External Chest Compression Research Articles

Comparison of Chest Compressions Metrics Measured Using the Laerdal Skill Reporter and Q-CPR: A Simulation Study.

There has been an increased emphasis on the quality of chest compressions as a part of the cardiopulmonary resuscitation (CPR) bundle of care for recent times. During CPR training, chest compression quality parameters can be measured directly from sensors within a manikin or from external devices placed on the manikin chest that use accelerometer-based technology. The aim of this study was to compare external chest compression data from the manikin-based Laerdal Skill Reporter (LSR) and the accelerometer-based Q-CPR technology, incorporated into the Philips MRx defibrillator, during CPR on a single Resusci Anne Simulator manikin. Each paramedic (n = 15) performed 2 sessions of 2 minutes of chest compressions, with a 2-minute rest period in between sessions. Both over-the-head and from-the-side positions were used on a single manikin. The quality of chest compressions were concurrently measured using both LSR and Philips MRx Q-CPR accelerometer with audiovisual feedback disabled. There was no significant difference in the measurement of the number of chest compressions performed in 2 minutes, the compression rate, total number of compressions of adequate depth, or the number of compressions exhibiting leaning between the LSR and the Phillips Q-CPR devices. There was a significant difference in measurement of compression depth (P < 0.0001) and duty cycle (P < 0.0001) with the MRx Q-CPR accelerometer demonstrating both lower compression depth and duty cycle compared with LSR. There was no significant difference in most chest compression quality metrics measured between the LSR and the Phillips Q-CPR devices when measured on a manikin. However, there were significant differences in the measurement of duty cycle and also the depth of compressions between the 2 devices with the Phillips Q-CPR device measuring lower depth of compression and duty cycle compared with the LSR device.

Resuscitation and risk factors of tracheal intubation of neonates born from high risk mothers

Objective To understand the whole situation of neonatal resuscitation in high risk deliveries. Methods Totally, 3 420 neonates born from high risk pregnant mothers in Tianjin Central Obstetrics and Gynecology Hospital from September 2013 to November 2014 were recruited and divided into four groups according the needs of resuscitation, including no resuscitation group (Group A), initial resuscitation group (Group B), initial resuscitation plus bag-and-mask or T-piece ventilation (positive pressure ventilation group, Group C), tracheal intubation and/or external chest compression and/or epinephrine administation (tracheal intubation group, Group D). Variance analysis, Chi-square test and Logistic regression analysis were applied to compare the differences of clinical conditions among these groups and to analyze risk factors of tracheal intubation requirement for extensive resuscitation. Results Among the 3 420 newborns, 2 360(69.0%) were assigned to Group A, 565 (16.5%) to Group B, 408 (11.9%) to Group C and 87 (2.5%) to Group D. Statistical differences were shown in the gestational age [(35.5±4.1), (33.0±4.3) and (32.1±4.8) weeks], birth weight [(2 593.8±663.6), (2 063.3±973.9) and (1 839.0±977.9) g], and the incidence of multiple births [66(11.7%), 65(15.9%) and 23(26.4%)], abruptio placentae [15(2.7%), 35(8.6%) and 9(10.3%)], umbilical cord prolapse [0(0.0%), 2(0.5%), and 10(11.5%)], abnormal fetal heart rate in labor [28(5.0%), 45(11.0%) and 46(52.9%)], prolonged labor [36(6.4%), 35(8.6%), and 20(23.0%)], meconium stained liquor [32(5.7%), 0(0.0%), and 8(9.2%)], and congenital anomaly [8(1.4%), 12(2.9%) and 7(8.0%)] among Group B, C and D (F or χ2=233.188, 105.050, 14.535, 19.934, 91.434, 149.366, 26.525, 28.602 and 13.765, all P<0.05). Multiple regression analysis revealed that gestational age <28 weeks (OR=1.290,95% CI:1.167-1.425), abnormal fetal heart rate in labor (OR=1.350,95%CI: 1.184-6.862) and meconium stained liquor (OR=1.397, 95%CI: 1.051-6.825) were independent risk factors for endotracheal intubation requirement (all P<0.05). Conclusions More newborns born from high risk mothers may need resuscitation, especially for those in small gestational age, with abnormal fetal heart rate during labor and meconium-stained liquor, thus close monitoring and management are necessary. Key words: Infant,premature; Resuscitation; Intubation,intratracheal; Infant,extremely low birth weight

Up-down hand position switch may delay the fatigue of non-dominant hand position rescuers and improve chest compression quality during cardiopulmonary resuscitation: a randomized crossover manikin study.

