Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations

Objectives: This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30: 2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims. Methods: This randomized crossover trial took place at three tertiary care hospitals and a seniors' center. Participants were aged >= 55 years without significant physical limitations (frailty score <= 3/7). They completed two 5-minute CPR sessions (using 30: 2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth >= 5cm). Results: Sixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI -3.51-2.33), MAP 1.64 (95% CI -0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30: 2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; p < 0.0001) and more adequate chest compressions (381.5 v. 324.9, mean difference. 62.0; p = 0.0001), although good compressions/minute declined significantly faster with the CCC method (p = 0.0002). Conclusions: CPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.