Original ContributionQuality of chest compressions during compression-only CPR: a comparative analysis following the 2005 and 2010 American Heart Association guidelines
Introduction
Early initiation of cardiopulmonary resuscitation (CPR) and defibrillation are critical for reducing the mortality and morbidity in patients suffering from cardiac arrest (CA) [1]. For every minute that CPR is delayed, the likelihood of survival would decrease approximately 10%. However, approximately 67% of CA victims are first witnessed by bystanders and the time interval for Emergency Medical Services arrival is eight min or more [2], [3]. Thus, it is most important for the laypersons to initially build the functional chain of survival. Nevertheless, bystanders may be reluctant to perform CPR due to the lack of confidence, unfamiliarity with resuscitation guidelines, fear of possible harm to the victims and so on [4].
Recently, chest compression-only CPR become more attractive because it is simpler to perform and also deliver a greater number of chest compressions than conventional CPR [5]. A latest meta-analysis showed that dispatcher-assisted chest compression-only CPR improved survival to hospital discharge by 22% [6]. Chest compression-only CPR has been encouraged by American Heart Association (AHA) to serve as an alternative to conventional CPR for untrained lay rescuers and trained lay rescuers who are not able to perform rescue breathing [7].
High-quality CPR is essential for successful resuscitation following CA, defined as compressions of adequate rate and depth, complete chest recoil, minimized pauses and avoiding excessive ventilation. The quality of chest compressions is the main prerequisite for good outcomes, and especially a deeper chest compression depth has been associated with a higher rate of defibrillation success and better short-term survival [8], [9]. Updated AHA guidelines in 2010 both increased the requirements of compression depth (from 38 to 50 mm to at least 50 mm) and compression rate (from approximately 100/min to at least 100/min) [10]. However, since rescuer fatigue may be a primary reason for decreasing the quality of chest compressions during CPR over time, this new guidelines may further increase physical exertion for the rescuer and the perceived fatigue greater and earlier.
In the present study, we sought to investigate the quality of chest compressions during compression-only CPR when CPR was performed according to the 2010 AHA guidelines (AHA 2010), and its effect on rescuer fatigue. Eight min of compression-only CPR was evaluated in a manikin model. Rescuers were randomly assigned to perform CPR according to the 2005 AHA guidelines (AHA 2005) or AHA 2010. We hypothesized that the application of 2010 AHA guidelines would improve the quality of chest compressions when compared with the 2005 AHA guidelines, even if rescuer fatigue would be increased.
Section snippets
Study design and participants
This study was a prospective, randomized and controlled study, which was conducted in Guangzhou, China. Two different methods of compression-only CPR based on AHA 2005 or AHA 2010 were performed. The aim was to evaluate the effectiveness of chest compressions under the latest 2010 AHA CPR guidelines. The study protocol was approved by the Institutional Review Board of Sun Yat-sen Memorial Hospital.
Eighty-six undergraduate volunteers, inexperienced in basic life support training and real CPR,
Baseline characteristics of participants
Originally, 86 participants were recruited into this study. Of these, three participants in the AHA 2005 group temporarily dropped out, and one participant in each group was excluded because they failed to pass the theoretical examination. Consequently, 39 participants in the AHA 2005 group and 42 participants in the AHA 2010 group completed this study.
There were no significant differences in baseline characteristics of participants, including demographic data such as gender, age, height and
Discussion
The present study demonstrated that during eight min of compression-only CPR, significantly greater compression depth and rate were achieved in the AHA 2010 group when compared to the AHA 2005 group. Although the number of appropriate compressions were less in the AHA 2010 group; however, the number of chest compressions at a depth of > 38 mm was significantly more than that in the AHA 2005 group. Consequently, greater physical exertion and significantly greater rescuer fatigue was observed in
Limitations
There were certain limitations in our study. First, these undergraduate volunteers participated in this study had only an average age of 20 years. They were younger and physically fitter for CPR performance than most of the actual rescuers who were at a middle and old age. This difference in age might cause a difference in the quality of chest compressions. Second, we evaluated the effectiveness of compression-only CPR in a simulated scenario. CPR on a manikin model couldn’t appropriately take
Conclusions
The quality of chest compressions was significantly improved following the 2010 AHA guidelines, however, it’s more difficult for the rescuer to meet the requirements of the guidelines due to the potential factors of increased physical exertion and rescuer fatigue.
Acknowledgments
This study was supported by National Nature Science Foundation of China (NSFC 81000823) and Dongguan City Science and Technology Foundation of China (201310515000183). Zhengfei Yang and Heng Li contributed equally to this work; Tao Yu and Zitong Huang contributed equally to this work.
References (27)
- et al.
Uninterrupted chest compression CPR is easier to perform and remember than standard CPR
Resuscitation
(2004) - et al.
Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis
Lancet
(2010) - et al.
Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest
Resuscitation
(2006) - et al.
Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study
Resuscitation
(2006) - et al.
Electrocardiogram waveforms for monitoring effectiveness of chest compression during cardiopulmonary resuscitation
Crit Care Med
(2008) - et al.
The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation
Chest
(2007) - et al.
A comparison of 2 types of chest compressions in a porcine model of cardiac arrest
Am J Emerg Med
(2009) - et al.
A new paradigm for human resuscitation research using intelligent devices
Resuscitation
(2008) - et al.
The impact of chest compression rates on quality of chest compressions - a manikin study
Resuscitation
(2012) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 1 Executive summary.
Resuscitation
(2010)