Chest Compression Fraction and Factors influencing it

Abstract

Introduction: Chest compression fraction (CCF) is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation. Targeting a CCF of at least 60% is intended to limit interruptions in compressions and maximize coronary perfusion during resuscitation. We aimed to identify the mean CCF and its relationship with various factors affecting it. Methods: Patients presenting to the emergency department in cardiac arrest at a single center were prospectively included in this study. Resuscitation was provided by trained health-care providers. The feedback device Cprmeter2™ was placed on the patient's sternum at the beginning of resuscitation. The total time taken for the entire resuscitation was noted by the device and CCF calculated. Results: The mean CCF was analyzed using descriptive statistics and was found to be 71.60% ± 7.52%. The total duration of resuscitation ( R = −0.55, P = < 0.001, min-max, 2.02–34.31, mean 12.25 ± 6.54), number of people giving chest compressions ( R = −0.48, P = < 0.001, min-max, 1–6, mean 4.04 ± 1.12), and total number of team members in resuscitation ( R = −0.50, P = < 0.001, min-max, 4–10, mean 6.65 ± 1.32) had negative correlation with CCF. Diurnal variation (day, n = 35; mean 69.20% ± 7% and night, n = 20; mean 75.80% ± 5.6%, P = 0.001) and patients receiving defibrillation (receiving n = 10 mean 67.00% ± 4.11% and not receiving n = 45 mean 72.62 ± 7.42%, P = 0.005) were found to significantly affect CCF. Conclusion: The mean CCF for cardiac arrest patients was well within the targets of guideline recommendation. CCF decreased when resuscitation lasted longer, during daytime when the defibrillator was used, the total team members increased, and also when the number of people giving chest compressions increased. CCF during resuscitation may improve if there is a focus on improving these factors and requires validation in multicentric settings.

Effectiveness of rescue Me CPR! smartphone app providing real-time guidance to untrained bystanders performing CPR

“…Reducing delay in the start of CPR, maximizing the ratio of time the patient is being perfused via compressions (i.e. Chest Compression Fraction), and increasing the overall quality of CPR have all been linked with increased OHCA survival rates [ 20 , 28 , 30 ]. The RMC and PGC app users in this study respectively initiated CPR compressions ∼20 s and ∼50 s slower than CPR certified subjects, though both reach compressions multiple minutes faster than the ∼3 min delay reported in dispatcher-assisted CPR, which somewhere between 20 % and 50 % of precincts don't provide data [ [31] , [32] , [33] ].…”

“…Chest compression fraction, CCF is a key metric quantifying CPR effectiveness, with a value of 1.0 representing the perfect but impossible situation of uninterrupted compressions applied immediately upon seeing the patient, with zero interruptions. AHA guidelines recommend a CCF of at least 0.6 and an idealized CCF of 0.8 or greater [ 28 , 30 ]. So, neither CPR certified subjects nor RMC app users achieved ‘idealized’ CPR on average.…”

“…This surrogate for perfusion time suggests that RMC app users reach equivalent if not superior levels of perfusion once compressions begin. An even more comprehensive metric of BLS quality is the frequency of high-quality CPR, as defined by the AHA, as detailed above [ 28 ]. While no group studied performed high-quality CPR consistently, RMC users did in 50 % of aggregate CPR cycles, and CPR certified subjects did so in 25 % of cycles.…”

“…3 . Chest compression fraction (CCF) is the proportion of time spent performing compressions compared to the total duration of the resuscitation [ 28 ]. High-quality CPR in compliance with AHA guidelines can be considered that which includes 30 compressions administered at a rate between 100 and 120 compressions per minute, compressing the chest >2 inches, a chest compression fraction of 0.8 or above, proper hand positioning, and two rescue breaths administered that cause chest rise (or this step intentionally omitted) [ 29 ].…”