Optimum compression to ventilation ratios in CPR under realistic, practical conditions: a physiological and mathematical analysis

To develop and evaluate a practical formula for the optimum ratio of compressions to ventilations in cardiopulmonary resuscitation (CPR). The optimum value of a variable is that for which a desired result is maximized. Here the desired result is assumed to be either oxygen delivery to peripheral tissues or a combination of oxygen delivery and waste product removal.Equations describing oxygen delivery and blood flow during CPR as functions of the number of compressions and the number of ventilations delivered over time were developed from principles of classical physiology. These equations were solved explicitly in terms of the compression/ventilation ratio and evaluated for a wide range of conditions using Monte Carlo simulations.As the compression to ventilation ratio was increased from 0 to 50 or more, both oxygen delivery and the combination of oxygen delivery with blood flow increased to maximum values and then gradually declined. For variables typical of standard CPR as taught and specified in international guidelines, maximum values occurred at compression/ventilation ratios near 30:2. For variables typical of actual lay rescuer performance in the field, maximal values occurred at compression/ventilation ratios near 60:2.Current guidelines overestimate the need for ventilation during standard CPR by two to four-fold. Blood flow and oxygen delivery to the periphery can be improved by eliminating interruptions of chest compression for these unnecessary ventilations.