What is CCF
Individuals suffering from a cardiovascular emergency may experience cardiac arrest. Cardiac arrest is exactly as it sounds, cardiac activity is arrested, stopped, and blood is not shuttling around the body as it should be. The American Heart Association (AHA) states that in one year 475,000 people die from cardiac arrest (Meaney, 2013). Lay rescuers and medical professionals trained in cardiopulmonary resuscitation (CPR) aim to get the heart pumping again through a combination of chest compressions and defibrillation. The Resuscitation Outcomes Consortium (ROC) found that patient survival is linked to the quality of CPR.
The AHA defines CPR as high-quality if it meets the following criteria:
Compression depth: 2 inches for Adults and children, 1-1/2 inches for infants.
Compression rate: 100-120 compressions per minute
Allowance of full chest recoil
Compression to breath ratio: 30:2 (1 rescuer for adults, children, and infants), 15:2 (2-rescuer for children and infants) *continuous compressions with the presence of an advanced airway
Compression duration: 2-minute intervals
Pauses between compressions no greater than 10 seconds
Avoidance of excessive ventilation (Sinz, 2020)
The ROC found that there is wide variability in patient survival, which was studied in both animal and clinical settings. Regardless of the setting, the success of resuscitation efforts was directly attributed to the quality of CPR delivered. Maximize resuscitation efforts by adhering to the above performance standards. It is reasonable to expect improved patient outcomes when EtCO2 is above 10 mmHg, and coronary perfusion pressure (CPP) is greater than 20 mmHg (Sinz, 2020).
CCF is shorthand for chest compression fraction. Chest compression fraction is a measure of time, specifically, the percentage of time during a resuscitation spent performing chest compressions. To calculate CCF you must divide the total amount of time spent performing chest compressions by the total resuscitation time. The AHA recommends a CCF greater than 60% for single-rescuer situations and greater than 80% for team-based situations (Sinz, 2020).
While CCF is just one component of a successful resuscitation, the ROC found that for every 10% increase in CCF, there was an increase in survival of 11% (Sinz, 2020). This metric incentivizes rescuers to maximize CCF. Minimize pauses in chest compressions to increase CCF and return CPP to an adequate level, which ensures the myocardium is perfused. A perfused myocardium is more responsive to medications and electrical therapies. Increase CCF by integrating practices like pre-charging the defibrillator, hovering over the patient’s chest during pauses if performing compression duties, and ensuring compressor switches are performed swiftly and efficiently. Resuscitations can be chaotic, which is why team members must work together fluently and understand the complex nature of the cardiac arrest.
In summary, adhere to the performance standards of high-quality CPR, aim for an EtCO2 of at least 10 mmHg and a CPP of at least 20 mmHg during chest compressions, and maximize CCF to a level of greater than 80% during team-based resuscitations. Supporting these metrics has been shown to improve patient outcomes greatly. An app that is highly helpful in calculating CCF is Full Code Pro from the AHA. The app is free and can be downloaded here https://apps.apple.com/us/app/full-code-pro/id589451064. Aim to save a life.
References
Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., Abella, B. S., Kleinman, M. E., Edelson, D. P., Berg, R. A., Aufderheide, T. P., Menon, V., & Leary, M. (2013). Cardiopulmonary resuscitation quality: Improving cardiac resuscitation outcomes both inside and outside the hospital. Circulation, 128(4), 417–435. https://doi.org/10.1161/cir.0b013e31829d8654
Sinz, E., Navarro, K., Cheng, A., & Hunt, E. A. (2020). Advanced cardiovascular life support: provider manual. American Heart Association.
