title: Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study.
abstract: OBJECTIVE
  Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin.
  
  
  METHODS
  A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break.
  
  
  RESULTS
  A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, -2% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD -3%; 95% CI, -19% to 14%).
  
  
  CONCLUSIONS
  The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines.
authors.affiliation: Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and elisezee@gmail.com.
authors.forename: Elise
authors.initials: E
authors.lastname: Zimmerman
authors.affiliation: Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and.
authors.forename: Naiomi
authors.initials: N
authors.lastname: Cohen
authors.affiliation: Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maniaci
authors.affiliation: Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pena
authors.affiliation: Department of Medical and Health Sciences Research, Florida International University Herbert Wertheim College of Medicine, Miami, Florida.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Lozano
authors.affiliation: Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and.
authors.forename: Marc
authors.initials: M
authors.lastname: Linares
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods*; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D000066908:Simulation Training