High Performance CPR – Performance Not Protocol!

Pit Crew CPR Positions jpg


This is a supplement to Adult Pit Crew CPR and Pediatric Pit Crew CPR.

Specifically, this is how we have modified our training process since attending the Resuscitation Academy in Seattle / King County.

Each rescuer should experience each position at least twice. In other words, you run the drill, stop and switch, run the drill, stop and switch. This drill is very well received by EMTs and paramedics! It’s fun to watch the performance improve over time.

That’s what it’s all about — perfecting resuscitation!

In a perfect world you would use an instrumented manikin to measure rate, depth, recoil; and volume of air when you squeeze the bag.

The Resuscitation Academy uses Laerdal‘s Resusci Anne QCPR AED Torso with Shock Link and SimPad in each “pod” of 6 rescuers. Each setup retails for about $6,000.00. I like how this particular setup “feels”. We have several different manikins and the more “advanced” ones don’t feel quite right when performing chest compressions.

Video: Adult High Performance CPR (HP-CPR) demonstration at the South Carolina Resuscitation Academy

We break our training down into four positions.

  • Position 1: Monitor / Code Commander
  • Position 2: Chest Compressions
  • Position 3: Airway
  • Position 4: Timekeeper / Assistant 

Once High Performance CPR is up and running we allow two additional rescuers to arrive on scene so we can establish IV/IO access and give epinephrine. We teach our teams to defer advanced airway management for the first 5 cycles unless it’s absolutely necessary (e.g., asphyxial arrest, unable to ventilate, need to protect airway).

Position 1

  • Places monitor at 45 degree angle to left shoulder (monitor can be set back a few feet from working area)
  • Checks pulse and announces “no pulse, begin CPR”
  • Attaches capnography circuit to monitor
  • Extends pads and coordinates placement with rescuer on chest compressions
  • Changes monitor to pediatric mode if applicable
  • When appropriate pre-charges the monitor and manages peri-shock pause

Position 2

  • “Hovers” during pulse check
  • Performs CPR at correct rate, depth, and recoil
  • Accepts feedback from crew members about CPR quality
  • Coordinates pad placement with rescuer on monitor
  • Counts out loud “13, 14, 15″ or “28, 29, 30” to prompt rescuer on airway to give breaths
  • Waits two full seconds for airway man to give breaths and continues compressions
  • Helps keep track of 2 minute cycle
  • When Code Commander announces “stop CPR” at the beginning of the peri-shock pause this rescuer clears out of the way

Position 3

  • Announces “I’ve got airway”
  • Selects the correct sized BVM and attaches capnography between mask and bag
  • Announces “ready for 15:2″ or “ready for 30:2”
  • Reminds rescuer on compressions to count last three
  • Ventilations are given correctly (just enough to produce chest rise with full release between ventilations)
  • Manages the patient’s airway as necessary

Position 4

  • Starts metronome and acts as timekeeper
  • Turns on oxygen and hooks up BVM to oxygen at 15 LPM
  • Selects correct sized OPA for the rescuer on the airway
  • Deploys and tests suction unit
  • If pediatric takes out Handtevy book and determines child’s age
  • Reminds rescuer on monitor to pre-charge the capacitor at 1:45 into the cycle

So far our crews have really enjoyed this method of training. When is the last time you’ve heard cheering and applause during a CPR class?

Check out the South Carolina Resuscitation Academy on Facebook!

See also

Adult Pit Crew CPR – The Explicit Details

Pediatric Pit Crew CPR

High Performance / Pit Crew CPR on the EMS Nation Podcast

Continuous Chest Compressions vs. 30:2. Does it matter? Depends on the quality!


  • Mike Helbock says:

    Tom et al.,
    This is a perfect example of taking the education that the Seattle/King County Resuscitation Academy offered…and making it your own!!
    Well done,

    Mike Helbock
    Faculty – Seattle/King County Resuscitation Academy

  • Brian says:

    We’ve also been doing our best to replicate this, by accident as I’ve never witnessed the Seattle / King County program.
    It’s the only way to get slick, almost seamless CPR.

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