Pit Crew CPR

Pit crew or High quality CPR is a co-ordinated resuscitation approach with an emphasis on:

  • Team work, co-ordination and communication
  • Clear leadership
  • a compression rate of 100-120 compressions per minute
  • Compression depth greater than two inches
  • Provision of sufficient chest recoil between each compression
  • Ensuring interruptions to compressions are minimized
  • Pre and post shock pauses kept to a minimum by hovering over chest during rhythm analysis and defibrillation, and immediately resuming after this is done
  • Rhythm assessment every two minutes
  • Rotation of person preforming compressions every two minutes


Most emergency service organisations that have adopted a pit crew approach to resuscitation use a position based plan that details specific roles for each position, although the number of these depends on crew member numbers and skill mix.


pit crew cpr.png


Position 1 role:

  • Assess A,B,C
  • Begins immediate chest compressions if cardiac arrest is established
  • Alternates compressions and BVM

Position 2 role:

  • Applies defibrillator\AED pads
  • Operates defibrillator\AED at end of each two minute cycle
  • Alternates compressions with P1
  • Ventilates with BVM when not carrying out compressions

Position 3 role:

  • Gathers required airway and ventilation equipment
  • Opens and clears airway
  • Inserts OPA\NPA\LMA device
  • Assembles and applies BVM using 2 handed technique is using NPA\OPA ensuring not to hyperventilate the patient

ALS: intubate without interruption to compressions if and when appropriate, attach and monitor capnography

Position 4 role:

  • Acts as team leader
  • Rotates and assists where needed
  • Family liaison
  • Records times and interventions


ALS|ILS interventions of gaining IV\IO access, administration of drugs adrenaline\epinephrine and amiodarone if VF\VT when directed to by the commander are usually incorporated by and additional position near the patient’s feet end

source1  source2

Source1 above shows an example of how the different skill mix and staff numbers can be integrated into the pit crew approach. It is also important to note that some providers also integrate the use of impedance threshold devices, mechanical compression devices and feed back devices into their pit crew models.


The team leader often uses cards containing checklists for CPR and post ROSC care such as this:


This ensures that all aspects of the pit crew approach are implemented.

Video’s of Pit Crew in action:

https://www.youtube.com/watch?v=Hlo8ttr_TXI – USA

https://youtu.be/iXw5fNfl5Rw – LAS



5 Comments Add yours

  1. Tatsu Kuwasaki says:

    Great summary of the roles we discussed at the C & C is now posted.
    Thank you Hannah for the great work!


  2. Tatsu Kuwasaki says:

    Thanks Hannah for a great work and Andrew for starting the online discussion.
    Here is a couple of things that I’d like to add;


    Christy L. Hopkins, Chris Burk, Shane Moser, Jack Meersman, Clair Baldwin and Scott T. Youngquist. (2016). Implementation of Pit Crew Approach and Cardiopulmonary Resuscitation Metrics for Out‐of‐Hospital Cardiac Arrest Improves Patient Survival and Neurological Outcome. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.115.002892

    Pearson, D. A., Darrell Nelson, R., Monk, L., Tyson, C., Jollis, J. G., Granger, C. B., & … Runyon, M. S. (2016). Clinical paper: Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative. Resuscitation, 105165-172. https://doi.org/10.1016/j.resuscitation.2016.04.008

    And here is a great presentation by London Ambulance.

    See you all on 23/01/17 at Wrights Rd for C & C discussions.


  3. geehannah says:

    There is also the option of Fire rotating out of position 1 (effectively a 1a &1b), leaving position 2 to operate the defib and draw up/administer drugs, therefore the unseen position 5 is not required. Kind of like as shown in this video https://www.youtube.com/watch?v=mBnXFn5fOuM


  4. Andrew O says:

    Alrighty then. Excellent job Hannah. I suppose we’re really just left on how to apply the principles of pit crew to our shift.

    As far as position allocations go, we end up where we end up in the start. Ideally, we would end up with fire in positions 1&2, ALS on 3, ILS in the unannounced position 5 (the IV and drugs position) leaving anyone capable in 4.

    This is likely to be an EMT, so I guess EMTs need to start learning how to run an arrest… for me, this means a few things, stepping up for leadership, learning the arrest protocols again, and managing family and the scene. What does it mean for everyone else, of the ALS and ILS variety?


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