Previous studies have shown improved external chest compression (ECC) quality and delayed rescuer fatigue when the dominant hand (DH) was in contact with the sternum. However, many rescuers prefer placing the non-dominant hand (NH) in contact with the sternum during ECC. We aimed to investigate the effects of up-down hand position switch on the quality of ECC and the fatigue of rescuers during cardiopulmonary resuscitation (CPR). After completion of a review of the standard adult basic life support (BLS) course, every candidate performed 10 cycles of single adult CPR twice on an adult manikin with either a constant hand position (CH) or a switched hand position (SH) in random order at 7-day intervals. The rescuers’ general characteristics, hand positions, physiological signs, fatigue appearance and ECC qualities were recorded. Our results showed no significant differences in chest compression quality for the DH position rescuers between the CH and SH sessions (p>0.05, resp.). And also no significant differences were found for Borg score (p = 0.437) or cycle number (p = 0.127) of fatigue appearance after chest compressions between the two sessions. However, for NH position rescuers, the appearance of fatigue was delayed (p = 0.046), with a lower Borg score in the SH session (12.67 ± 2.03) compared to the CH session (13.33 ± 1.95) (p = 0.011). Moreover, the compression depth was significantly greater in the SH session (39.3 ± 7.2 mm) compared to the CH session (36.3 ± 8.1 mm) (p = 0.015). Our data suggest that the up-down hand position switch during CPR may delay the fatigue of non-dominant hand position rescuers and improve the quality of chest compressions.

Case Series Defining Role of External Chest Compressions (ECC) in Patients with Ventricular Assist Device (VAD)

Case Series Defining Role of External Chest Compressions (ECC) in Patients with Ventricular Assist Device (VAD)

The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults

ObjectiveThis study was conducted to evaluate the appropriateness of the chest compression (CC) depth recommended in the current guidelines and simulated external CCs, and to characterize the optimal CC depth for an adult by body mass index (BMI). MethodsAdult patients who underwent chest computed tomography as a screening test for latent pulmonary diseases in the health care center were enrolled in this study. We calculated the internal anteroposterior (AP) diameter (IAPD) and external AP diameter (EAPD) of the chest across BMIs (<18.50, 18.50-24.99, 25.00-29.99, and ≥30.00 kg/m2) for simulated CC depth. We also calculated the residual chest depths less than 20 mm for simulated CC depth. ResultsThere was a statistically significant difference in the chest EAPD and IAPD measured at the lower half of the sternum for each BMI groups (EAPD: R2 = 0.638, P < .001; IAPD: R2 = 0.297, P < .001). For one-half external AP CC, 100% of the patients, regardless of BMI, had a calculated residual internal chest depth less than 20 mm. For one-fourth external AP CC, no patients had a calculated residual internal chest depth less than 20 mm. For one-third external AP CC, only 6.48% of the patients had a calculated residual internal chest depth less than 20 mm. ConclusionsIt is not appropriate that the current CC depth (≥50 mm), expressed only as absolute measurement without a fraction of the depth of the chest, is applied uniformly in all adults. In addition, in terms of safety and efficacy, simulated CC targeting approximately between one-third and one-fourth EAPD CC depth might be appropriate.

Low compliance with the 2 minutes of uninterrupted chest compressions recommended in the 2010 International Resuscitation Guidelines

BackgroundWe aimed to analyze compliance with 2010 European guidelines' quality criteria for external chest compressions (ECC) during 2 minutes of uninterrupted cardiopulmonary resuscitation. MethodsSeventy-two healthy nurses and physicians trained in advanced cardiopulmonary resuscitation performed 2 uninterrupted minutes of ECC on a training manikin (Resusci Anne Advanced SkillTrainer; Laerdal Medical AS, Stavanger, Norway) that enabled us to measure the depth and rate of ECC. When professionals agreed to participate in the study, we recorded their age, body mass index (BMI), smoking habit, and their own subjective estimation of their physical fitness. To measure fatigue, we analyzed participants' heart rates, percentage of maximum tolerated heart rate (MHR), and subjective perception of their fatigue on a visual analog scale. ResultsNearly half (48.6%) the rescuers failed to achieve a minimum average ECC depth of 50 mm. Only 48.1% of ECCs fulfilled the 2010 guidelines' quality criteria; quality deteriorated mainly after the first minute. Poor ECC quality and deteriorating quality after the first minute were associated with BMI < 23 kg/m2.Rescuers with BMI ≥ 23 kg/m2 fulfilled the quality criteria throughout the 2 minutes, whereas those with BMI < 23 kg/m2 fulfilled them for 80% of ECCs during the first minute, but for only 30% at the end of the 2 minutes. ConclusionsCompliance with the 2010 guidelines' quality criteria is often poor, mainly due to lack of proper depth. The greater depth recommended in the 2010 guidelines with respect to previous guidelines requires greater force, so BMI < 23 kg/m2 could hinder compliance. Limiting each rescuer's uninterrupted time doing ECC to 1 minute could help ensure compliance.

