Friedrich Maass, who resuscitated a teenager for 60 minutes
with closed-chest cardiac massage in 1891 (with return of
mental function), described that the optimal technique was to
apply forceful pressure and to do so at a rapid rate.24 The
quality of modern chest compression efforts in and out of
hospitals has been quantified through use of an accelerometer
placed on the sternum. Results demonstrated that chest
compressions were frequently interrupted, and cardiac massage
was withheld for an astonishing 48% of pulseless
resuscitation time. Furthermore, compression depth was frequently
too shallow.72,78 The observation that modern chest
compressions are not performed adequately is disconcerting
in the context of the current statistics of survival and
neurological recovery after cardiac arrest, with the healthy
appreciation that cerebral perfusion is zero in the absence of
both native and artificial circulation. The 2005 American
Heart Association resuscitation guidelines therefore advocate
that chest compressions be performed at 100 per minute
(“push hard and fast”) with few and very brief interruptions
for ventilation and pulse checks. There is also a new recommended
ratio of compressions to breathing of 30:2, and
compressions should be immediately reinitiated after shock
delivery instead of reassessing the rhythm or pulse.76 These
interventions increase the number of chest compressions
delivered each minute. If retraining life support personnel
does not improve performance of external cardiac massage,
feedback devices that evaluate the quality of each compression
should be employed to promote proper technique.