Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance

McDonald, Catherine; Heggie, James; Jones, Christopher M.; Thorne, C. J. R.; Hulme, Jonathan

doi:10.1136/emermed-2012-201610

Cited by 101 publications

(84 citation statements)

References 18 publications

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“…Vertical bars indicate 0.95 confidence intervals during external cardiac compression [10], which could also be observed in this study. The average chest compression depth gradually decreased during the task and in the 2 nd minute the depth was already insufficient (< 40 mm).…”

Section: Discussionsupporting

confidence: 58%

“…It has been assumed that it is possible to prolong the period of time between rescuer change even up to 10 minutes. This suggestion seems to be reasonable as none of the participants of this study mentioned fatigue, and in other sources, fatigue was the most frequently noted factor demanding rescuer change during external cardiac massage [10,17,19,20,21]. Other complaints (wrist pain, knee pain, lumbosacralis pain) indicated by the CCC-CPR rescuers were similar to those found in other sources but they came out relatively late during observation and were not a reason to stop resuscitation [22].…”

Section: Discussionmentioning

confidence: 50%

“…It has also been pointed out that the increasing fatigue of the rescuer has an impact on the quality of chest compression and may be difficult to perform by physically unprepared individuals who do not always have the sufficient skills [7,8,9,10]. The 2010 AHA guidelines emphasize a compression rate of at least 100/min and a compression depth of at least 2 inches (5 cm) [1,6,11].…”

Section: Introductionmentioning

confidence: 99%

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Depth and rate of chest compression in CPR simulation during 10-minute continuous external cardiac compression

Bucki

Karpe

Michnik

et al. 2017

Ann. Acad. Med. Siles.

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Depth and rate of chest compression in CPR simulation during 10-minute continuous external cardiac compressionOcena głębokości i częstotliwości kompresji klatki piersiowej podczas symulacji resuscytacji krążeniowo-oddechowej, w trakcie 10-minutowego ciągłego zewnętrznego masażu serca AB ST R ACT I N T R O D U C T I O N:External cardiac massage has been a basic CPR maneuver for years. The aim of the study was to assess the quality of chest compression during a real-time continuous cardiac compression simulation on a cardiopulmonary resuscitation mannequin (considering medical rescuer experience and BMI). M A T E R I A L A N D M E T H O D S:This was a prospective study involving 17 medical rescuers, and 21 Medical Rescue students and university lecturers. During the simulation the participants performed continuous external cardiac compression for 15 minutes or until the refusal to continue. The depth and rate were analyzed at 60-second periods, leading to average values of cardiopulmonary resuscitation effectiveness. The analysis covered complete research data gathered in real time (10 minute periods). R E S U L T S:The average compression depth significantly decreased from the first (40.66 SE ± 0.80 mm) to the fourth minute of the study (38.21 SE ± 0.95 mm). The average compression rate was significantly different between the initial values (120.97 SE ± 2.83/min) and the sixth minute of the study (123.69 SE ± 2.55/min). The average compression depth amounted to n 36.03 SE ± 1.22 mm in non-professionals and 40.06 SE ± 1.37 mm in professionally active participants. In the participants with a BMI > 25, the only differentiating point in time was the beginning of the task when the average compression depth was 41.97 SE ± 1.12 mm. In the participants with a BMI < 25, there was a gradual decrease in the compression depth within the initial four minutes of the task.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

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Depth and rate of chest compression in CPR simulation during 10-minute continuous external cardiac compression

Bucki

Karpe

Michnik

et al. 2017

Ann. Acad. Med. Siles.

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“…However, some studies demonstrate that the quality of CPR performance during SCA is poor, even when CPR is conducted by medical staff [4][5][6][7]. Due to the fact that CC must be performed as continuously as possible and maintained over time, fatigue may be also a critical quality factor in CC [8][9][10]. European Resuscitation Council (ERC) guidelines have acknowledged this evidence and recommend a switch of rescuers every 2 min [1].…”

Section: Introductionmentioning

confidence: 99%

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

et al. 2017

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A b s t r a c tBackground: Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardiopulmonary resuscitation. Aim:To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin. Methods:This was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2).Results: After training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experimental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007). Conclusions:A simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

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“…(6) Several manikin studies have revealed that BLS quality drops significantly during the first two minutes, especially the depth of compression, even when verbal feedback was provided in case of decreased compression depth. (7)(8)(9)(10)(11)(12)(13) These studies offer sophisticated insight into the process of BLS in terms of physical capabilities of providers. However, we still do not have the answers to the following questions: Do subjective parameters positively correlate with objective ones?…”

Section: Discussionmentioning

confidence: 99%

Rescuer fatigue does not correlate to energy expenditure during simulated basic life support

2016

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It is known that providing basic life support (BLS) may be limited by the physical capabilities of rescuers. The other factor that may affect BLS quality is its energy expenditure. Therefore, we decided to compare the energy expenditure of standard BLS with a compression-ventilation ratio of 30:2 (S-BLS) and compression-only BLS (CO-BLS) and assess the sensation of fatigue and perceived exertion associated with these activities.Methods. We conducted a simulation study on 10 healthy volunteers using a resuscitation manikin. Participants were randomly assigned to start with CO-BLS or with S-BLS, in accordance with recent guidelines. Later, every individual provided the other type of BLS. BLS was terminated in the event of exhaustion, impossibility to retain high-quality BLS or after 30 minutes of BLS. Energy expenditure was expressed as relative oxygen consumption (VO2/ kg) and area under the curve of all VO2/ kg measurements during each BLS procedure indexed to one minute (AUCVO2/kg min). All participants completed a survey to assess perceived intensity of exertion by Borg, and sensation of general fatigue by visual analogue scale.Results. Maximal VO2/kg (23.16±3.94 vs. 20.17±2.14 ml/kg/min, p=0.049) and AUCVO2/kg min (18.90±3.13 vs. 15.91±2.07 ml/min3; p=0.021) during S-BLS were significantly higher compared to CO-BLS. Conversely, a more intense rate of perceived exertion (16.6±2.0 vs. 13.8±1.2, p=0.001) and sensation of general fatigue (86.5±10.8 vs. 75.0±14.3, p=0.058) were associated with CO-BLS. Neither sensation of general fatigue, nor perceived exertion correlated with energy expenditure.Conclusions. Energy expenditure of S-BLS was higher than of CO-BLS in our study, while sensation of fatigue and perceived exertion reflected the opposite association.

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Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance

Cited by 101 publications

References 18 publications

Depth and rate of chest compression in CPR simulation during 10-minute continuous external cardiac compression

Depth and rate of chest compression in CPR simulation during 10-minute continuous external cardiac compression

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

Rescuer fatigue does not correlate to energy expenditure during simulated basic life support

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