Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study

Abstract

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...

CPR performance in the presence of audiovisual feedback or football shoulder pads

“…On the AED device, depth accuracy would automatically be calculated at 0% when participants compressed below 5.0 cm or above 6.0 cm. One recent study reported the compression rate was 106.6±17.5 cpm with the metronome sound at 100 times and 112.0±17.1 cpm without the metronome sound 27. A lower mean compression rate was reported of 103.1 cpm with audiovisual feedback and 108.0 cpm without feedback, but the IQR was between 96 and 110 cpm with audiovisual feedback, and 99 and 117 cpm without feedback 16.…”

The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

“…The group using the metronome persisted longer in the appropriate frequency range than the group that did not use the device, showing that the use of technology and devices can improve care and influence ROSC in real situations 24 .…”

Metronome Use Positively Affect Cardiopulmonary Resuscitation Parameters: Prospective Observational Multicenter Manikin Study

“…In CPR simulation studies carried out on untrained bystanders by Rasmussen [14] and Park [8] and in those carried out on trained rescuers by Zimmerman [10], Hafner [9],Chung [18], Kern [7] and Jantti [6], the use of a metronome during CPR was found to increase success rates in terms of reaching target chest compression rates (p-values; 0.04, 0.018, 0.001, 0.002, 0.001, 0.001, and < 0.001, respectively).…”

“…Studies investigating the use of a metronome to increase the quality and effectiveness of CPR have also been conducted [5][6][7][8][9][10][11][12][13][14][15][16][17][18].The use of a metronome was shown to be effective in reaching the target compression [6-10, 14, 18] and ventilation rates [5][6][7][8][9][10][11][12][13][14][15][16], and to affect compression depth [6,[8][9][10][12][13][14][15]. However, no definitive conclusions have been reached regarding the effects of metronome use on chest compression and ventilation rates [6][7][8][9][10][11][12][13][14][15][16][17][18].…”