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Abstract
We hypothesized that a unique tock and voice metronome could prevent both suboptimal
chest compression rates and hyperventilation.
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.
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).
A unique combination tock and voice prompting metronome was effective at directing
correct chest compression and ventilation rates both before and after intubation.
Copyright 2009 Elsevier Ireland Ltd. All rights reserved.