Rescuer Fatigue in Cardiopulmonary Resuscitation: A Review of the Literature

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. Introduction CPR provides minimal organ blood flow (e.g. to the brain and heart) to maintain life until other advanced procedures can be performed, such as defibrillation and advanced life support (ALS). CPR is critical if defibrillation is delayed after collapse and increases the likelihood of Journal of Emergency Primary Health Care (JEPHC), Vol. 7, Issue 4, 2009 – Article 990375 Author(s): Hendrik Gutwirth, Brett Williams, Malcolm Boyle survival. 1 CPR is the second link in the “chain of survival” that can buy time between the first link (Early Access to Emergency Care) and third link (Early Defibrillation). 2 CPR is a life saving technique used by health professionals in the hospital and prehospital settings. Observational studies of health professionals performing CPR in hospital and prehospital have revealed inadequate depth of compressions 3 , excessive ventilations 4 , and excessive interruptions to external cardiac compressions. 5 Inadequate chest compressions may be due to rescuer fatigue which may result in insufficient blood flow, which is important given the recent changes to compression/ventilation ratios from 15:1/5:2 to 30:2. 6 However, there is a lack of evidence pertaining to any specific compression-ventilation ratio associated with improved outcome in patients with cardiac arrest. 6 The objective of this paper was to determine the extent of fatigue associated with CPR in both the hospital and prehospital settings. Method Design This study is a review of the scientific literature covering CPR fatigue in a range of medical electronic databases. Process The electronic databases were the Cochrane Database of Systematic Reviews, Ovid MEDLINE (1950-April 2009), EMBASE (1974-April 2009), CINAHL (1982April 2009). The following MeSH terms and