A Study of Chest Compression Rates During Cardiopulmonary Resuscitation in Humans: The Importance of Rate-Directed Chest Compressions

doi:10.1001/archinte.1992.00400130153020

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Vol. 152 No. 1, JANUARY 1992

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A Study of Chest Compression Rates During Cardiopulmonary Resuscitation in Humans

The Importance of Rate-Directed Chest Compressions

Karl B. Kern, MD; Arthur B. Sanders, MD; John Raife, MD; Melinda M. Milander, RN; Charles W. Otto, MD; Gordon A. Ewy, MD

Arch Intern Med. 1992;152(1):145-149.

Abstract

. A prospective, cross-over trial was performed comparing twodifferent rates of precordial compression using endtidal carbondioxide as an indicator of the efficacy of cardiopulmonary resuscitationin 23 adult patients. A second purpose of this study was todetermine the effect of audioprompted, rate-directed chest compressionson the endtidal carbon dioxide concentrations during cardiopulmonaryresuscitation. Patients with cardiac arrest received externalchest compressions, initially in the usual fashion without ratedirection and then with rhythmic audiotones for rate directionat either 80 compressions per minute or 120 compressions perminute. Nineteen of 23 patients had higher end-tidal carbondioxide levels at the compression rate of 120 per minute. Themean end-tidal carbon dioxide level during compressions of 120per minute was 15.0±1.8 mm Hg, slightly but significantlyhigher than the mean level of 13.0±1.8 mm Hg at a compressionrate of 80 per minute. However, end-tidal carbon dioxide levelsincreased rather dramatically when audiotones were used to guidethe rate of chest compressions. Mean end-tidal carbon dioxideconcentration was 8.7±1.2 mm Hg during standard cardiopulmonaryresuscitation immediately before audio-prompted, rate-directedchest compression and increased to 14.0±1.3 mm Hg afterthe first 60 seconds of audible tones directing compressions.Using end-tidal carbon dioxide as an indicator of cardiopulmonaryresuscitation efficacy, we conclude that audible rate guidanceduring chest compressions may improve cardiopulmonary resuscitationperformance.

(Arch Intern Med. 1992;152:145-149)

Author Affiliations

From the Section of Cardiology, Department of Medicine (Drs Kern and Ewy and Ms Milander), Section of Emergency Medicine, Department of Surgery (Dr Sanders), and the Department of Anesthesiology (Dr Otto), University Medical Center, Tucson, Ariz; and the Department of Emergency Medicine, St Joseph's Hospital, Phoenix, Ariz (Dr Raife).

Footnotes

Accepted for publication September 30, 1991.

Reprint requests to the Section of Cardiology, University ofArizona College of Medicine, University Medical Center, 1501N Campbell Ave, Tucson, AZ 85724 (Dr Kern).

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