title: Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study.
abstract: BACKGROUND
  Rescuer fatigue during cardiopulmonary resuscitation (CPR) is a likely contributor to variable CPR quality during clinical resuscitation efforts, yet investigations into fatigue and CPR quality degradation have only been performed in simulated environments, with widely conflicting results.
  
  
  OBJECTIVE
  We sought to characterize CPR quality decay during actual in-hospital cardiac arrest, with regard to both chest compression (CC) rate and depth during the delivery of CCs by individual rescuers over time.
  
  
  METHODS
  Using CPR recording technology to objectively quantify CCs and provide audiovisual feedback, we prospectively collected CPR performance data from arrest events in two hospitals. We identified continuous CPR "blocks" from individual rescuers, assessing CC rate and depth over time.
  
  
  RESULTS
  135 blocks of continuous CPR were identified from 42 cardiac arrests at the two institutions. Median duration of continuous CPR blocks was 112s (IQR 101-122). CC rate did not change significantly over single rescuer performance, with an initial mean rate of 105+/-11/min, and a mean rate after 3 min of 106+/-9/min (p=NS). However, CC depth decayed significantly between 90s and 2 min, falling from a mean of 48.3+/-9.6mm to 46.0+/-9.0mm (p=0.0006) and to 43.7+/-7.4mm by 3 min (p=0.002).
  
  
  CONCLUSIONS
  During actual in-hospital CPR with audiovisual feedback, CC depth decay became evident after 90s of CPR, but CC rate did not change. These data provide clinical evidence for rescuer fatigue during actual resuscitations and support current guideline recommendations to rotate rescuers during CC delivery.
authors: Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors: Noah T
authors: NT
authors: Sugerman
authors: Dana P
authors: DP
authors: Edelson
authors: Marion
authors: M
authors: Leary
authors: Elizabeth K
authors: EK
authors: Weidman
authors: Daniel L
authors: DL
authors: Herzberg
authors: Terry L
authors: TL
authors: Vanden Hoek
authors: Lance B
authors: LB
authors: Becker
authors: Benjamin S
authors: BS
authors: Abella
mesh_terms: D001296:Audiovisual Aids; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004634:Emergency Medical Technicians; D005221:Fatigue / Q000209:etiology* / Q000503:physiopathology; D005246:Feedback; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*