Cardiac arrest (CA) represents a significant global public health challenge, severely endangering both individual lives and public safety. Over the past years, cardiopulmonary resuscitation (CPR) techniques have advanced significantly. In 2013, the American Heart Association proposed high-quality CPR (HQ-CPR) as a key component for enhancing survival and neurological prognosis in patients with CA. HQ-CPR extends beyond the fundamental skills of compression and ventilation by prioritizing key metrics such as compression rate and depth, full chest recoil, minimal interruptions, and early defibrillation, representing a pivotal shift of CPR toward evidence-based, standardized, and precision-oriented practices. Despite the widespread recognition and adoption of HQ-CPR in Western nations, China continues to encounter multiple barriers in CPR dissemination and quality assurance, including low public training rates, variable instructional quality, delayed emergency responses, and disparities in healthcare resource allocation. Accordingly, this article provides a comprehensive review of the essential components of HQ-CPR. By analyzing the key challenges in China’s current clinical implementation, this paper focuses on exploring the latest research on enhancing resuscitation efficacy in recent years, especially focusing on new strategies to minimizing myocardial ischemia and improving reperfusion efficiency, in order to provide information for clinical optimization and improving patient outcomes following CA.