Background: High-quality cardiopulmonary resuscitation (CPR) is critical for maintaining effective circulation during cardiac arrest. CPR success depends on uninterrupted, high-quality chest compressions delivered at an appropriate rate and depth. However, whether this performance can be sustained under prolonged working conditions is uncertain.
Objectives: This simulation-based study evaluated the impact of fatigue developing during 24-h shifts on CPR quality among emergency medicine residents.
Methods: This prospective simulation study included 37 emergency medicine residents from two tertiary hospitals. Participants performed CPR on a manikin equipped with feedback devices at 0, 8, 16, and 24 h of a 24-h shift. Each session lasted 10 min and consisted of five 2-min cycles of chest compressions, interspersed with 2-min rest periods. Compression rate, depth, and quality metrics were recorded. Fatigue levels were assessed using the Modified Borg Scale before and after each session.
Results: Mean chest compression rate and depth remained within guideline-recommended ranges at all time points, indicating sustained clinical performance. Although subjective fatigue scores increased significantly and progressively throughout the shift (p < 0.001), this physiological strain did not correlate with a significant decline in CPR quality metrics. While minor statistical fluctuations were observed in compression rate relative to baseline, the group performance consistently met standard resuscitation targets.
Conclusion: Emergency medicine residents maintained guideline-compliant CPR throughout 24-hour shifts despite fatigue. However, implementing fatigue management strategies, including optimized scheduling and structured rest, is recommended for provider and patient safety.
Keywords: basic life support; cardiopulmonary resuscitation; emergency department; fatigue; manual chest compressions; physician; shift work schedule.
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