Figure - available via license: Creative Commons Attribution 2.0 Generic
Content may be subject to copyright.
Minute-to-minute results of external chest compression performed by male participants for 30:2 in correlation to physical fitness determined by the heart rate at 75 watts of rowing (HR75). A: compression depth, lower vs. higher HR75: p < 0.001; B: compression rate, lower vs. higher HR75: p < 0.001. Black squares = low HR75; white squares = high HR75. Asterisks indicate significant differences comparing the first minute with the subsequent minutes of compression within each group. *: p < 0.1; **: p < 0.05; ***: p < 0.01. Data are presented as mean ± standard error of mean. For the definition of lower and higher HR75 please refer to the main text.
Source publication
During circulatory arrest, effective external chest compression (ECC) is a key element for patient survival. In 2005, international emergency medical organisations changed their recommended compression-ventilation ratio (CVR) from 15:2 to 30:2 to acknowledge the vital importance of ECC. We hypothesised that physical fitness, biometric data and gend...
Citations
... Past studies have demonstrated that CCD and complete chest recoils were negatively correlated with CCR [12,20], and compression rates above 120 cpm are associated with adverse effects for compression depth and complete chest recoils [21][22][23]. While height, weight, body mass index (BMI), and muscle strength are positive predictors of compression depth [24][25][26], in general men's compression depth is greater than that of women's [17,18,26,27]. The 2020 AHA guidelines recommend alternating rescuers every 2 minutes or every 200 consecutive chest compressions during CPR to maximize the percentage of adequate compressions [8,14]. ...
... Past studies have demonstrated that CCD and complete chest recoils were negatively correlated with CCR [12,20], and compression rates above 120 cpm are associated with adverse effects for compression depth and complete chest recoils [21][22][23]. While height, weight, body mass index (BMI), and muscle strength are positive predictors of compression depth [24][25][26], in general men's compression depth is greater than that of women's [17,18,26,27]. The 2020 AHA guidelines recommend alternating rescuers every 2 minutes or every 200 consecutive chest compressions during CPR to maximize the percentage of adequate compressions [8,14]. ...
... In reality, getting the CCD to this depth is not easy for most chest compression performers [7,17]. A previous study found that during CPR, more than half of the performers had a CCD smaller than 38-51 mm, and 91.6% of the performers had a CCD smaller than 50 mm [21], and the CCD decreased with compression time [26,45] which are similar to the results of this study. In the present study, the mean CCD of WV-CPR and V-CPR were 44.48 mm and 44.49 ...
Background: Chest compressions are the basis of cardiopulmonary resuscitation (CPR), and high-quality chest compressions can improve survival rate in patients with out-of-hospital cardiac arrest. Although many efforts have been made to improve the quality of CPR in inexperienced adults, the results are still not high, especially during emergencies. The primary purpose of this study is to investigate whether a brief instructional chest compression-only CPR video could improve chest compression quality in inexperienced adults.
Methods: One hundred adults with no CPR experience (age: 20.28 ± 2.28 years; women: 50, men: 50) participated in this study. Participants completed body composition and handgrip strength measurements, and performed two CPR quality tests on the Laerdal® Little Anne QCPR Manikin, namely without video-CPR (WV-CPR) and video-CPR (V-CPR). The WV-CPR quality test was performed first. After 2 minutes of continuous chest compression, the participants rested for 10 seconds and repeated 3 cycles (phase 1, phase 2, and phase 3). After resting for more than 72 hours, V-CPR quality test was conducted. During the V-CPR with video intervention, the participants also continued to compress the chest for 2 minutes, and then rested for 10 seconds, repeating 3 cycles.
Results: In phase 1, compared with WV-CPR, the V-CPR has a significant increase (p < 0.001) in chest compression fraction (CCF) (56.31 ± 33.22% vs. 41.82 ± 32.30%) and percent of correct compression rate (PCCR) (96.17 ± 8.45% vs. 26.31 ± 37.55%). In addition, the V-CPR has significantly lower (p < 0.001) chest compression rate (CCR) (110.85 ± 2.40 cpm vs. 128.86 ± 24.52 cpm) and rating of perceived exertion (RPE) (11.89 ± 2.25 vs. 12.87 ± 2.25). For phases 2 through 3, V-CPR and WV-CPR achieved significant differences in CCF, CCD, CCR, PCCR, and RPE (p < 0.01). There were significant differences (p < 0.05) in CCF, CCD, chest compression rebound rate, and RPE among the different administration stages of both WV-CPR and V-CPR.
Conclusions: The results of this study revealed that a brief instructional chest compression-only CPR video could improve chest compression quality for inexperienced adults by reducing fatigue and CCR, and increasing CCF and PCCR.
