I have a Question

This is something I failed to mention on a previous blog post;

http://lumo-wafflings.blogspot.com/2009/01/afternoon-in-resuscitation.html

It was my first week. I am still new to all of this, but I was VERY new back in January. If you haven't read this post, basically it was my first resus attempt and I was doing the compressions. The patient ultimately died.

My question is: What is the correct rate of compressions in CPR, and is there any reason why a faster or slower speed would be appropriate?

Whilst doing the compressions, the registrar next to me was managing the airway. He was very supportive, talking me through the procedure and encouraging me to get involved. Now one thing I find a very hazy subject is how fast the compressions should be done. The guidelines are 100 compressions per minute. I was going faster than this, but definitely no faster than 140bpm. Halfway through, one of the deputy charge nurses took over the compressions at what seemed like a rate of knots! It was at least twice as fast as me, and I felt a little inadequate. Was I doing it wrong? Was I going too slow? I can't have been, the paramedic was doing it slower than I was...

One of the doctors, I can't remember who, suddenly looked hopeful;

'Those are good compressions Mark*, I think we might have a chance now'

His words cut straight through me.

I was doing this as I had been trained to, I was sure I was at the right depth at a suitable speed, but who was I to argue with a doctor?

I stood and watched the rest of them get on with it. I felt slightly confused as I watched his chest go up and down at a rate of at least 200 beats per minute. I asked myself; 'Was I completely wrong?' And after they stopped, I wondered if my part in the resuscitation attempt had actually contributed to his death. I became very disillusioned and I lost a lot of confidence on that day. I haven't been in resus since my first week, which I have since felt to be a good thing. The thought of being involved in resus and being made to feel so small nearly put me off altogether.

I didn't tell anyone about this for a while, I found it quite upsetting and I felt like I had hindered them rather than helped. I went back and talked to the registrar about this only recently, and he told me what I wanted to hear. He said that it was extremely rude of this doctor to say something that, and that I should have spoken to him about it after. Honestly, I was nearly in tears at the time, so I could never have confronted him over what he thought of me.

After speaking to many doctors, nurses, ambulance staff, etc. it all seems like a grey area. However, I have only heard arguments that support compression speed to be limited. I won't go into too much detail now, but one view provides a strong arugment that if the rate is above 150bpm, the heart isn't being perfused, so going too fast is doing more harm than good. Of course it is worth remembering that most people actually involved in a resus attempt will feel the effects of their own adrenaline which could contribute to the panic and will ultimately make them go faster anyway. It just makes me stop and wonder, when I see a patient in cardiac arrest brought in by an ambulance crew and they are calm and doing CPR as I was trained, then the patient is put in A&E everything changes and it becomes a race to see who can go the fastest. I have yet to hear an argument that supports a fast pace of compressions, so if you have one I would love to know.

I tried to get in touch with the resuscitation council on the subject thinking that they might be able to shed some light on this blurry subject, but I have had no reply. Surely there needs to be guidelines to say what is too fast and what is too slow. I find that some people think that the rate doesn't matter at all, but if the basics aren't being done correctly then how can you expect it to be successful?

Answers on a postcard please.

I am in no position to have any sort of say in how things should or shouldn't be done, (and who would listen to a lowly health care assistant anyway?), but even if it's for my own benefit I'd love this to be cleared up.