Abstract
Background The current basic life support guidelines recommend two-minute shifts for providing chest compressions when two rescuers are performing cardiopulmonary resuscitation. However, various studies have found that rescuer fatigue can occur within one minute, coupled with a decay in the quality of chest compressions. Our aim was to compare chest compression quality metrics and rescuer fatigue between alternating rescuers in performing one- and two-minute chest compressions. Methods This prospective randomized cross-over study was conducted at Songklanagarind Hospital, Hat Yai, Songkhla, Thailand. We enrolled sixth-year medical students and residents and randomly grouped them into pairs to perform 8 minutes of chest compression, utilizing both the one-minute and two-minute scenarios on a manikin. The primary end points were chest compression depth and rate. The secondary end points included rescuers' fatigue, respiratory rate, and heart rate. Results One hundred four participants were recruited. Compared with participants in the two-minute group, participants in the one-minute group had significantly higher mean (standard deviation, SD) compression depth (mm) (45.8 (7.2) vs. 44.5 (7.1), P=0.01) but there was no difference in the mean (SD) rate (compressions per min) (116.1 (12.5) vs. 117.8 (12.4), P=0.08), respectively. The rescuers in the one-minute group had significantly less fatigue (P < 0.001) and change in respiratory rate (P < 0.001), but there was no difference in the change of heart rate (P=0.59) between the two groups. Conclusion There were a significantly higher compression depth and lower rescuer fatigue in the 1-minute chest compression group compared with the 2-minute group. This trial is registered with TCTR20170823001.
Highlights
Chest compression is the key component of cardiopulmonary resuscitation (CPR). e compression generates blood flow and oxygen delivery to the myocardium and brain by directly compressing the heart which increases intrathoracic pressure
Effective chest compression correlates with optimal coronary perfusion pressure and cardiac output resulting in a better chance for return of spontaneous circulation [1]. e latest basic life support guidelines from the American Heart Association recommends that rescuers should use a 2-minute chest compression rotation, or shorter if they feel fatigued, and the compression depth should be 5–6 cm with a rate of 100–120 per minute with minimal compression interruptions [2]
Data are presented as median or n (%); BMI, body mass index; CPR, cardiopulmonary resuscitation
Summary
Chest compression is the key component of cardiopulmonary resuscitation (CPR). e compression generates blood flow and oxygen delivery to the myocardium and brain by directly compressing the heart which increases intrathoracic pressure. E latest basic life support guidelines from the American Heart Association recommends that rescuers should use a 2-minute chest compression rotation, or shorter if they feel fatigued, and the compression depth should be 5–6 cm with a rate of 100–120 per minute with minimal compression interruptions [2]. Various studies have found that the quality of chest compressions decreases dramatically after a short period. One report showed a significant reduction in chest compression performance from 79.7% in the first minute to 24.9% in the second [3]. Another report found that the percentage of correct chest compressions decreased significantly after 1 minute of compressions with a decline in adequate compression of 18.6% per minute [4]. Previous studies have been somewhat conflicting, with some studies finding a superior percentage of appropriate compression depth with lower fatigue when rescuers
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