2.1 Adult Chest Compressions: Position, Rate, Depth & Recoil

2.1 Adult Chest Compressions: Position, Rate, Depth & Recoil

Chest compressions create blood flow during cardiac arrest. High-quality compressions are defined by observable, measurable actions: correct hand position, an appropriate rate and depth, complete recoil, and very short interruptions.

Position the patient and rescuer

Place the patient supine on a firm, flat surface. If the person is on a soft mattress, follow the facility process for making the surface firm without creating a long delay. Kneel beside the chest or position yourself at the bedside so your shoulders can remain directly above your hands.

Expose the chest enough to locate the sternum and permit AED pad placement. Put the heel of one hand on the lower half of the sternum and the heel of the other hand on top. Interlace or lift the fingers so pressure is not directed onto the ribs. Keep the arms straight and use body weight to press vertically downward.

Meet all quality targets

For an adult:

• Rate: 100-120 compressions per minute.
• Depth: at least 2 inches (5 cm).
• Upper depth limit: avoid compressions deeper than 2.4 inches (6 cm).
• Recoil: allow the chest to return fully after each compression.
• Interruptions: keep every pause under 10 seconds and eliminate avoidable pauses.

Rate and depth must be achieved together. Compressions faster than 120/min often become shallow and reduce recoil. Compressions slower than 100/min provide fewer opportunities for blood flow. A metronome or feedback device can help, but the rescuer still watches the patient's chest and responds to the device's prompts.

Recoil and leaning

After each downward stroke, release pressure while keeping the hands in contact with the landmark. Do not lift the hands so far that the position is lost, and do not rest body weight on the chest between compressions. Full recoil allows the chest to re-expand before the next compression.

“Push hard and fast” never means bouncing, striking the chest, or compressing over the xiphoid process. Each stroke should be smooth, vertical, and followed by complete release.

Minimize interruptions

Pause only for actions that cannot occur during compressions, such as rhythm analysis, shock delivery, or the two breaths in a 30:2 cycle. Teams should prepare those actions while compressions continue:

• Apply AED pads without stopping compressions when feasible.
• Charge or prepare equipment according to training while the compressor continues.
• State the clear command promptly.
• Resume compressions immediately after a shock or no-shock message.
• Prepare the next compressor before the planned switch.

AED analysis requires everyone to be clear because motion can interfere with rhythm detection. Once the device permits contact again, restart compressions without pausing for a pulse check unless the device or organized-care protocol directs an assessment because signs of life are present.

Compressor rotation

Fatigue can reduce depth or recoil before the compressor notices it. With enough rescuers, change compressors about every 2 minutes, or sooner when feedback or observation shows declining quality. Announce the switch in advance. The incoming rescuer places hands on the same lower-sternum landmark and begins as soon as the outgoing rescuer moves away.

The switch should occur during an already necessary pause, such as AED analysis, and should take less than 10 seconds. Do not wait for a rescuer to become exhausted.

Feedback and corrective coaching

Compression feedback devices may report rate, depth, recoil, and interruption time. Correct one problem at a time with specific language: “slightly deeper,” “allow full recoil,” or “slow to 100-120.” Visual observation remains important because the device cannot manage all aspects of positioning and safety.

Common technique errors

• Hands too high, too low, or over the ribs.
• Bent elbows that turn each compression into an arm movement.
• Rate above 120/min with inadequate depth.
• Leaning between compressions.
• Long pauses for ventilation, equipment setup, or rescuer changes.
• Continuing poor technique despite feedback.

For exam questions, select the response that preserves the full quality bundle. A rate of 100-120/min is not enough if the compressions are shallow, recoil is incomplete, or interruptions are prolonged.

Skill rehearsal

Practice compressions on a feedback-enabled manikin when available. Use a 2-minute interval and review the displayed rate, depth, recoil, and interruption time. Then repeat while a partner prepares an AED so you learn to keep compressing through equipment setup and stop only for analysis. The purpose of rehearsal is not to chase one perfect number; it is to maintain the entire quality bundle while communicating and changing roles under time pressure.