Written by Jason Lesnick
Spoon Feed
This review updates our CPR knowledge. Compression-only bystander CPR improves survival to hospital discharge compared to conventional bystander CPR. CPR monitoring tools are not associated with improved outcomes.
High-quality compressions reign supreme
New research is constantly being published about CPR and how to maximize cardiac arrest patient outcomes like survival, neurologic outcomes, and return of spontaneous circulation (ROSC). This narrative review synthesizes current literature on CPR techniques, mechanical adjuncts, and monitoring strategies in cardiac arrest with regard to their effects on outcomes.
Current evidence suggests compression-only CPR by bystanders improves survival to hospital discharge versus conventional bystander CPR, though no difference exists among trained responders. Mechanical devices (e.g., LUCAS, AutoPulse) do not improve ROSC or neurologic outcomes, though they enhance CPR quality and guideline adherence.
Based on the current evidence, monitoring of chest compressions is not associated with improved ROSC, survival, or neurologic outcomes, but can provide important information and improve guideline adherence. Types of monitoring examined included end tidal CO2, regional cerebral oxygen saturation, ultrasound, real-time feedback from the AED, a CPR coach, and arterial line monitoring.
If compression quality is poor, the team must make changes to improve CPR quality (e.g., switch compressors) in order to optimize patient outcomes. The optimal compression rate remains 100–120/min with ≥60% compression fraction, while >80% is ideal.
How does this change my practice?
This paper highlights, once again, the value of high-quality compressions in our cardiac arrest patients. I found it interesting that overall U.S. out-of-hospital cardiac arrest survival was 9% as of 2022.
Source
Emergency medicine updates: Cardiopulmonary resuscitation. Am J Emerg Med. 2025 Jul;93:86-93. doi: 10.1016/j.ajem.2025.03.057. Epub 2025 Mar 24. PMID: 40168915
