer to take over and deliver compressions with correct form and technique. This helps maximize blood flow throughout the rescue attempt.

3. Motivation

Just like with any task, rescuers may experience drops in motivation and focus over longer periods of time performing CPR alone. Switching positions keeps rescuers engaged and prevents declines in compression performance that could occur from losing focus or growing bored with the task. The fresh rescuer is highly motivated to deliver optimal compressions.

4. Compliance

The 2020 American Heart Association CPR guidelines recommend switching rescuer positions every 2 minutes to maximize compliance with the recommendations. Following guidelines has been strongly associated with improved outcomes in cardiac arrest victims. Meeting the switching timelines set forth helps ensure rescuer teams are following guidelines to the best of their abilities under stressful conditions.

How Often Should Positions Be Switched?

The latest AHA guidelines specifically recommend switching rescuer positions every 2 minutes when performing single-rescuer CPR on an adult.

• For two-rescuer CPR on an adult, switch who is compressing and who is ventilating every 5 cycles, or roughly every 2 minutes.
• For single-rescuer pediatric CPR on a child, the guidelines recommend switching rescuer positions every 2 minutes just as with adults.
• During two-rescuer pediatric CPR, the rescuers should switch roles (compressions vs. ventilation) every 2 minutes to avoid fatigue and sustain quality.

These 2-minute interval recommendations are based primarily on scientific simulations and practical experience showing declines in quality may occur beyond this timeframe for most rescuers. Strictly adhering to the intervals helps ensure compressions are consistently delivered with proper force and technique throughout the entire cardiac arrest event.

While rescuer teams should aim to switch at the 2-minute mark whenever possible, the guidelines allow for flexibility based on individual rescuer ability or circumstances of the rescue attempt. As long as fatigue is avoided and quality maintained, the switches can be made at approximately 2 minutes rather than an exact timeframe. The overall objectives of preventing fatigue and promoting high-quality CPR should be prioritized.

Signs It May Be Time for a Switch

For rescuers performing CPR alone without another person to call for a switch, it’s important to be able to recognize when it’s time for a position change. Some signs that suggest it’s time for a switch include:

• Breathing heavily or feeling very tired between compressions
• Strong soreness or aching in the arms/shoulders being used for compressions
• Difficulty maintaining proper compression rate, depth, hand placement
• Feeling less focused on counting compressions out loud or following prompts
• Compressions that are becoming more shallow and incomplete between chest recoils
• Seeing others on the rescue team starting to look more fatigued as well.

If any of these signs are present, the rescuer should announce they need a change and have another team member promptly take over compressions. Waiting until feeling completely exhausted will compromise CPR quality and reduce the chances of return of spontaneous circulation. Recognizing early fatigue cues allows for a smooth transition.

Improving Rescuer Compliance With Position Switches

As guidelines aim to optimize CPR outcomes, it’s important that rescuer teams follow procedures like switching positions precisely to comply with recommendations. Here are some ways healthcare facilities can help maximize compliance:

• Educational Refreshers: Provide in-person or online refresher courses highlighting the rationale for switches. Reinforce success depends on quality.
• Posted Reminders: Have timer devices and cue cards visible as a constant reminder switches are due at 2 minutes. Consider signs in code rooms.
• Targeted Simulations: Include switching drills in team simulations to practice seamlessly. Providing feedback increases comfort.
• Peer Support: Encourage rescuers to politely remind each other when a switch is needed instead of continuing alone out of duty. Safety first.
• Leadership Buy-In: Medical directors should stress importance of strict guideline adherence for best outcomes to all staff levels.
• Positive Reinforcement: Consider an “award” program recognizing excellent CPR including consistent position switches for continuous quality improvement efforts.

Rigorous staff education combined with ongoing positive reinforcement and reminders has shown results in improving adherence to cardiac arrest guidelines and protocols. Making the “switch at 2” a standard routine will optimize the chance of survival in victims of sudden cardiac arrest at healthcare facilities.

Conclusion

In conclusion, regularly switching rescuer positions every 2 minutes during CPR is a key guideline recommendation backed by sound scientific evidence. Strict compliance optimizes compression quality, prevents fatigue issues, and supports the ultimate CPR goals of maximizing perfusion and the chance of a good outcome. With a bit of practice and focused education provided above by Heart Start CPR, healthcare teams can make the switch an automatic part of their high-performance CPR skills.

FAQs About Switching Rescuer Positions

What if there is only one rescuer available?

If only one rescuer is available to perform CPR, they should continue compressions and switch their compressing hand position every 2 minutes (e.g. from two-handed compressions to one hand, or switching arms used). This allows a break for the primary compressing muscles while still maintaining chest compressions.

How can rescuer teams maximize endurance?

Rescuers can work on general strength and endurance training to boost their CPR performance abilities. Practicing compressions on manikins regularly also builds stamina. Staying hydrated and well-rested before a shift enhances endurance as well. Taking breaks as frequently as needed is always recommended to maintain quality resuscitations.