Rethinking the 2-minute rule in adult basic life support cardiopulmonary resuscitation

Abstract

The standard 2-minute cycle of cardiopulmonary resuscitation (CPR) followed by rhythm analysis has long guided out-of-hospital cardiac arrest basic life support. However, recent studies suggest this method may not optimize return of spontaneous circulation. Research shows most ventricular fibrillation recurrences occur within a minute post-shock, supporting earlier defibrillation and rhythm analysis during CPR to improve survival. Conversely, when no shock is needed, longer CPR durations may be more beneficial. This commentary article reviews the evolution of CPR guidelines and critically assesses new evidence, advocating for a re-evaluation of the 2-minute interval in favour of more flexible, patient-specific resuscitation strategies.