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High Performance CPR

03 May 2024 - Susan Helmrich

Just like a NASCAR pit crew, optimising resuscitation outcomes requires high performance CPR. For this to occur, it is important to minimise interruptions to compressions and optimise perfusion:

  • rate (100-120/min)
  • depth (⅓ depth of patients chest)
  • recoil (full chest recoil to allow ventricular refilling & coronary artery perfusion)
  • ventilations (2 breaths every 30 compressions or 10 breaths/min)

The 2020 ILCOR guidelines (Nolan et al 2020)¹, discuss strategies for planning interruptions to compressions with an emphasis on keeping this time to less than 5 seconds.  This is an achievable goal, but requires precision throughout the resuscitation with all team members.

The impact of integrating a CPR Coach

Recent studies have shown that the integration of a trained cardiopulmonary resuscitation (CPR) Coach during resuscitation enhances the quality of CPR during simulated cardiac arrest. A CPR Coach’s primary role is to provide real time feedback to compressors to optimise compliance with current CPR guidelines and cognitively unload the Resuscitation Leader, enabling them to focus on the algorithm and reversible causes.

The CPR Coach is not a new concept, but a role not always present in resuscitation teams.  Along with defibrillators that provide CPR data and biometric devices such as waveform capnography, the CPR coach is instrumental in focusing on the best CPR in order to maximise oxygenation and perfusion during resuscitation.  

In research led by Prof Betsy Hunt at the John Hopkins Medicine Simulation Centre, teams with a CPR coach demonstrated significant improvements in overall CPR, chest compression depth, chest compression fraction, and pre and post shock pause duration (Cheng et. al. 2018)².

High performance CPR

High performance CPR should be the aim of all resuscitation attempts.  

high performance CPR infographic

Teams should focus on the following points:

  • Coordination and early initiation of CPR with time to first defibrillation less than 2 minutes
  • Target CPR feedback to achieve resuscitation recommendations for depth, rate, recoil and ventilations
  • Provide real-time coaching to improve the quality of chest compressions, and overall chest compression fraction (% of time compressions are performed within target range)
  • Utilise feedback devices such as defibrillators with CPR metrics, Waveform capnography (aim for ETCO2 >20 mmHg) and Diastolic blood pressure if arterial lines are in situ (aim for DBP >40)
  • Coordinate procedures during resuscitation to minimise time off chest
  • Cognitively unload the resuscitation team leader with a CPR Coach

Outcomes from introducing a CPR coach

In my experience as a Resuscitation Coordinator, when a CPR coach was introduced as an integral member of resuscitation teams, there was an increased focus on the effectiveness of CPR throughout the resuscitation.  Generally, time off chest was reduced, and when we reviewed the data from the defibrillators, there was an increase in CPR quality with a significant change in chest compression fraction.  An added benefit was the ability of the team leader being able to focus on assessing and reversing the cause of arrest.  The CPR coach was undertaken by the nurse using the defibrillator, or a nurse who didn’t have another role assigned to them.

Training with equipment that provides CPR feedback including depth, rate and recoil data is beneficial for developing muscle memory and awareness of the requirements for high performance CPR. Utilisation of equipment that provides real-time data such as Zoll defibrillators with CPR feedback pads during training and resuscitation events is integral to high performance CPR. 

How well do you think your teams perform in a resuscitation? 

Quality improvement projects are an empowering tool for passionate clinicians.  If you have a passion for resuscitation and improving patient outcomes, you should consider implementing high performance CPR through the role of CPR Coach and learn more by attending one of our Adult or Paediatric Advanced Life Support (ALS or PALS) Courses via the links below.

Medcast provides resuscitation courses across Melbourne, Sydney and Brisbane with some of Australia’s leading resuscitation educators. We also offer in-house courses at your facility, which is a great opportunity for us to show you the importance of a CPR coach, and how you can incorporate this role into your resuscitation practices.

Related courses


  1. Nola J., Maconochie I., Soar J., Olasveengen T., et al. (2020) Executive summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations. Circulation 142:S2-S27.
  2. Cheng A., Duff Jl, Kessler D., Brown L., Hunt E. (2018) Optimizing CPR performance with CPR coaching for pediatric cardiac arrest: A randomized simulation-based clinical trial Resuscitation 132: P33-40.
Susan Helmrich
Susan Helmrich

Susan is the Head of Nursing Education for the Medcast Group.

DipAppScNsg, BN, CritCareCert, CoronaryCareCert, TraumaNsgCareCert, CertIV(TAE), MN(Ed), and GradCert(Ldrshp & Mgt).

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