Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway

Oh, Je Hyeok; Lee, Sang Jin; Kim, Sung Eun; Lee, Kwang Jung; Choe, Jong‐In; Kim, Chan Woong

doi:10.1016/j.resuscitation.2008.06.022

Cited by 62 publications

(44 citation statements)

References 13 publications

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“…16 There have been metronome-based studies illustrating improvement of adequate compression rate, but, unlike our study, they demonstrated a negative impact on the depth of chest compressions. 18,19 Our study focused on rate-only feedback from a metronome because it is easily accessible as part of the defibrillator machine on code carts and the defibrillators in the resuscitation room. The actual cause of suboptimal chest compression depth with metronome guidance is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been hypothesized that various factors could contribute to shallower compressions, including multitasking, rescuer fatigue, and rescuer distraction (concentrating on rate management rather than maximal effort). [18][19][20] The effect of greater compression depth is associated with increased coronary perfusion pressure, higher success of defibrillation, increased cardiac output, and improved clinical outcomes. 21,22 A compression depth of 5 cm is more effective than 4 cm in children and adults.…”

Section: Discussionmentioning

confidence: 99%

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Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study

et al. 2015

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Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin.METHODS: A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break.RESULTS: A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, 22% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD 23%; 95% CI, 219% to 14%). CONCLUSIONS:The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines. WHAT'S KNOWN ON THIS SUBJECT:The frequency of cardiac arrest is significantly lower in children than in adults, rendering the delivery of high-quality cardiopulmonary resuscitation more difficult. Metronome-based studies in adults showed improvement in adequate compression rate, with a detrimental effect on the depth of chest compressions. WHAT THIS STUDY ADDS:This is the first pediatric study to confirm that the use of a metronome during cardiopulmonary resuscitation significantly improves the delivery of adequate rate without affecting the compression depth. This effect was more prominent among medical students and pediatric residents and fellows than nurses. Dr Zimmerman conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analysis, and drafted the initial manuscript; Dr Cohen coordinated and supervised data collection, carried out the initial analysis, and drafted the initial manuscript; Drs Maniaci, Pena, and Linares carried out initial analysis and reviewed and revised the manuscript; Dr Lozano provided statistical advice on the study design, carried out initial analysis, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.This trial has been registered at www.clinicaltrials.gov (identifier NCT02511470). 4 Poor-quality cardiopulmonary resuscitation (CPR) has been cited as a contributing factor to this dismal statistic on outcomes. 4 Optim...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study

et al. 2015

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Section: S256 Circulationmentioning

confidence: 99%

“…[208][209][210][211]217 One study showed statistically significantly reduced mean compression depth, but this may not be clinically significant (39.3±9.5 mm to 35.8±8.2 mm; P<0.01). 208 Two other studies showed a nonsignificant increase in the proportion of participants unable to perform compressions to adequate depth (OR, 1.23; 95% CI, 0.87-1.74; P=0.24). 209,210 Two neonatal studies showed improved compliance with chest compression rates and manual inflation rates, but results were limited to certain pieces of music ("Radetzkymarsch" 211 and ABBA's "SOS" 217 ).…”

Section: S256 Circulationmentioning

confidence: 99%

Part 8: Education, Implementation, and Teams

et al. 2015

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“…All 3 studies found that compression rate was more appropriate when auditory guidance was used, although there was a negative impact on compression depth in 1 study. [94][95][96] If feedback devices are not available, auditory guidance (eg, metronome, music) may be considered to improve adherence to recommendations for chest compression rate only (Class IIb, LOE B-R). These recommendations are made, balancing the potential benefit of improved CPR performance with the cost of the use of such devices during training.…”

Section: Cpr Feedback/prompt Devices In Training Eit 648 -New and Updmentioning

confidence: 99%