The Goldilocks Rule: Rate Matters

A lot of positive progress has been made in the process of resuscitating cardiac arrest victims. Our understanding of the physiology has improved, the tools at our disposal to successfully intervene in a code are phenomenal, and a cultural philosophy that “it actually works” is sweeping our profession. One of the biggest changes in the process has been a revival on focusing on the basics – and nothing is more basic in a resuscitation than chest compressions.

Chest compressions are the foundation on which a resuscitation is built. And like any foundation, we need it to be of high quality or the entire process will crumble.  I do not care if you have the best drugs, the greatest defibrillator, or the smartest clinician at a code. Without high quality chest compressions, the ultimate outcome will be less than desirable.

In the last few years, there have been some great PSA about performing CPR. My favorite is “Vinnie Jones' hard and fast Hands-only CPR.” Check it out!

Although this PSA is for lay-person CPR, Vinnie hinted at some important aspects of high quality CPR that professional providers need to remember - push hard and fast. However, the actual rate matters.

Think about the baseline in a healthy person. There is a small range in all of our vitals, but a deviation to one extreme or another is a bad thing. A heart rate of 30 or a rate of 240 is a bad thing in a living person. Those rates must be really bad in a person whom we are resuscitating with compressions. Right?

So we do not want a rate that is too slow, nor too fast. We want a rate that is just right! Call it the Goldilocks rule! 100 compressions per minute. That’s the rate! And while we are on the subject of rates, do not breathe too fast for them either! The AHA recommends a rate no faster than 10 breaths per minute.

Build that foundation and watch a real life fairy-tale unfold!

How about it?