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What CPR Strategy is Best? Continuous Compressions or 30:2?

October 25, 2021

Written by Aaron Lacy

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During cardiopulmonary resuscitation, when correctly done, a chest compression strategy of 30 compressions followed by 2 breaths (30:2) was associated with higher survival than continuous chest compressions (CCC). However, there was significantly less adherence to the 30:2 strategy when compared to CCC.

Why does this matter?
Proper chest compression technique is pounded into our brains because it is likely the most important intervention provided during a code. If there is an optimal compression strategy to improve survival, it must be implemented.

What’s the best way to bump-bump-bump to ‘Stayin’ alive?’
This was a secondary analysis of a large RCT that showed that a pause in compressions to give 2 rescue breaths (30:2) vs continuous CPR (CCC) with asynchronous breaths made no impact on survival to hospital discharge. However, we know that time off the chest is associated with worse outcomes and is likely what matters most.  Does these data look different when strategies are controlled for adherence to a given compression strategy?

An automated algorithm devised to detect adherence to chest compression strategy was applied to the 26,810 patients included in the original RCT. Overall, 54.4% adherence was noted for the CCC strategy (n = 12,276) versus 48.3% for the 30:2 strategy (n = 7,037). These numbers show that a CCC strategy is easier to adhere to but also show there is low adherence to either strategy overall. While the original study showed no difference between CCC and 30:2, when controlled for adherence, an intended CCC strategy had a lower OR for survival (OR 0.72, 95% CI 0.64-0.81) than a 30:2 strategy (OR 1.05, 95% CI 0.90-1.22); interaction p < 0.01). 

So, while 30:2 seems like the better choice based on this data, focus on adhering to whatever strategy your team picks or knows well. The best strategy is to do your BLS and ACLS instructors proud and provide high quality, high compression fraction, and low interruption CPR.

CPR compression strategy 30:2 is difficult to adhere to, but has better survival than continuous chest compressions when done correctly. Resuscitation. 2021 Aug;165:31-37. doi: 10.1016/j.resuscitation.2021.05.027. Epub 2021 Jun 5.

What are your thoughts?