The nurse is the team leader for a client in cardiopulmonary arrest. Compressions are 120/min with two one-second bag-valve-mask ventilations. There is visible rise and fall of the chest with ventilations. The patient remains cyanotic and no pulse is palpable with compressions. Which action should the team implement next?

• A. Allow complete chest recoil.
• B. Increase ventilation rate.
• C. Decrease compression rate.
• D. Continue without changes.

Answer: (A)

During CPR, letting the chest recoil completely after each compression is essential because it allows the heart to fill again and venous blood to return to the right heart. This preload is what the next compression uses to push blood forward. If the rescuer maintains any pressure on the chest or doesn’t allow full recoil, the heart can’t fill adequately, reducing cardiac output and perfusion to vital organs. Even with a fast compression rate and ventilations, if recoil is incomplete, circulation remains poor, which is why the patient stays cyanotic and pulseless.

So, the next step is to ensure complete chest recoil with every compression, removing any leaning or sustained pressure on the chest and allowing the chest to return fully to its normal position before the next compression. Increasing ventilation rate or decreasing compression rate would not address the underlying issue of poor venous return, and continuing without changes would not improve perfusion.