External chest compression

En France, l’arret cardiorespiratoire extrahospitalier touche environ 50 000 patients par an. Cet article rappelle les elements cles pour la realisation du massage cardiaque externe. Les dernieres recommandations sur la prise en charge des AC ont ete publiees en 2010 par l’European Resuscitation Council. Les recommandations actuelles preconisent de realiser entre 100 et 120 compressions thoraciques par minute ; avec les mains au « centre de la poitrine », une profondeur de compressions entre 5 a 6 cm (pour un adulte), une decompression complete du thorax et un rapport compression sur decompression a 1/1. Les interruptions de compressions thoraciques doivent etre minimisees. L’utilisation du plan dur est necessaire lors d’un massage sur une surface molle. Le controle de l’efficacite du massage peut etre fait a l’aide de l’ETCO2. L’utilisation de dispositif de dispositifs guides et de retroaction peut etre proposee pour ameliorer la qualite du massage. Cependant, les limites de tels dispositifs en particulier sur les surfaces molles doivent etre connues. La formation au massage cardiaque externe doit etre generalisee et proposee au public. Le massage cardiaque externe reste une technique fondamentale pour esperer la survie des patients souffrant d’un arret cardiaque. Sa maitrise est une obligation pour les professionnels de sante en particulier ceux de l’urgence.

Dominant Hand Position Improves the Quality of External Chest Compression: A Manikin Study Based on 2010 CPR Guidelines

BackgroundThe 2010 cardiopulmonary resuscitation (CPR) guidelines increased the importance of external chest compression. However, the best hand position to be the compressing one has not been identified. ObjectivesTo investigate the effects of dominant or nondominant external chest compression hand position during CPR. MethodsMedical students performed five cycles of conventional CPR and completed one questionnaire. The CPR performances were manually evaluated, and detailed aspects of the external chest compression quality were assessed via the SimMan® Essential system (Laerdal China Ltd., Hangzhou, China). ResultsOne hundred fifty-seven students participated in the nondominant hand (NH) group, and 68 students participated in the dominant hand (DH) group. The manual evaluations revealed no differences between the two groups. The proportion of chest compressions “above 100 cpm [compressions per minute]” was higher in the DH group than in the NH group (97% vs. 92%, respectively, p = 0.002). The frequency distributions of the chest compression rates were also significantly different between the two groups (p < 0.0001). The distribution of the NH group was concentrated within “130–139” cpm, whereas this distribution was concentrated within “140–149” cpm in the DH group. The chest compression depth of the DH group was deeper than that of the NH group (p = 0.001). The depth of the fifth cycle was significantly decreased compared with those of cycles 1, 2, and 3 in the NH group. A greater number of full chest recoils were observed in the NH group (p = 0.02). ConclusionThe dominant hand position during CPR was associated with a higher chest compression rate, a greater chest compression depth, and delayed fatigue.

Epinephrine administration in lipid-based resuscitation in a rat model of bupivacaine-induced cardiac arrest: optimal timing.

