CPR Quality Series Part 3: Chest Recoil

Welcome to the third installment of our cardiopulmonary resuscitation (CPR) quality series!

To recap: In part 1 of our series, we covered the basics of high-quality CPR and how CPR feedback technology can help achieve it. Then in part 2, we focused on compression depth, taking a closer look at where the guidelines for depth come from and strategies for meeting those guidelines.

Now in part 3, we’ll turn our attention to an often overlooked — but equally important — aspect of CPR: chest recoil.

Why is full chest recoil important, what are common barriers to allowing for full recoil, and what can we do to address them? Keep reading to find out.

Chest recoil: What is it and why is it important?

What is it?

When a responder takes his or her weight off the chest completely in between compressions, it allows the chest to re-expand fully. This is called full chest recoil.

Why is it important for CPR?

The goal of CPR is to restore blood flow and perfuse the vital organs — essentially acting as the pumps for the heart when it takes a breather. Compressions generate that blood flow from the heart every time a responder pushes down during CPR. So where does chest recoil come in?

When a responder allows for full chest recoil during CPR, it creates a negative intrathoracic pressure. This allows the coronary arteries to refill, creating preload. The heart is then able to pump more blood to the brain and other vital organs during the next compression. The result? Increased cerebral perfusion pressure and ultimately, positive neurologic outcomes.¹

The bottom line: When you understand the anatomy behind it, it’s clear that chest recoil is just as important as the compressions themselves. Without full recoil, the compression that follows will be less effective. That’s why the American Heart Association (AHA) recommends that responders avoid leaning in between compressions, which can inhibit full recoil.²

Still, despite the AHA’s recommendation, chest recoil doesn’t always receive the same focus or attention in training settings as other components of CPR. That brings us to our next point: common barriers.

Common barriers

On paper it sounds simple: Avoid leaning and let the chest re-expand fully in between compressions. This allows the coronary arteries to refill, maximizing the effectiveness of the next compression. So why isn’t it always done in practice?

Lack of awareness

Put simply, chest recoil just doesn’t get the same attention as other aspects of CPR. Training courses tend to focus on the tenets of high-quality CPR (particularly rate and depth) and place less emphasis on considerations like chest recoil. This translates to real-life events as well. With so many other components of high-quality CPR to consider and execute — and without a feedback device that measures chest recoil in the moment — it’s easy to overlook.

Physical attributes

Interestingly, one study of CPR in laypeople found that responders who were taller, had a higher body mass index, and were male were less likely to allow for full chest recoil.³ This suggests that physical attributes may play a role as well.

Strategies to improve

What can be done to address these barriers and improve chest recoil execution during CPR? Here are 3 strategies to consider.

1. Increase awareness

While responders can’t control physical attributes that may play a role, increased awareness of the importance of chest recoil will go a long way. Making chest recoil a greater focus during CPR training for all responders — including education of the anatomy behind it — can help address the knowledge gap.

2. Track CPR quality

Using waveform capnography to measure end-tidal carbon dioxide readings can help responders determine if they are creating appropriate pump and perfusion with their compressions. If the readings indicate that they’re not, responders can then consider factors — such as inadequate chest recoil — that might be affecting CPR quality.

3. Use mechanical CPR

In some situations, using a mechanical CPR device may be appropriate as well. This is an automated solution that removes the inconsistencies and variability that are inevitable when CPR is performed manually.⁴

The bottom line

Chest recoil may not get the same attention as other components of CPR, but it’s equally important. Avoiding leaning, increasing awareness of the importance of chest recoil, tracking CPR quality, and using mechanical CPR when appropriate can all help address the common barriers that prevent full recoil.