Question: Is it advised that when a patient is not adequately perfusing but still technically with a pulse, that CPR be commenced? In discussing this with my colleagues, we are speaking in regards to a patient who may technically still have an idioventricular or agonal pulse and is circling the drain. Instead of waiting the 30 sec-1 min for the patient to be completely VSA, would it not be better to get on the chest and begin compressions in an attempt at increasing perfusion?
Great question. The provision of CPR is defined by the Heart and Stroke Foundation of Ontario Guidelines (HSFO) and not the Base Hospital. CPR should be initiated when a pulse is not present and a patient has no perfusion (apart from children). While it is tempting to begin CPR early in anticipation of an imminent arrest, it is also possible that patients in the condition you describe are maintaining some degree of cerebral perfusion and beginning active chest compressions would possibly be painful as well as asynchronous with the still contracting myocardium.
New American Heart Association Guidelines are being released this year so perhaps this recommendation will change!