The medical community commonly uses lipid emulsion combined with epinephrine in local anesthetic-induced cardiac arrest, but the optimal timing of epinephrine administration relative to lipid emulsion is currently unknown and needs to be determined. Thirty adult male Sprague-Dawley rats were subjected to bupivacaine-induced asystole and were then randomly divided into 3 groups. The temporal administration of epinephrine varied in each group: (1) immediately after the completion of the initial bolus of lipid emulsion therapy (postILE0); (2) immediately after cardiac arrest before the initial bolus of lipid emulsion (preILE); or (3) 1 minute after the completion of the initial bolus of lipid emulsion (postILE1). External chest compression was administered until the return of spontaneous circulation or the end of a 20-minute resuscitation period. The postILE0, preILE, and postILE1 groups displayed different survival rates (100%, 30%, and 40%; P = 0.003). After return of spontaneous circulation, the rate-pressure product of the postILE0 group was higher than that of the postILE1 group (P < 0.001). Wet-to-dry lung weight ratio of preILE and postILE1 groups was higher than that of the postILE0 group (P < 0.05). The rate of damaged alveoli of the postILE0 group was lower than those of the preILE (P = 0.001) and postILE1 (P < 0.001) groups. Concentrations of bupivacaine in the cardiac tissues of the postILE0 group were lower than that of the postILE1 group (P = 0.01). In the rat model of bupivacaine-induced cardiac arrest, the optimal timing for the administration of epinephrine to produce best outcomes of successful cardiopulmonary resuscitation is immediately after the completion of the lipid emulsion bolus. This optimal timing/therapeutic window is of paramount importance.

Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model

BackgroundThe main objective of this study was to compare the volume of gas insufflated in the stomach with continuous external chest compressions plus continuous oxygen insufflation (C-CPR) versus standard-CPR (S-CPR) which alternates external chest compressions and synchronized positive insufflations through a bag-valve-mask with a 30/2 ratio. The secondary objective was to compare upper airway pressures (intratracheal and intramask) generated during continuous oxygen insufflation. Material and methodsOpen, prospective, randomized, cross over, comparative, non-inferiority study. CPR was performed for six minutes periods, on seven fresh human corpses, with C-CPR or S-CPR in a random order. Before each CPR period, the stomach was completely emptied through the gastrostomy tube, and then 200mL of air was injected in the stomach to be sure it was not collapsed. The gastric volume was measured at the end of each intervention. Intratracheal and intramask pressures were recorded continuously during C-CPR. Results were provided as mean±standard deviation. Statistical analyses were done with a paired student t test. ResultsInduced-gastric inflation was lower with C-CPR (221±130mL) than with S-CPR (5401±2208mL, p=0.001). Throughout C-CPR, no difference was found between the intratracheal and intramask pressures (4.4±1.2; 4.0±0.8cmH2O, respectively, p=0.45). ConclusionThis human cadaver study demonstrates that continuous oxygen insufflation induced less gastric inflation than intermittent insufflation during CPR.

Role of Dominant Hand Position during Chest Compression by Novice Rescuers: An Observational Simulation Study

Introduction The aim of this study was to determine the effect of hand positioning on the quality of external chest compression (ECC) by novice rescuers. Methods This observational simulation study was conducted for 117 included participants. After completion of an adult cardiopulmonary resuscitation (CPR) training program for 3-h, the participants selected which of their hands would be in contact with the mannequin during ECC and performed 5 cycles of single rescuer CPR on a recording mannequin. The participants were assigned to 2 groups: the dominant hand group (DH; n=40) and the non-dominant hand group (NH; n=29). The depth and rate of ECC were analysed to compare the effectiveness of ECC between 2 groups. Results The rate of ECC was significantly faster in the DH group (mean, 117.3 ±11.4/min) than in the NH group (mean, 110.9±12.2/min) (p=0.028). However, the depth of ECC in the dominant hand group (mean, 52.4±5.9 mm) was not significantly different from that in the non-dominant hand group (mean, 50.8±6.0 mm) (p=0.287). Similarly, the portion of ECC with inadequate depth in the dominant hand group (mean, 1.8±4.3%) was not significantly different from that in the non-dominant hand group (mean, 5.3±15.6%) (p=0.252). Conclusions ECC can be performed with an acceptably higher rate of compressions when the dominant hand of the novice rescuer is placed in contact with the sternum. However, the position of the dominant hand does not affect the depth of ECC. (Hong Kong j.emerg.med. 2014;21:382-386)

0391. Comparison of the histopathologic effects on the lungs of two external chest compression devices (lucas versus autopulse) in a swine model of ventricular fibrillation

Given the difficulty of performing efficient CPR compressions, technology has turned to automaticity. LUCAS device has a pneumatically driven piston to compress the heart and uses active decompression suction on the upstroke. AUTOPULSE is a load distributing band compressor, that is mechanically actuated and battery driven. It provides both direct compression and semi-circumferential thoracic compression.

