title: Two minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial.
abstract: OBJECTIVE
  While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial.
  
  
  METHODS
  119 teams, consisting of three to four physicians each, were randomized to receive a graphical display of the simplified circular adult BLS algorithm with the instruction to perform CPR for either 2 min or five cycles 30:2. Subsequently teams had to treat a simulated unwitnessed cardiac arrest. Data analysis was performed using video-recordings obtained during simulations. The primary endpoint was adherence, defined as being within ±20% of the instructed target (i.e. 96-144s in the 2 min teams and 4-6 cycles in the fivex30:2 teams).
  
  
  RESULTS
  22/62 (35%) of the "two minutes" teams and 48/57 (84%) of the "five×30:2″ teams provided CPR within a range of ± 20% of their instructed target (P<0.0001). The median time of CPR prior to rhythm check was 91s and 87s, respectively, (P=0.59) with a significant larger variance (P=0.023) in the "two minutes" group.
  
  
  CONCLUSIONS
  This randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable.
authors.affiliation: Department of Orthopedics and Trauma Surgery, Bethesda Hospital, Duisburg, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Weichert
authors.affiliation: Department of Anaesthesiology, Bethesda Hospital, Duisburg, Germany; Department of Anaesthesiology 1, Witten/Herdecke University, Witten, Germany.
authors.forename: Timur
authors.initials: T
authors.lastname: Sellmann
authors.affiliation: Institution for Emergency Medicine, Arnsberg, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Wetzchewald
authors.affiliation: Department of Psychology, Technical University of Dortmund, Dortmund, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Gasch
authors.affiliation: Department of Medical Intensive Care, University Hospital of Basel, Basel, Switzerland.
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
authors.affiliation: Department of Medical Intensive Care, University Hospital of Basel, Basel, Switzerland. Electronic address: stephan.marsch@usb.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008348:Manikins; D010820:Physicians / Q000592:standards*; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*; D016037:Single-Blind Method; D013997:Time Factors; D014741:Video Recording
keywords: Cardiopulmonary resuscitation; Guideline adherence; Randomized controlled trial; Simulation