Rescuer-limited cardiopulmonary resuscitation as an alternative to 2-min switched CPR in the setting of inhospital cardiac arrest: a randomised cross-over study

Emerg Med J. 2015 Jul;32(7):539-43. doi: 10.1136/emermed-2013-203477. Epub 2014 Aug 4.

Abstract

Background: The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend that chest compression be rotated every 2 min to prevent rescuer fatigue. However, the quality of chest compression using 2-min switched CPR tends to decrease rapidly due to rescuer fatigue. We aimed to compare the effectiveness of use of 2-min switched CPR and rescuer-limited CPR (the person performing compressions is allowed to switch with another rescuer prior to 2 min if feeling fatigued) in the setting of inhospital cardiac arrest.

Methods: Using a randomised cross-over trial design, 90 medical students were grouped into pairs to perform four cycles of 2-min switched CPR and rescuer-limited CPR (495 s per technique). During each trial, the total number of compressions performed, mean depth of compression and proportion of effective compressions performed (compression depth >5 mm) were recorded for identification of significant differences and changes in pulse rate and RR were measured to determine the extent of exhaustion.

Results: Compared with 2-min switched CPR, the mean compression was deeper (51 vs 47 mm, p<0.001), total number of compressions greater (476 vs 397, p=0.003) and proportion of effective compressions greater (56% vs 47%, p=0.004) during rescuer-limited CPR. Subgroup analysis by 30-s unit showed more consistent compression quality during rescuer-limited CPR. No significant differences in change in pulse rate and RR were found between the two techniques.

Conclusions: Rescuer-limited CPR yields a greater number of effective compressions and more consistent quality of CPR than 2-min switched CPR. Rescuer-limited CPR might be a suitable alternative for treating inhospital cardiac arrest.

Keywords: cardiac arrest; resuscitation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cardiopulmonary Resuscitation / methods*
  • Cardiopulmonary Resuscitation / standards
  • Cross-Over Studies
  • Fatigue / prevention & control*
  • Female
  • Heart Arrest / therapy*
  • Heart Rate
  • Humans
  • Male
  • Manikins
  • Time Factors
  • United States
  • Young Adult