Three Methods of Manual External Chest Compressions During Microgravity Simulation

Cardiopulmonary resuscitation (CPR) in microgravity is challenging. There are three single-person CPR techniques that can be performed in microgravity: the Evetts-Russomano (ER), Handstand (HS), and Reverse Bear Hug (RBH). All three methods have been evaluated in parabolic flights, but only the ER method has been shown to be effective in prolonged microgravity simulation. All three methods of CPR have yet to be evaluated using the current 2010 guidelines. There were 23 male subjects who were recruited to perform simulated terrestrial CPR (+1 G(z)) and the three microgravity CPR methods for four sets of external chest compressions (ECC). To simulate microgravity, the subjects used a body suspension device (BSD) and trolley system. True depth (D(T)), ECC rate, and oxygen consumption (Vo2) were measured. The mean (+/- SD) D(T) for the ER (37.4 +/- 1.5 mm) and RBH methods (23.9 +/- 1.4 mm) were significantly lower than +1 G(z) CPR. However, both methods attained an ECC rate that met the guidelines (105.6 +/- 0.8; 101.3 +/- 1.5 compressions/min). The HS method achieved a superior D(T) (49.3 +/- 1.2 mm), but a poor ECC rate (91.9 +/- 2.2 compressions/min). Vo2 for ER and HS was higher than +1 Gz; however, the RBH was not. All three methods have merit in performing ECC in simulated microgravity; the ER and RBH have adequate ECC rates, and the HS method has adequate D(T). However, all methods failed to meet all criteria for the 2010 guidelines. Further research to evaluate the most effective method of CPR in microgravity is needed.

Insulin/Glucose Infusion Successfully Resuscitates Bupivacaine-induced Sudden-onset Circulatory Collapse in Dogs

In previous studies, insulin reversed the cardiac toxicity gradually induced by a continuous infusion of bupivacaine. In this randomized controlled study, we intended to simulate a more relevant clinical situation by injecting bupivacaine rapidly as a bolus to induce sudden-onset circulatory collapse in dogs. We then evaluated the insulin effect. Bupivacaine (10 mg·kg−1 iv) was rapidly administered intravenously to 12 dogs. At the onset of circulatory collapse (defined as a mean arterial pressure [MAP] of 30 mmHg), external chest compression was initiated. Insulin (2 U·kg−1 iv) was given to the insulin-glucose (IG) group (n = 6) and the same volume of 0.9% saline was given to the control (C) group (n = 6). The primary outcome was successful resuscitation defined as both MAP ≥ 60 mmHg and sinus rhythm on an electrocardiogram that lasted ≥ 60 sec. Hemodynamic and blood variables were measured, including cardiac output and electrocardiogram intervals. All IG dogs were successfully resuscitated within 15 (3) min, whereas none of the control dogs were resuscitated (P = 0.002). After circulatory collapse, the average MAP was higher in group IG than in group C (P = 0.006). Insulin effectively reversed the sudden-onset circulatory collapse in dogs caused by an intravenous bolus injection of bupivacaine.

The Seated Arm-Lock Method : A New Concept of Basic Life Support in Simulated Hypogravity of the Moon and Mars

Cardiopulmonary resuscitation (CPR) is an emergency procedure to return life to a person in cardiac arrest. This is indicated in those who are unresponsive with no breathing or only gasps. Studies have shown that the priority should be given to good external chest compressions, and to avoid the case where artificial ventilation may compromise survival [1]. Consistently with human space flight programs aboard the International Space Station (ISS), the Evetts-Russomano method seems to be appropriate to rescue a victim of cardiac arrest in microgravity [2,3,4,5] but, in hypogravity, as far as we know, no method is yet appropriate to rescue astronauts [6]. According to our trial, using the classical basic life support (BLS) technique does not provide good results, especially during extended periods of resuscitation. The Seated Arm-Lock ( SeAL ) method seems to offer improved outcomes in simulated hypogravity.

Effect of selective intra-aortic volume expansion in CPP during prolonged ventricular fibrillation

Background: Coronary perfusion pressure (CPP) is a valuable predictor of return of spontaneous circulation. In refractory cardiac arrest, CPP is usually inadequate. Resuscitative efforts based solely on external chest compression may be limited in their ability to generate adequate CPP. The aim of this study is to investigate the effect of selective intra-aortic volume expansion in CPP during prolonged ventricular fibrillation (VF).

