title: Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest.
abstract: BACKGROUND AND GOAL OF STUDY: The relationship between chest compression rate and compression depth is unknown. In order to characterise this relationship, we performed an observational study in prehospital cardiac arrest patients. We hypothesised that faster compressions are associated with decreased depth.
  
  
  METHODS
  In patients undergoing prehospital cardiopulmonary resuscitation by health care professionals, chest compression rate and depth were recorded using an accelerometer (E-series monitor-defibrillator, Zoll, U.S.A.). Compression depth was compared for rates <80/min, 80-120/min and >120/min. A difference in compression depth ≥0.5 cm was considered clinically significant. Mixed models with repeated measurements of chest compression depth and rate (level 1) nested within patients (level 2) were used with compression rate as a continuous and as a categorical predictor of depth. Results are reported as means and standard error (SE).
  
  
  CONCLUSIONS
  One hundred and thirty-three consecutive patients were analysed (213,409 compressions). Of all compressions 2% were <80/min, 62% between 80 and 120/min and 36% >120/min, 36% were <4 cm deep, 45% between 4 and 5 cm, 19% >5 cm. In 77 out of 133 (58%) patients a statistically significant lower depth was observed for rates >120/min compared to rates 80-120/min, in 40 out of 133 (30%) this difference was also clinically significant. The mixed models predicted that the deepest compression (4.5 cm) occurred at a rate of 86/min, with progressively lower compression depths at higher rates. Rates >145/min would result in a depth <4 cm. Predicted compression depth for rates 80-120/min was on average 4.5 cm (SE 0.06) compared to 4.1 cm (SE 0.06) for compressions >120/min (mean difference 0.4 cm, P<0.001). Age and sex of the patient had no additional effect on depth.
  
  
  CONCLUSIONS
  This study showed an association between higher compression rates and lower compression depths. Avoiding excessive compression rates may lead to more compressions of sufficient depth.
authors: Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium. koen.monsieurs@uza.be
authors: Koenraad G
authors: KG
authors: Monsieurs
authors: Melissa
authors: M
authors: De Regge
authors: Kristof
authors: K
authors: Vansteelandt
authors: Jeroen
authors: J
authors: De Smet
authors: Emmanuel
authors: E
authors: Annaert
authors: Sabine
authors: S
authors: Lemoyne
authors: Alain F
authors: AF
authors: Kalmar
authors: Paul A
authors: PA
authors: Calle
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged