title: Chest compression depth after change in CPR guidelines--improved but not sufficient.
abstract: OBJECTIVE
  Cardiopulmonary resuscitation is one of the most vital therapeutic options for patients with cardiac arrest. Sufficient chest compression depth turned out to be of utmost importance to increase the likelihood of a return of spontaneous circulation. Furthermore, the use of real-time feedback-systems for resuscitation is associated with improvement of compression quality. The European Resuscitation Council changed their recommendation about minimal compression depth from 2005 (40 mm) to 2010 (50 mm). The aim of the present study was to determine whether this recommendation of the new guidelines was implemented successfully in an emergency medical service using a real-time feedback-system and to what extend a guideline-based CPR training leads to a "change in behaviour" of rescuers, respectively.
  
  
  RESULTS
  The electronic resuscitation data of 294 patients were analyzed retrospectively within two observational periods regarding fulfilment of the corresponding chest compression guideline requirements: ERC 2005 (40 mm) 01.07.2009-30.06.2010 (n=145) and ERC 2010 (50mm) 01.07.2011-30.06.2012 (n=149). The mean compression depth during the first period was 47.1mm (SD 11.1) versus 49.6 mm (SD 12.0) within the second period (p<0.001). With respect to the corresponding ERC Guidelines 2005 and 2010, the proportion of chest compressions reaching the minimal depth decreased (73.9% vs. 49.1%) (p<0.001). There was no correlation between compression depth and patient age, sex or duration of resuscitation.
  
  
  CONCLUSIONS
  The present study was able to show a significant increase in chest compression depth after implementation of the new ERC guidelines. Even by using a real-time feedback system we failed to sustain chest compression quality at the new level as set by ERC Guidelines 2010. In consequence, the usefulness of a fixed chest compression depth should be content of further investigations.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany.
authors.forename: Tim-Gerald
authors.initials: TG
authors.lastname: Kampmeier
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany.
authors.forename: Roman-Patrik
authors.initials: RP
authors.lastname: Lukas
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Steffler
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Muenster, Germany.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sauerland
authors.affiliation: Department of Anaesthesiology, Catholic University Hospital Bochum, Germany.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Weber
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany.
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany; City of Muenster Fire Department, Germany. Electronic address: bohna@stadt-muenster.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000295:instrumentation / Q000592:standards*; D004632:Emergency Medical Services; D056228:Feedback, Sensory; D005260:Female; D005858:Germany; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000295:instrumentation / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Chest compression; Guideline adherence; Quality management; Real-time feedback