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An Observational Study on Importance of CPR Provider Medical Safety: Hemodynamic Changes and Fatigue in Young Healthy Adults after Multiple Cycles of CPR

Hanbyul Choi, Hyo Ju Lee, Eun-Kyung Jeong, Christopher C Lee, Ho Jung Kim, Adam J Singer, Han Ho Do

Title: An Observational Study on Importance of CPR Provider Medical Safety: Hemodynamic Changes and Fatigue in Young Healthy Adults after Multiple Cycles of CPR.

Background: Cardiopulmonary Resuscitation (CPR) guidelines emphasize delivery of effective chest compressions but do not strongly address the medical safety of CPR providers. We determined the effects of chest compressions on healthy adult firefighters’ symptoms, hemodynamics, and electrocardiography after performing multiple cycles of CPR.

Methods and Findings: Healthy adult firefighters were trained in CPR (compression: ventilation= 30:2, compression rate: at least 100/min, compression depth: at least 2 inches) and performed CPR on mannequins. Provider vital signs (blood pressure, heart rate, respiratory rate, O2 saturation, end-tidal CO2 tension, and pulse pressure), electrocardiography, and fatigue scores (on a scale of 0 to 10 from none to worst) were determined immediately before CPR (T1), after 5 cycles of CPR (T2), and after 10 cycles of CPR (T3). In addition, the presence of clinical symptoms (e.g., shortness of breath, dizziness) among the providers was determined after CPR. 39 firefighters participated in the study. Their mean age was 35.54 ± 10.26 years. Many providers developed fatigue, shortness of breath, and dizziness. Significant changes in heart rate (𝒑=0.000), respiratory rate (𝒑=0.010), end-tidal CO2 ( 𝒑=0.000), O2 saturation (𝒑=0.000), and pulse pressure (𝒑=0.000) were observed after both 5 and 10 cycles of CPR. One participant developed sinus dysrhythmia and premature ventricular contractions (PVC) after 10 cycles of CPR.

Conclusions: Delivery of chest compression results in fatigue and hemodynamic alterations in many young healthy adults after performing 5 or 10 cycles of CPR. To optimize medical safety of CPR providers, guidelines and education should take into account the age and presence of cardiac disease of CPR providers.