Provision of adequate chest compressions remains a standard of care for optimal outcome in cardiopulmonary arrest. Given the recent changes to CPR rates and a greater emphasis on pushing faster and deeper, this has raised questions surrounding rescuer fatigue and efficacy of compressions. While a body of work has been undertaken on previous CPR rates and associated fatigue levels, there is a shortage of literature on the latest CPR rates and associated rescuer fatigue in the hospital and prehospital settings. The objective of this paper was to determine the extent of fatigue associated with CPR in both the hospital and prehospital settings.
Design A review of the literature using a variety of medical databases, including Cochrane Database of Systemic Reviews, Ovid MEDLINE, EMBASE, and CINAHL electronic databases. The following MeSH terms were used in the search: CPR fatigue, chest compression, compression depth, out of hospital, in-hospital, prehospital, emergency medical services.
Results 21 articles met the inclusion criteria, with three of these papers being from the prehospital setting. Currently, there is low level evidence determining the most appropriate length of time in providing quality chest compression before rescuer fatigue occurs. Overall chest compressions were shallower at least half of the time due to fatigue, and the mean compression rate was found to be higher than recommended.
Conclusions The findings of this study suggest that the quality of chest compressions deteriorates soon after commencing CPR, and that high quality prehospital studies are lacking.
Brett Williams BAVEd, Grad Cert ICP, Grad Dip EmergHlth, MHlthSc, PhD (Candidate) MACAP, NAEMSE.
Brett Williams is a senior lecturer at Monash University (Department of Community Emergency Health & Paramedic Practice) with over 15 years experience in paramedic education. He has been heavily involved in the ideological transition of paramedic education from vocational origins to the higher education sector and has developed curriculum for both undergraduate and postgraduate students in face-to-face and e-learning modes.
Brett is currently undertaking his PhD. Brett's research and teaching interests are focused on the paradigm of student-centred learning, alternative learning opportunities, innovative teaching strategies and interprofessional education.
JEPHC PUBLICATIONS EducationQualitative analysis of undergraduate paramedic students' perceptions of using case-based learning in an online learning environment
Using creative and contemporary teaching strategies to promote emancipation, empowerment and achievement in undergraduate paramedic students - a personal reflection The Implementation of Case-Based Learning - Shaping the Pedagogy in Ambulance Education Opinion "Developmental Disability Medicine: Is it time for its inclusion into the paramedic curriculum?" an interview with Dr Jane Tracy
Removal of Invasive Devices from Deceased Persons: Forensic implications for Paramedics - A Victorian Perspective. an Interview with Professor Stephen Cordner Book Reviews "eACLS" American College of Emergency Physicians & National Safety Council. February 2004. Conference Reports OLT-2005 "Beyond Delivery" Conference 27 September 2005, QUT, Brisbane The Australian College of Ambulance Professionals 2004 National Conference at Alice Springs September 9-11
Mal Boyle ADipBus (GenAdmin), BInfoTech, MClinEpi, PhD
Mal is a senior lecturer at Monash University - Department of Community Emergency Health & Paramedic Practice teaching primarily evidence-based paramedic practice to undergraduate students. Primary research interests include prehospital trauma management and linking of ambulance datasets to other health related datasets and subsequent analysis. Mal is still a practicing Mobile Intensive Care Ambulance (MICA) Paramedic in rural Victoria.
Hendrik is an Accredited Exercise Physiologist (AEP) with the Australian Association for Exercise and Sports Science (AAESS). Hendrik has a strong academic background in Applied Exercise Science, having previously completed two undergraduate degrees in these fields (with a Disability Major) and a Masters of Exercise Science (Strength and Conditioning). Hendrik has extensive experience in injury management, posture correction and athlete preparation. Hendrik is currently completing his Bachelor of Emergency Health (Paramedic) through Monash University.
Williams, Brett; Boyle, Malcolm; and Gutwirth, Hendrik
"Rescuer Fatigue in Cardiopulmonary Resuscitation: A Review of the Literature,"
Journal of Emergency Primary Health Care:
4, Article 4.
Available at: http://ro.ecu.edu.au/jephc/vol7/iss4/4