... The same study concluded that a rescuer with a higher BMI and in better physical fitness results was able to deliver consistent results with less fatigue. 12 Electromyography studies to measure muscle activity in the spinal and lumbar area on compressors show that fatigue began at the 2-minute mark and from the 5-minute mark, muscle activity was reduced which signals fatigue. This imbalance of muscle force has the potential to cause long-term injury in rescuers. ...
Background:
High-quality cardiopulmonary resuscitation (HQ-CPR) focuses on improving heart and brain blood perfusion. The evaluation of HQ-CPR included depth, frequency, rate of chest compressions, and the occurrence of chest recoil between two chest compressions. Staff performing CPR may not be performing HQ-CPR since it is influenced by individual stamina, physical strength, and lack of target marker. We aimed to study the impact of 100 times per minute rate vs. 120 times per minute CPR rate on the depth and percentage of depth-on-target done by trained staff on a manikin.
Methods:
This was a cross-over randomized control study. The subjects were anesthesiology and intensive care residents in a tertiary teaching hospital in Indonesia, all certified to perform advanced life support. The subject was asked to perform both CPR of 100 and 120 times per minute after a period of one-day rest. The standardized adult manikin was used, and the depth of CPR was measured using a pad-sensor attached to the manikin, and the results were transferred to recording software. Analysis was done using the chi-square analysis, and p < 0.05 was considered statistically significant.
Results:
A total of 35 subjects were included. The results showed that the average compression depth at 100 times/minute was more statistically superficial than the 120 times/minute treatment (5.210 ± 0.319 vs. 5.430 ± 0.283, p = 0.007). In contrast, the compression depth-on-target percentage was significantly higher at a speed of 100 times per minute (37.130 ± 10.233 vs. 18.730 ± 7.224, p = 0.0001).
Conclusion:
One hundred times per minute CPR resulted in a statistically significant lower compression depth, although not clinically significant, with a statistically significant higher percentage of compression depth-on-target than 120 times per minute CPR.
... The ability to perform adequate ECCs increases in line with BMI; a BMI ≥ 18.5 in adults has been identified as the success threshold, which our sample mostly matches. Some studies have indicated that upper body muscle strength levels in rescuers can ensure that adequate ECCs will be performed [20,[35][36][37]. Our data confirm that, with this new device, average upper body muscle strength levels are independently beneficial in achieving a higher percentage of adequate ECCs in short resuscitations. ...
To examine the performance of a novel low-cost, ultra-compact, and attractive auditory feedback device for training laypeople in external chest compressions (ECCs), we conducted a quasi-experimental cross-sectional study from September to November 2021 at the Faculty of Nursing of Albacete, University of Castille-La Mancha, Spain. The ECC sequence was performed in the laboratory with the new device for basic hands-on CPR training. Results: One hundred college students were included in this study. The compression rate/min with the new device was 97.6, and the adequate %ECC was 52.4. According to the status of body mass index (BMI) and muscle strength of the upper limbs in the bivariate analysis, it was observed that the new device discriminated between those who performed correct ECCs according to their BMI and muscle strength and those who did not, which led to significantly influenced results in terms of the percentage of ECCs with correct depth. Conclusions: The new ultra-compact auditory feedback device “Salvando a Llanetes®” demonstrated utility for teaching and learning ECCs in basic CPR. We can affirm that the analyzed device is an adequate, safe and economical method for teaching “CPR Hands-Only™” to the general population.
... [15] A study related to the impact of physical fitness reported that rescuers with a higher BMI and better physical fitness performed better external chest compression. [16] These results were also present in the entire cohort and sex-based subgroups. In a study of muscular fitness involving college students, the ability to provide adequate external chest compression was influenced by the rescuer's muscle strength. ...
Objectives: This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil.
Patients and methods: This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed.
Results: Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001).
Conclusion: The power score combination of upper extremity functionality and the rescuer’s weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.
... As muscle mass and back muscle strength are essential in physical activities and maintaining posture, their impact on the quality of chest compressions were also the subject of an analysis in a student group [13]. Moreover, based on current scientific research, the quality of CPR depends on other physiological parameters such as height [14], body weight [15,16], body mass index [14,17] or body fat [18]. Therefore, we aimed to evaluate the relationship between selected body composition components and chest compression and ventilation parameters provided by nurses in our study. ...
... As muscle mass and back muscle strength are essential in physical activities and maintaining posture, their impact on the quality of chest compressions were also the subject of an analysis in a student group [13]. Moreover, based on current scientific research, the quality of CPR depends on other physiological parameters such as height [14], body weight [15,16], body mass index [14,17] or body fat [18]. Therefore, we aimed to evaluate the relationship between selected body composition components and chest compression and ventilation parameters provided by nurses in our study. ...
The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR.
... Lightweight rescuers, especially women, have been proven not to perform adequate chest compression depth [24,25] and allow complete chest recoil [26]. Similarly, rescuers who are underweight perform CPR worse than those of normal weight or excess weight [27,28]. High levels of muscle strength and physical fitness are positively associated with adequate chest compression [23,29,30]. ...
... Regarding the effects of nursing students' physical characteristics, none of the physical characteristics measured in the training and control group participants had any impact on their CPR performance in any phase of our study. However, there is evidence that chest compression quality depends on the rescuer's body weight [23][24][25][26][27][28], since their mass is proportional to the force transferred to the patient's chest [44]. Furthermore, a force of 50 kg is needed to achieve 5 cm of chest compression, so lightweight rescuers need more muscle strength [45]. ...
Background
Cardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers’ physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics.
Method
Sixty nursing students participated in this randomized clinical trial (control group n = 28; training group n = 32). Their physical characteristics (weight, height, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)% index, handgrip strength, and CPR position strength) were measured before starting the trial. The training group followed a CPR training programme based on deliberate practice, providing feedback on their performance using an FD. All participants were evaluated during two-minute CPR compression/ventilation cycles.
Results
The training group showed an improved ability to perform chest compressions (F(2, 115.2) = 13.3; p < .001; ω²p = 0.17) and ventilations (F(2, 115.3) = 102.1; p < .001; ω²p = 0.63), improving their overall quality of CPR (F(2, 115.2) = 40.1; p < .001; ω²p = 0.40). The physical characteristics of the participants did not affect CPR performance in any study phase.
Conclusions
A structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.
... Hal ini disebabkan karena mayoritas subjek yang termasuk dalam sampel penelitian adalah perawat wanita dengan berat badan yang agak rendah. Dalam studi lain, peserta dengan BMI yang lebih tinggi dan indeks kebugaran fisik yang baik merasa kurang lelah selama melakukan RJP (Russo et al., 2011). ...
Resusitasi Jantung Paru (RJP) merupakan tindakan pengembalian aliran parsial darahteroksigenasi sampai sirkulasi darah kembali spontan. Salah satu metode mempertahankankualitas kompresi RJP yaitu dengan musik “Stayin Alive” karena memiliki iramateratur dengan kecepatan 103 bpm. Tujuan penelitian untuk mengetahui pengaruhmusik “Stayin Alive” terhadap kualitas kompresi RJP frekuensi dan kedalaman RJPoleh mahasiswa perawat. Penelitian ini merupakan penelitian kuantitatif dengan MetodeQuasy-Experiment Pre test Posttest with Control Group Design. Pemilihan sampel secaratotal sampling dengan jumlah 70 mahasiswa Profesi Ners kemudian dirandomisasidan dibagi menjadi dua kelompok yaitu kelompok intervensi dan kelompok kontrol.Pada kelompok intervensi saat melakukan kompresi sambil mendengarkan iramamusik lagu “Stayin Alive”, sedangkan kelompok kontrol dengan perhitungan “Rule ofFive”. Analisis data menggunakan Uji Mann Whitney untuk analisis tidak berpasangan.Penelitian menunjukkan hasil tidak ada perbedaan yang signifikan rerata frekuensi dankedalaman RJP antara kelompok intervensi dengan kelompok kontrol nilai p-value=0,381(p>0,05) untuk frekuensi RJP dan p-value=0,295 (p>0,05) untuk frekuensi kedalamanRJP. Kesimpulan Intervensi musik “Stayin Alive” dan “Rule of Five” sama-sama mampumeningkatkan kualitas kompresi RJP baik frekuensi maupun kedalaman karena tidakada perbedaan yang signifikan antara kelompok intervensi dan kontrol
... Similarly, there is a positive correlation between high BMI and high-quality CPR. Rescuers with higher BMI showed better chest compression performance and less fatigue, while rescuers with relatively lower BMI showed lower chest compression performance [17]. Furthermore, according to Kaminska et al. (2018), fat-free mass, trunk muscle mass, left or right arm muscle mass and basal metabolic rate are positively correlated with the depth of manual chest compressions [18]. ...
Background: Whether intermittent chest compressions have an effect on the quality of CPR is worthy of discussion. The purpose of this study was to investigate differences in the chest compression quality of emergency medical technicians (EMTs) performing cardiopulmonary resuscitation (CPR) with different rest intervals.
Methods: Seventy male firefighters with EMT licenses participated in this study. Participants completed body composition measurements and three CPR quality tests, as follows: (1) CPR-uninterrupted for 10 minutes; (2) after 2 days of rest, CPR 10s-intermittent (CPR-10s), for 2 minutes each time and 5 cycles; (3) after another 2 days of rest, CPR 20s-intermittent (CPR-20s), for 2 minutes each time and 5 cycles.
Results: Body composition results showed that body mass (BM), body mass index (BMI), upper limb muscle mass (ULMM), core muscle mass (CMM), and upper limb-core muscle mass (UL+CMM) were positively correlated with chest compression depth (CCD) (p < 0.05). Analysis of the three different modes of CPR quality analysis indicated significant differences in the chest compression fraction (CCF, F = 6.801, p = 0.001), chest compression rebound rate (CCRR, F = 3.919, p = 0.021), and ratings of perceived exertion (RPE, F = 23.815, p < 0.001). Among the different performance cycles of CPR-10s, significant differences were found in CCF, CCD, CCR (chest compression rate), and RPE (p < 0.05). On the other hand, among the different performance cycles of CPR-20s, significant differences were found in CCD, CCR, and RPE (p < 0.05). Moreover, the CCF, CCD, and RPE scores of the two tests reached significant differences in specific phases (p < 0.05).
Conclusions: This study confirmed that the upper limb muscle mass or the weight of the upper body of EMTs is positively correlated with the quality of CPR. In addition, intermittent chest compressions with safe interruption intervals can reduce fatigue caused by long-term chest compressions and maintain better chest compression quality.
... Only a few studies have investigated the fitness levels and physical health measures among ECPs (5,6), despite the literature detailing the demonstration of the physical demands in the profession. For example, Russo et al (7) examined the impact of physical fitness on the quality of external chest compressions during CPR and found that rescuers of superior physical fitness were able to sustain high quality chest compressions and lower rescuer fatigue. Furthermore, Coffey et al (1) assessed the physical demands of the paramedic occupation in Canada. ...
Objective: The purpose of the study was to examine the relationship between validated fitness parameters and an emergency rescue simulation (RS) circuit performed by emergency care providers (ECPs).
Methods: A cross-sectional study was selected to determine the relationship between the fitness tests and the RS. Twenty ECPs in the North West province of South Africa participated in the study. Demographic data were collected, followed by testing of anthropometric characteristics and field fitness tests measuring muscular strength, muscular endurance, aerobic capacity, anaerobic capacity and flexibility. Thereafter, participants had to complete a RS circuit. Pearson's correlation coefficient was used to assess the relationship between variables. Differences in age, gender and body mass index formed part of the descriptive statistics. A test-retest reliability method was applied to evaluate the reliability of the RS.
Results: Significant correlations were found between the RS and the 250 m shuttle run (r=0.83; p<0.01), flexed-arm hang test (r=-0.59; p<0.01), Cooper 12-minute test (r=-0.56; p<0.01), and the maximum push-up test (r=-0.51; p<0.05).
Conclusion: Findings demonstrate a possible association between aerobic capacity, anaerobic capacity, muscular strength, muscular endurance and ECP performance in an occupational task-related RS. Improved performance in these specific fitness areas may enable ECPs to be better prepared for the physical demands of their occupation. The RS may also be used as a tool to assess job (physical) preparedness of qualified ECPs during their recruitment, but this requires further validation.
... Some researchers have suggested an association between the quality of CPR and rescuer fitness factors, which can have the greatest impact on the rescuer strength [16,19,20]. However, it is challenging to recommend a program to strengthen the rescuers' muscle as an indispensable method to improve CPR performance because there are many limitations including a shortage of lead-time. ...
Abstract
Objective: Considering the potential role of shift cycle time on chest compression quality
during cardiopulmonary resuscitation (CPR) and the available contradictory results in
this regard, the present study aimed at evaluating the effect of 1‑min versus 2‑min shift
cycle time on the quality of CPR. Materials and Methods: In this randomized crossover
study, 80 rescuers performed CPR on a manikin in two scenarios with a rotation of 1 and
2‑min cycles. The quality of CPR was evaluated and compared based on the information
obtained regarding the chest compression depth, recoil, and rate of chest compression. In
addition, rescuer fatigue was recorded in 1‑min versus 2‑min shift cycles. Results: In the
1‑min group, the number of chest compressions per minute, complete recoil, and good
rate with the mean of 114.89 ± 3.62, 54.34 ± 3.86, and 76.06 ± 8.00 were significantly
higher than those of the 2‑min group with the mean of 113.78 ± 4.94, 53.49 ± 5.27, and
73.98 ± 7.87 (P < 0.05), respectively. In addition, the quality of CPR provided by males was
significantly higher than females in both groups. The score of rescuer fatigue was higher
in the 2‑min group as compared with the 1‑min group (P < 0.001). Conclusion: According
to the results of the present study, the difference in the quality of CPR in terms of the
number of chest compressions, complete recoil, and good rate was higher in the 1‑min
group as compared with the 2‑min group. In addition, the quality of CPR in terms of
chest compression depth and number in both 1‑and 2‑min rotation cycles was higher for
male rescuers than females. Furthermore, rescuer fatigue was higher in the 2‑min group as
compared with the 1‑min group. The mentioned finding may be a factor in reducing, albeit
slightly, the quality of CPR in the group with a longer time.
