Which Compression to Ventilation Ratio Should You Use?

November 3, 2017

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According to this large systematic review, in adults a 30:2 compression to ventilation ratio was better than 15:2.  For kids, either ratio was better than compression only CPR, except under 1 year in which ventilations did not improve outcome beyond compression-only (likely due to being underpowered).

Why does this matter?
When you take PALS and BLS, you are taught to do a compression to ventilation ratio of 30:2 when solo; 15:2 with two-rescuer CPR in children.  But does this make a difference in outcome?

30:2, 5:1, 15:2, compression-only – which is it?
Which compression to ventilation ratio is better?  This was an ILCOR BLS task force systematic review of 28 studies.  They concluded that in adults, 30:2 was superior to 15:2.  In children either 30:2 or 15:2 was superior to compression-only CPR. But in children under 1 year, 30:2 or 15:2 and compression-only CPR showed no difference.  However, with only 2 pediatric studies, the infant subgroup analysis was likely underpowered to detect any differences.  The take home for me is to ventilate kids and keep it simple – if you forget, do 30:2 on everyone.  When you take PALS or BLS, make sure you know 15:2 is the answer for two-rescuer CPR in pediatric patients.

Source
Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review.  Resuscitation. 2017 Sep;118:112-125. doi: 10.1016/j.resuscitation.2017.05.032. Epub 2017 Jun 2.

Peer reviewed by Thomas Davis, MD.