Should we be teaching single rescuer procedure as the first line action for adult cardiac arrest?

Well, we think the answer is no. Current assessment requirements for CPR and First Aid training in Australia require the following:

• perform uninterrupted CPR on both an adult and an infant resuscitation manikin placed on the floor

• use correct hand location, compression depth rate in line with the ARC recommended ratio of compressions and ventilations

• follow single rescuer procedure, including the demonstration of a rotation of operators with minimal interruptions to compressions

Some would say, what’s wrong with this requirement?

Firstly, there is no requirement for this is only done in Advanced classes which are rarely delivered in workplaces.

We need to go back to basics to be able to understand the inefficiency of single rescuer CPR.

The recommended ratio of compressions to breaths is 30:2. This results in only 30% of the resuscitation time being spent doing compressions. The scientific evidence demonstrates clearly that to increase survivability with CPR there needs to be over 80% of the time doing compressions. This is call compression fraction! – the percentage of time doing compressions.

Now don’t forget, lay people only practice CPR when they attend a training course, which is possibly only once a year and then only spending a few short minutes (maybe only up to 5 minutes, actually doing CPR).

If we look at the maths, it goes like this:

It takes approximately 20 seconds to do 30 compressions, then it takes an additional 15 seconds to complete the 2 breaths (and we are assuming here, that the breaths have been successfully delivered and with in all honestly, breaths almost never work and additional time is spent attempting to redo the breaths, consuming even more time). Then we’re back to the next cycle.

So now to complete 1 cycle of 30:2 probably takes in the real world about 30 seconds plus and the end result being that possible 2-3 breaths have been delivered per minute and only 50-60% of the time spent doing compressions. Because of the lengthy time interrupting compressions the amount of effective forward blood flow is minimal.

Now add the time it takes to utilize a defibrillator which is approximately 25 seconds plus every 2 minutes, we now only have a compression fraction of maybe 50%

If we now look at 2 rescuer CPR we see a significant change. Again, allowing only 20 seconds to complete 30 compressions, it now only takes approximately 5 seconds to deliver the 2 breaths. Allowing for the use of a defibrillator every 2 minutes we end up with a compression fraction now, of approximately 70%.

It may appear to some that this is not a big difference, but when we take into account that compressions are now only being interrupted by 5 seconds, this results in better forward blood flow reach the heart and brain.

So, what should be taught in a standard "workplace CPR program"?

Firstly, for the witnessed adult sudden cardiac arrest – compression only CPR. This is done whilst help is being call for, a defibrillator being retrieved and calling for more rescuers.

Next should be the application of a defibrillator, followed by 2 rescuer CPR. Note, that ‘compression only CPR’ has a compression fraction of 90% plus.

In summary; a quality CPR program should include the following CPR instruction:

1. Adult CPR – both 'compression only' CPR and 2 rescuer CPR

2. The mandatory use of pocket resuscitation masks as a standard item for 2 rescuer CPR

3. Thorough training in the use of AEDs (defibrillators)

4. Standard CPR (30:2) for infants and children

5. The mandatory use of child and infant manikins for CPR training for these age groups.