High-Quality CPR and Defibrillation Principles

Key Points

• High-quality CPR is a primary contributor to survival after cardiac arrest.
• CPR actions are rhythm and pulse dependent; not all interventions are indicated in all arrests.
• Defibrillation is emergently indicated for ventricular fibrillation and pulseless ventricular tachycardia.
• Asystole is not a shockable rhythm and requires non-shock resuscitation priorities.

Pathophysiology

Cardiac arrest eliminates effective perfusion, rapidly threatening cerebral and multisystem viability. CPR provides temporary circulatory support through chest compressions and ventilatory support strategies until return of spontaneous circulation or definitive advanced care.

Defibrillation interrupts nonperfusing ventricular electrical chaos to enable organized cardiac activity. Rhythm recognition is therefore central to selecting shock versus non-shock pathways.

Classification

• Respiratory arrest with pulse: Rescue breathing indicated; chest compressions are not routine first action.
• Pulseless arrest: CPR indicated to maintain perfusion.
• Shockable arrest rhythms: Ventricular fibrillation and pulseless ventricular tachycardia.
• Non-shockable arrest rhythm: Asystole.

Nursing Assessment

NCLEX Focus

Questions emphasize immediate differentiation of pulse/no-pulse states and shockable versus non-shockable rhythms.

• Assess responsiveness, pulse status, and breathing adequacy without delay.
• Assess monitor rhythm rapidly when equipment is available.
• Assess CPR quality indicators during active resuscitation.
• Assess need for AED/manual defibrillator and team role assignment.

Nursing Interventions

• Initiate high-quality CPR immediately for pulseless arrest.
• Apply AED or defibrillator promptly when shockable rhythm criteria are met.
• Continue coordinated CPR-defibrillation cycles per current algorithm guidance.
• Use available code-cart resources to support airway, medications, and rhythm management.
• Perform structured post-event handoff documenting rhythm, shocks, and response.

Rhythm-Action Mismatch

Delivering shocks to non-shockable rhythms or delaying CPR in pulseless arrest can worsen outcomes.

Pharmacology

During advanced resuscitation, emergency medications are integrated with CPR and rhythm-guided defibrillation; nursing roles include preparation, administration support, and event-timeline documentation.

Clinical Judgment Application

Clinical Scenario

A patient with sudden collapse has no palpable pulse; monitor rhythm appears nonperfusing.

Recognize Cues: Pulselessness confirms need for immediate perfusion support. Analyze Cues: Rhythm category determines whether defibrillation is indicated. Prioritize Hypotheses: Rapid CPR plus correct rhythm-specific pathway is the top survival determinant. Generate Solutions: Begin compressions, prepare defibrillator, coordinate team roles. Take Action: Deliver algorithm-concordant CPR and shock decisions. Evaluate Outcomes: Rhythm and perfusion reassessment guide ongoing cycles and escalation.

Related Concepts

• ecg-waveform-basics-and-12-lead-application - Rhythm interpretation principles support emergency rhythm recognition.
• advanced-airways-and-intubation - Airway control may be required during prolonged or unstable resuscitation.
• manual-resuscitators-and-manual-ventilation - Bag-valve-mask support is core to arrest airway management.
• oxygen-therapy-device-selection-and-monitoring - Oxygen strategy integrates with emergency ventilation support.
• respiratory-failure - Respiratory deterioration may precede arrest and requires early intervention.

Self-Check

1. Why is asystole managed without defibrillation?
2. Which rhythms are classically shockable in pulseless arrest?
3. How does CPR quality influence post-arrest survival potential?