title: Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.
abstract: BACKGROUND
  Updated life-support guidelines were published by the European Resuscitation Council (ERC) in 2010, increasing the required depth and rate of chest compression delivery. This study sought to determine the impact of these guidelines on rescuer fatigue and cardiopulmonary resuscitation (CPR) performance.
  
  
  METHODS
  62 Health science students performed 5 min of conventional CPR in accordance with the 2010 ERC guidelines. A SkillReporter manikin was used to objectively assess temporal change in determinants of CPR quality. Participants subjectively reported their end-fatigue levels, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery.
  
  
  RESULTS
  49 (79%) participants reported that fatigue affected their CPR performance, at an average of 167 s. End fatigue averaged 49.5/100 (range 0-95). The proportion of chest compressions delivered correctly decreased from 52% in min 1 to 39% in min 5, approaching significance (p=0.071). A significant decline in chest compressions reaching the recommended depth occurred between the first (53%) and fifth (38%) min (p=0.012). Almost half this decline (6%) was between the first and second minutes of CPR. Neither chest compression rate, nor rescue breath volume, were affected by rescuer fatigue.
  
  
  CONCLUSIONS
  Fatigue affects chest compression delivery within the second minute of CPR under the 2010 ERC guidelines, and is poorly judged by rescuers. Rescuers should, therefore, be encouraged to interchange after 2 min of CPR delivery. Team leaders should be advised to not rely on rescuers to self-report fatigue, and should, instead, monitor for its effects.
authors.affiliation: School of Clinical & Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: McDonald
authors.forename: James
authors.initials: J
authors.lastname: Heggie
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Jones
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Thorne
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hulme
mesh_terms: D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D016757:Death, Sudden, Cardiac; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D017410:Practice Guidelines as Topic / Q000592:standards; D057566:Self Report; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult