Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial

• Published in: Resuscitation 2010-02, Vol.81 (2), p.206-210
• Main Authors: Kern, Karl B, Stickney, Ronald E, Gallison, Leanne, Smith, Robert E
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary resuscitation (CPR); Cardiopulmonary Resuscitation - instrumentation; Cardiopulmonary Resuscitation - methods; Chest compression; Emergency; Emergency and intensive respiratory care; Humans; Intensive care medicine; Manikins; Medical sciences; Prospective Studies; Time Factors; Ventilation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2009.10.015

Abstract Aim We hypothesized that a unique tock and voice metronome could prevent both suboptimal chest compression rates and hyperventilation. Methods A prospective, randomized, parallel design study involving 34 pairs of paid firefighter/emergency medical technicians (EMTs) performing two-rescuer CPR using a Laerdal SkillReporter Resusci Anne® manikin with and without metronome guidance was performed. Each CPR session consisted of 2 min of 30:2 CPR with an unsecured airway, then 4 min of CPR with a secured airway (continuous compressions at 100 min−1 with 8–10 ventilations/min), repeated after the rescuers switched roles. The metronome provided “tock” prompts for compressions, transition prompts between compressions and ventilations, and a spoken “ventilate” prompt. Results During CPR with a bag/valve/mask the target compression rate of 90–110 min−1 was achieved in 5/34 CPR sessions (15%) for the control group and 34/34 sessions (100%) for the metronome group ( p < 0.001). An excessive ventilation rate was not observed in either the metronome or control group during CPR with a bag/valve/mask. During CPR with a bag/endotracheal tube, the target of both a compression rate of 90–110 min−1 and a ventilation rate of 8–11 min−1 was achieved in 3/34 CPR sessions (9%) for the control group and 33/34 sessions (97%) for the metronome group ( p < 0.001). Metronome use with the secured airway scenario significantly decreased the incidence of over-ventilation (11/34 EMT pairs vs. 0/34 EMT pairs; p < 0.001). Conclusions A unique combination tock and voice prompting metronome was effective at directing correct chest compression and ventilation rates both before and after intubation.