Abstract 5: Multicenter Characterization Of Rescuer Fatigue During In-hospital Cardiopulmonary Resuscitation
Background: The delivery of high quality chest compressions (CC) is a crucial component of resuscitation from cardiac arrest. Rescuer fatigue has been hypothesized to adversely affect CC quality. Previous manikin studies have reported conflicting results regarding both the timing and magnitude of fatigue during cardiopulmonary resuscitation (CPR), and data from actual resuscitation care regarding rescuer fatigue remain sparse.
Objective: We sought to characterize rescuer fatigue during clinical in-hospital CPR performance, with the hypothesis that quantitative evidence of CC quality deterioration occurs over three min of continuous CC delivery.
Methods: Data from two independent tertiary-care hospitals were collected from 7/07 to 5/08. CPR performance transcripts from consecutive in-hospital arrests were evaluated using a CPR-recording/feedback defibrillator. Data were analyzed only for > 90 sec periods of uninterrupted CPR to ensure that each segment represented a single rescuer. These periods were sub-divided into sequential 30 sec segments over which the mean compression rate and depth were calculated.
Results: A total of 135 uninterrupted CC periods were collected from 43 unique arrest episodes. The median (IQR) period duration was 112.0 (102.9 –124.7) sec. We observed a decrease in mean CC depth over the course of 30-sec segments. The mean (SD) compression depth (mm) for each consecutive segment was: 48.3 (9.6); 48.5 (9.1); 47.9 (8.9); 46.0 (9.0); 44.0 (8.4); 43.7 (7.4), revealing a statistically significant decrease in depth over time (p=0.002). There was no significant change in compression rate or “leaning”.
Conclusions: During in-hospital CPR, compression depth decays modestly but significantly over three min of performance, despite the availability of CPR feedback. These findings highlight the need for further quantitative study of CC fatigue, especially in the pre-hospital setting where individual rescuers perform CC for prolonged periods of time.