High-performance CPR Is a Proven Game-Changer

If you’re already familiar with high-performance CPR, skip to the next section. But many systems are still trying to educate their staff on the topic – so here is a brief summary. 

CPR is life-critical – but it’s inherently inefficient. It provides just 10% to 30% of normal blood flow to the heart, and only 30% to 40% of normal blood flow to the brain.⁵ That’s why quality matters. Considering this reality emphasizes the urgency behind the need to make CPR as efficient as possible to increase its effectiveness and buy more time.  

This is the intent behind high-performance CPR.  

CPR quality contributes to the extensive variability of survival between and within systems of care.⁶ High-performance CPR can make drastic improvements to survival rates. King County, WA saw a 50% improvement in discharged survival in the first year following high-performance CPR training,⁷ and their survival rates are among the highest in the world.⁸  

Now that you’re up to speed on the importance of high-performance CPR, read these five tips for training success. 

1. Define and rehearse clear roles

Role clarity is the backbone of high-performance CPR. When everyone knows their position before the call comes in, precious seconds aren’t wasted on scene.  

Allow teams to practice their roles repeatedly until the choreography feels like second nature. Without this kind of repetition, even experienced providers can slip into hesitation or overlap responsibilities when the pressure is on. 

2. Measure to improve – as a team

It may seem obvious that measurement is key to improvement – but this holds especially true for CPR, as it is nearly impossible to judge CPR quality by look or feel alone.  

Key parameters of high-quality CPR include: 

• Compression rate of 100-120 per minute
• Depth of 2-2.4 inches
• Full recoil
• Avoiding excessive ventilation (just enough to observe initial chest rise)
• Minimal peri-shock pauses⁹
• Correct hand position¹⁰ 

Precise measurement and feedback promotes continuous improvement of both individual and team CPR skills. 

3. Train for “organized chaos” across scenarios 

High-performance CPR rarely happens in a controlled, predictable environment. Teams need to be ready for cramped apartments, crowded public spaces, or complex multi-patient incidents. Training should mimic this variety so providers can adapt their workflow, communication, and timing under any circumstance. 

By rotating through multiple types of environments and scenarios, teams build adaptability while reinforcing high-quality compressions, efficient shock delivery, and smooth communication – even when the environment isn’t ideal. 

4. Practice seamless defibrillation

Effective defibrillation training will help teams move seamlessly from rhythm recognition to shock delivery without unnecessary compression pauses. Repeated practice builds confidence and reinforces the choreography that makes high-performance CPR so effective in the field. 

Using realistic equipment allows learners to rehearse pad placement, energy selection, and shock delivery under the same pressures they’ll face in real emergencies.  

5. Give learners a “view of themselves from the outside” 

Experts agree that debriefing is a fundamental component of resuscitation education that drives performance improvement.¹² Optimal feedback and debriefing practices have been shown to promote acquisition and retention of skills and even affect patient outcomes.¹³ 

The most valuable learning happens after the scenario ends. Reviewing exactly what went well and what slowed things down turns a run-through into lasting skill improvement. Without this step, teams risk carrying the same inefficiencies into the next scenario – or the next real call. 

Video-assisted debriefing brings a powerful layer of reflection to high-performance CPR training. By capturing real-time performance, teams can review exactly how roles were executed, how well communication flowed, and where delays or inefficiencies occurred.  

"When we’re live in an environment, we have our own internal perception of what’s going on. [Learners] have one perception of how an event went when they were live in it, but when they go back and watch the video, they say, ‘I see now.’"

- Ed Biebel

Clinical Simulation Manager, Rowan College at Burlington County

Read Ed’s full story: Preparing Paramedic Students with Video-Assisted Debriefing at Rowan College