References

, 8 ed. Philadelphia: Lippincott, Williams and Wilkins; 2010

Abella BS, Sandbo N, Vassilatos P Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005; 111:(4)428-34

Ashton A, McCluskey A, Gwinnutt CL Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min. Comparative Study. Resuscitation. 2002; 55:(2)151-5

Baubin M, Schirmer M, Nogler M Rescuer's work capacity and duration of cardiopulmonary resuscitation. Resuscitation. 1996; 33:(2)135-9

Bjørshol C, Søreide E, Torsteinbø T Quality of chest compressions during 10min of single-rescuer basic life support with different compression: ventilation ratios in a manikin model. Resuscitation. 2008; 77:(1)95-100

Bridgewater FH, Zeitz C, Field J The impact of the ILCOR 2005 CPR guidelines on a physical fitness assessment: a comparison of old and new protocols. Resuscitation. 2008; 76:(3)405-12

Bridgewater FHG, Bridgewater KJ, Zeitz CJ Using the ability to perform CPR as a standard of fitness: a consideration of the influence of aging on the physiological responses of a select group of first aiders performing cardiopulmonary resuscitation. Resuscitation. 2000; 45:(2)97-103

Chen MJ, Fan X, Moe ST Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: a metaanalysis. J Sports Sci. 2002; 20:(11)873-99

Chi C-H, Tsou J-Y, Su F-C Effects of compression-to-ventilation ratio on compression force and rescuer fatigue during cardiopulmonary resuscitation.2009

Arnfinn Br, Eldar Sr, Tor Harald T Quality of chest compressions during 10min of single-rescuer basic life support with different compression: ventilation ratios in a manikin model. Resuscitation. 2008; 77:(1)95-100

Deschilder K, De Vos R, Stockman W The effect on quality of chest compressions and exhaustion of a compression— ventilation ratio of 30:2 versus 15:2 during cardiopulmonary resuscitation—a randomised trial. Resuscitation. 2007; 74:(1)113-8

Edelson DP, Abella BS, Kramer-Johansen J Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006; 71:(2)137-45

Greingor JL Quality of cardiac massage with ratio compression-ventilation 5/1 and 15/2. Resuscitation. 2002; 55:(3)263-7

Gutwirth H, Williams B, Boyle M Rescuer Fatigue in Cardiopulmonary Resuscitation: A Review of the Literature. JPEHC. 2009; 7:(4)1-9

Handley AJ, Koster R, Monsieurs K European Resuscitation Council Guidelines for Resuscitation 2005: Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2005; 67:S7-S23

Hightower D, Thomas SH, Stone CK Decay in quality of closed-chest compressions over time. Ann Emerg Med. 1995; 26:(3)300-3

Jantti H, Silfvast T, Turpeinen A Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation. 2009; 80:(4)453-7

Kramer-Johansen J, Myklebust H, Wik L Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation. 2006; 71:(3)283-9

Lamb KL, Eston RG, Corns D Reliability of ratings of perceived exertion during progressive treadmill exercise. Br J Sports Med. 1999; 33:(5)336-9

Losert H, Sterz F, Kohler K Quality of cardiopulmonary resuscitation among highly trained staff in an emergency department setting. Arch Intern Med. 2006; 166:(21)2375-80

Lucia A, Heras JF, Perez M The importance of physical fitness in the performance of adequate cardiopulmonary resuscitation. Chest. 1999; 115:(1)158-64

Ochoa FJ, Ramalle-Gomara E, Lisa V The effect of rescuer fatigue on the quality of chest compressions. Resuscitation. 1998; 37:(3)149-52

Riera SQ, Gonzalez BS, Alvarez JT The physiological effect on rescuers of doing 2min of uninterrupted chest compressions. Resuscitation. 2007; 74:(1)108-12

Trowbridge C, Parekh JN, Ricard MD A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation. BMC Nurs. 2009; 8:(6)

Yannopoulos D, Aufderheide TP, Gabrielli A Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Critical Care Medicine. 2006; 34:(5)1444-9

CPR compression depth and rate in relation to physical exertion in paramedic students

03 February 2012
Features
02 February 2012
Volume 4 · Issue 2

Abstract

The International Liaison Committee on Resuscitation (ILCOR) guidelines suggest rescuers deliver cardiopulmonary resuscitation (CPR) in cycles of 30 chest compressions and 2 ventilations (30:2) at a rate of 100 compressions per minute with a compression depth of 4-5 cm. Given this increase from the previous CPR cycle of 15:2, there is now also greater emphasis on pushing faster and deeper with minimal interruption. This has led to speculation surrounding rescuer fatigue and compression inefficiency. The purpose of this pilot study was to assess the level of work intensity and fatigue among undergraduate students during simulated CPR, including the quality of chest compressions. Methods: this was an observational pilot study investigating second year undergraduate paramedic students’ fatigue levels and quality of chest compressions following 20 minutes of simulated CPR. Data were collected at baseline and after every 2 minutes until conclusion of twenty minutes. Measurements of work intensity and fatigue included heart rate, rating of perceived exertion (Borg), compression depth and compression frequency. Results: a total of 7 subjects participated (2 male, 5 female), with five students aged 21-25 years. Male subjects showed a significantly slower compression rate when compared to females (108.0 vs 125.6 chest compressions per minute, P=0.006). Heart rate was significantly higher than rest (prior to commencing CPR) after 14 minutes of CPR (P=0.045). Perceived exertion was significantly higher than at rest at 2, 6, 10, 14, and 18 minutes, (P<0.01). Conclusion: this pilot study suggests that high levels of fatigue and perceived exertion are present early when undertaking CPR in a controlled setting, with some fatigue attributed to the faster than recommended chest compression rates.

In 2010, the International Liaison Committee on Resuscitation (ILCOR) recommended that rescuers deliver cardiopulmonary resuscitation (CPR) in cycles of 30 chest compressions and 2 ventilations (30:2) at a rate of 100 compressions per minute with a compression depth of 4-5 cm (40-50 mm). The National Resuscitation Council and Joint Royal College Ambulance Liaison Committee both recommend a compression depth of 5-6 cm. Given this change to CPR rates from the previous 15:2 to 30:2 (ILCOR, 2005), there is also now greater emphasis on pushing faster and deeper with minimal interruptions. However, it is known that the effective delivery of CPR is physically demanding, requiring quick, consistent application of intense forces which has led to speculation surrounding rescuer fatigue and quality of compressions. It has also been demonstrated by several investigators that physical fatigue in the rescuer occurs as soon as one minute after commencing compressions and most times the rescuer is unaware that fatigue has reduced their compression effectiveness (Gutwirth et al, 2009).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Cardiopulmonary Resuscitation
Compression Depth
Rescuer Fatigue
Prehospital Emergency Care