compressions/min), interposed abdominal compression CPR (IAC-CPR), active compression–decompression CPR (ACD-CPR) using a suction device applied to the chest, vest CPR, open chest massage, simultaneous ventilation–compression CPR, and use of automated feedback devices that monitor the quality of CPR To date, compression rates and automated performance feedback have been the most promising The other techniques are not supported by pediatric data and their use is not indicated Compression rates affect the cardiac output During CPR, CPP rises during consecutive chest compressions and falls during pauses Compression rates of more than 100 have been shown to improve cardiac output, CPP, and 24-hour survival when compared with rates less than 80 Although the optimal compression rate remains unknown, compression rate of at least 100/min is now recommended for all ages beyond the neonatal period There is some evidence in adults that compression-only CPR (no ventilation) produces similar survival rates Because of the etiology of pediatric arrest, in addition to a higher metabolic rate and lower functional residual capacity, this practice is not recommended for children with an asphyxial arrest The optimal duty cycle (compression:relaxation) also remains unknown To date, a duty cycle of 50% is believed to provide the highest flow rates Leaning or incomplete decompression of the chest during the relaxation phase occurs commonly and may affect the cardiac output generated by CPR by decreasing venous return Open cardiac massage provides better blood flow to vital organs in animals and in adults when compared with CPR However, because of the compliance of the thoracic structures in children, this technique may not offer any benefit There is inadequate data to recommend its use in the resuscitation of children who have suffered a medical cause of their arrest In the newly arrested patient, CPR should be provided immediately to establish a minimum of circulation to the brain and heart, as this is associated with improvements in both survival and outcome Though health care providers may assume mastery of this seemingly basic skill, many studies have demonstrated that the quality of CPR administered in both OHCA and IHA meets the AHA standards