What Is High-performance CPR?


High-performance cardiopulmonary resuscitation (HP-CPR) involves performing compressions at the proper depth and rate, while making sure to not lean on the chest and keeping interruptions to a minimum. High-performance CPR is also referred to as high-quality CPR by the medical community, and the terms are interchangeable. When someone suffers sudden cardiac arrest (SCA), lay rescuers should feel confident they can provide high-performance CPR immediately to help the victim survive. Fortunately, HP-CPR is more straightforward than it once was and adheres to the most recent developments in resuscitation research.

In the past, rescuers used different methods such as mouth-to-mouth to help restore regular breathing and heartbeats. It wasn't until 1960 that the American Heart Association developed CPR and began promoting it. A standard training program emerged for public and professional use shortly afterward.

A stringent analysis of survival rates prompted rescuers and medical professionals to further refine their approach to CPR. This concentrated approach to improve survival rates resulted in the development of high-performance CPR.

Ultimately, the goal of high-performance CPR is to improve the circulation of oxygen and blood in the victim’s body while emergency medical personnel are on the way. When CPR must be performed, using an automated external defibrillator (AED) with CPR feedback technology can maximize effectiveness.

Why High-performance CPR Is Important

High-performance CPR pumps oxygenated blood to a victim’s heart and brain. Bystanders can use this tactic immediately while they wait for emergency medical services to arrive onsite. This improves survival rates considerably and provides better outcomes than outdated forms of CPR:

  • In a study in Arizona, patients who suffered cardiac arrest were 2.7 times more likely to survive if the rescuer used ZOLL® Real CPR Help® technology and received scenario-based training (compared to a rescuer with traditional training and no feedback technology).1

You don't need to be a trained professional to rescue SCA victims with CPR. High-performance CPR can be taught to everyone and is the best way to keep the victim stable until an AED is found and administered.

How and When to Enact High-performance CPR

When to Administer High-performance CPR

The first step of administering high-performance CPR is identifying when an individual requires rescue. There are several scenarios that may indicate or precede the need for HP-CPR, including:

  • No pulse
  • Sudden collapse
  • Sudden cardiac arrest
  • Unconsciousness
  • Breathing problems
  • Drowning

A person in need of HP-CPR must receive care as quickly as possible. It is generally advised that bystanders should perform HP-CPR if somebody seems to need rescue. If a victim does not need HP-CPR, monitor their pulse every two minutes.

Steps for High-performance CPR

When administering high-performance CPR, compression depth and rate are a major determinant of survival outcomes. The American Heart Association and European Resuscitation Council recommend delivering compressions at a rate of 100–120 per minute at a depth of 2–2.4 inches (5–6 centimeters), in the middle of the chest. Research shows that when rescuers compressed at a depth of <1.5 inches (<3.8 cm), survival rates after out-of-hospital cardiac arrest were reduced by 30%.2

In addition to maintaining the correct compression rate and depth, other best practices include:

  1. Immediately calling emergency services, or have a bystander call
  2. Locating and attaching an AED, or ask a bystander to do so
  3. Starting chest compressions within 10 seconds of SCA. Following instructions provided by AED when applicable
  4. Pushing hard and fast — the AHA and ERC recommend a compression depth of 2–2.4 inches (5-6 centimeters) and a rate of 100–120 beats per minute
  5. Allowing complete chest recoil
  6. Minimizing compression interruptions
  7. Avoiding excessive ventilation

Frequently Asked Questions About High-performance CPR

Even after receiving the proper guidance and training, there may be uncertainties about high-performance CPR. Here are some answers to frequently asked questions about this practice:

What Medical Equipment Is Needed for High-performance CPR?

While specific medical equipment is not required to provide high-performance CPR, technology can make it significantly easier. An AED that provides CPR feedback on compression depth and rate is particularly helpful.

ZOLL® monitor/defibrillators have cutting-edge Real CPR Help® technology that provides audio and visual feedback to ensure rescuers’ compressions are at the optimal rate and depth. For professional rescuers, automated CPR devices such as the AutoPulse® Resuscitation System, can provide automated high-performance CPR to victims of sudden cardiac arrest.

Should I Perform CPR if There Is a Pulse?

No. If a pulse is present, a rescuer should not perform CPR. Instead, they should continue to monitor the victim’s pulse and breathing until a medical professional arrives. If the victim loses their pulse at any point, begin high-performance CPR and continue with HP-CPR until a medical professional is ready to intervene.

How Long Should I Perform CPR?

CPR should be administered if a person appears in need and should continue until signs of life are exhibited, such as breathing or regained consciousness, or until a trained medical responder or EMS provider intervenes.

What Are the New AHA and ERC CPR Guidelines?

Reference the American Heart Association (AHA) CPR Guidelines and European Resuscitation Council (ERC) Guidelines for the most recent updates.

Learn More

Integrated, real-time CPR feedback from ZOLL AEDs can help rescuers deliver high-performance CPR. Learn more about ZOLL AEDs.

1Bobrow BJ, et al. Ann Emerg Med. 2013 Jul;62(1):47–56.e1. Epub 2013 Mar 7.
2https://www.ahajournals.org/doi/full/10.1161/cir.0b013e31829d8654

Additional HP-CPR Resources