Comparison of survival in cardiorespiratory arrest patients receiving conventional manual or external mechanical chest compression

Comparison of survival in cardiorespiratory arrest patients receiving conventional manual or external mechanical chest compression

Quality of external chest compressions, time or body mass index and fitness

Quality of external chest compressions, time or body mass index and fitness

The correlation between the impedance cardiogram and end-tidal carbon dioxide during cardiopulmonary resuscitation in a porcine model of cardiac arrest

Introduction: Studies were conducted to evaluate cardiopulmonary resuscitation (CPR) in a simulated low gravitational field, such as Mars (hypoG), aimed at providing an insight into the performance of terrestrial CPR. Methods: Two studies were conducted to evaluate external chest compressions (ECC) depth and rate, as well as perceived exertion (RPE) and the physiological cost, when 4 sets of 30 ECCs were performed on a standard CPR mannequin for 1.5min during Mars simulation, using terrestrial (1Gz) as control. The first study (n=20; 2005 guidelines) also evaluated the electromyographic (EMG) activity of four muscles (triceps brachii, erector spinae, upper rectus abdominis, pectoralis major). The second study (n=30; 2010 guidelines) included range of elbow flexion, minute ventilation (VE) and peak oxygen consumption (VO2 peak) measurements. HypoG simulation was achieved using a body suspension device (BSD) and a counterweight system. Results: In both studies, subjects successfully performed ECCs at 1Gz and hypoG. In the first study, therewere increases from 1Gz values of 32% (p<0.001) for RPE and 44% (p=0.002) for HR when ECCswere performedduringMars simulation. In hypoG, the triceps brachii showed less activity when compared with the other three muscles studied (p<0.001). A higher RPE (p<0.05) was also seen in the second study, which was accompanied by an increased VE (11.4±5.9 to 37.5±10.3 Lmin−1, p<0.05) and VO2 peak (3.2±1.1 to 20.5±7.6 mLkg−1 min−1, p<0.05). The arm flexion angle during hypogravity CPR, compared to 1Gz CPR, was also increased (4.3±2.8◦ to 14.0±8.1◦, p<0.05). Conclusion: Simulated reduction of upper body weight did not decrease the ability to perform proper ECCs, however, it increased the physiological cost and altered performance of the ‘straight arm’ CPR technique. These findings could be used to improve terrestrial CPR, especially when physical disparities are encounteredwith the rescuer being smaller and lighter than the patient.

An investigation into fatigue of witness and quality of external chest compression in the resuscitation Manikin

Objective To investigate the effect of fatigue of witness and quality of external chest compression according to the requirement of 2010 guidelines for cardiopulmonary resuscitation.Methods A total of 96 volunteer participants in basic life support training course were recruited from the College of Automation in the Guangdong University of Technology.All volunteers were randomly (random number) divided into two groups:2010 guidelines group and 2005 guidelines group.The instructors explained the procedures of external chest compression as required as per different guidelines and then guided the trainees to practice CPR as they learned.Trainees,who completed entire training course and passed the examination,were eligible into the study.In the final investigation,trainees of two groups were asked to perform 8-min continuous external chest compression of CPR.The demographics of trainees such as age,gender,tallness,body weight,heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),blood lactate and rating of perceived exertion (RPE) were recorded before and immediately after CPR.Results Of them,42 and 39 subjects were finally enrolled into 2010 group and 2005 group,respectively.There was no statistically significant difference in basic status of trainees between two groups.After 8-min external chest compression,trainees in 2010 guidelines group brought about greater compression depth and rate than those in 2005 guidelines group (P ＜0.05).On the contrary,HR,SBP and lactate were also higher in 2010 guidelines group than those in 2005 guidelines group (P ＜ 0.05).Furthermore,the quality of external chest compression declined to a sub-optimal pattern [(47.63 ±7.87) mm vs.(40.26 ±5.93) mm,P ＝0.000] even though RPE value still indicated a status of relative easiness [(11.35 ± 1.29) vs.(10.54 ± 1.74),P =0.000].Conclusions When the recommendation of 2010 guidelines for cardiopulmonary resuscitation was followed,trainees in current study could perform optimal compression depth and rate even in the occurrence of increased fatigue.Therefore,study on this manikin showed it had better to conduct rescuer-exchange in every minute so as to get high quality of external chest compression. Key words: 2010 guideline for cardiopulmonary resuscitation; Quality of chest compression; Degree of fatigue; Manikin