Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-10-16

open access

Page views 2554
Article views/downloads 1145
Get Citation

Connect on Social Media

Connect on Social Media

The effect of chest compression frequency on the quality of resuscitation by lifeguards. A prospective randomized crossover multicenter simulation trial

Jacek Smereka1, Łukasz Iskrzycki1, Elżbieta Makomaska-Szaroszyk2, Karol Bielski2, Michael Frass3, Oliver Robak3, Kurt Ruetzler4, Michael Czekajło5, Antonio Rodríguez-Núnez6, Jesús López-Herce7, Łukasz Szarpak25
Pubmed: 30338845
Cardiol J 2019;26(6):769-776.


Background: The ability to perform high-quality cardiopulmonary resuscitation is one of the basic
skills for lifeguards. The aim of the study was to assess the influence of chest compression frequency on
the quality of the parameters of chest compressions performed by lifeguards.
Methods: This prospective observational, randomized, crossover simulation study was performed with
40 lifeguards working in Warsaw, Wroclaw, and Poznan, Poland. The subjects then participated in
a target study, in which they were asked to perform 2-min cycles of metronome-guided chest compressions
at different rates: 80, 90, 100, 110, 120, 130, 140, and 150 compressions per minute (CPM).
Results: The study involved 40 lifeguards. Optimal chest compression score calculated by manikin
software was achieved for 110–120 CPM. Chest compression depth achieved 53 (interquartile range
[IQR] 52–54) mm, 56 (IQR 54–57) mm, 52.5 (IQR 50–54) mm, 53 (IQR 52–53) mm, 50 (IQR 49–51)
mm, 47 (IQR 44–51) mm, 41 (IQR 40–42) mm, 38 (IQR 38–43) mm for 80, 90, 100, 110, 120, 130,
140 and 150 CPM, respectively. The percentage of chest compressions with the correct depth was lower
for rates exceeding 120 CPM.
Conclusions: The rate of 100–120 CPM, as recommended by international guidelines, is the optimal
chest compression rate for cardiopulmonary resuscitation performed by lifeguards. A rate above 120 CPM
was associated with a dramatic decrease in chest compression depth and overall chest compression
quality. The role of full chest recoil should be emphasized in basic life support training.

Article available in PDF format

View PDF Download PDF file


  1. Pakula RJ, Wanat S. CPR in terms of maritime search and rescue service working conditions. Disaster Emerg Med J. 2017; 2(2): 104–105.
  2. Iskrzycki L, Smereka J, Rodriguez-Nunez A, et al. The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation. Kardiol Pol. 2018; 76(3): 574–579.
  3. Aleksandrowicz S, Madziala M, Iskrzycki L, et al. Performance of chest compressions with the use of the new mechanical chest compression machine lifeline arm: a randomized crossover manikin study in novice physicians. Disaster Emerg Med J. 2016; 1(1): 30–36.
  4. Smereka J, Kasiński M, Smereka A, et al. The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial. Kardiol Pol. 2017; 75(6): 589–595.
  5. Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2): S414–S435.
  6. Truszewski Z, Szarpak L, Kurowski A, et al. Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses. Am J Emerg Med. 2016; 34(3): 381–385.
  7. Smereka J, Szarpak L, Rodríguez-Núñez A, et al. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med. 2017; 35(10): 1420–1425.
  8. Wieczorek W, Kaminska H. Impact of a corpuls CPR mechanical chest compression device on chest compression quality during extended pediatric manikin resuscitation: a randomized crossover pilot study. Disaster Emerg Med J. 2017; 2(2): 58–63.
  9. Czekajlo M, Dabrowska A. In situ simulation of cardiac arrest. Disaster Emerg Med J. 2017; 2(3): 116–119.
  10. Abelsson A. Learning through simulation. Disaster Emerg Med J. 2017; 2(3): 125–128.
  11. Freund B, Kaplan PW. A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms. Cardiol J. 2017; 24(3): 324–333.
  12. Claesson A, Karlsson T, Thorén AB, et al. Delay and performance of cardiopulmonary resuscitation in surf lifeguards after simulated cardiac arrest due to drowning. Am J Emerg Med. 2011; 29(9): 1044–1050.
  13. Kurowski A, Szarpak Ł, Bogdański Ł, et al. Comparison of the effectiveness of cardiopulmonary resuscitation with standard manual chest compressions and the use of TrueCPR and PocketCPR feedback devices. Kardiol Pol. 2015; 73(10): 924–930.
  14. Telec W, Baszko A, Dąbrowski M, et al. Automated external defibrillator use in public places: a study of acquisition time. Kardiol Pol. 2018; 76(1): 181–185.
  15. Abelairas-Gómez C, Barcala-Furelos R, Szarpak Ł, et al. The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation. Kardiol Pol. 2017; 75(1): 21–27.
  16. Abelairas-Gómez C, Barcala-Furelos R, Szarpak Ł, et al. Response to the letter concerning the article:. Kardiol Pol. 2017; 75(1): 88–89.
  17. Kaminska H, Wieczorek W, Matusik P, et al. Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association Guidelines. Kardiol Pol. 2018; 76(3): 642–647.
  18. Jorge-Soto C, Abilleira-González M, Otero-Agra M, et al. Schoolteachers as candidates to be basic life support trainers: A simulation trial. Cardiol J. 2018 [Epub ahead of print].
  19. Abelairas-Gómez C, Barcala-Furelos R, Mecías-Calvo M, et al. Prehospital Emergency Medicine at the Beach: What Is the Effect of Fins and Rescue Tubes in Lifesaving and Cardiopulmonary Resuscitation After Rescue? Wilderness Environ Med. 2017; 28(3): 176–184.
  20. Kalén A, Pérez-Ferreirós A, Barcala-Furelos R, et al. How can lifeguards recover better? A cross-over study comparing resting, running, and foam rolling. Am J Emerg Med. 2017; 35(12): 1887–1891.
  21. Barcala-Furelos R, Abelairas-Gomez C, Palacios-Aguilar J, et al. Can surf-lifeguards perform a quality cardiopulmonary resuscitation sailing on a lifeboat? A quasi-experimental study. Emerg Med J. 2017; 34(6): 370–375.
  22. Szpilman D, de Barros Oliveira R, Mocellin O, et al. Is drowning a mere matter of resuscitation? Resuscitation. 2018; 129: 103–106.
  23. Deakin CD, Sidebottom DB, Potter R. Can rescuers accurately deliver subtle changes to chest compression depth if recommended by future guidelines? Resuscitation. 2018; 124: 58–62.
  24. Kilgannon JH, Kirchhoff M, Pierce L, et al. Association between chest compression rates and clinical outcomes following in-hospital cardiac arrest at an academic tertiary hospital. Resuscitation. 2017; 110: 154–161.
  25. Lee SH, Kim K, Lee JH, et al. Does the quality of chest compressions deteriorate when the chest compression rate is above 120/min? Emerg Med J. 2014; 31(8): 645–648.
  26. Zou Y, Shi W, Zhu Y, et al. Rate at 120/min provides qualified chest compression during cardiopulmonary resuscitation. Am J Emerg Med. 2015; 33(4): 535–538.
  27. Sutton RM, Reeder RW, Landis W, et al. Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes. Resuscitation. 2018; 130: 159–166.
  28. Fernando SM, Vaillancourt C, Morrow S, et al. Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators. Resuscitation. 2018; 128: 138–143.
  29. Bae J, Chung TN, Je SMo. Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial. BMJ Open. 2016; 6(2): e010873.
  30. Chung TN, Kim SW, You JeS, et al. A higher chest compression rate may be necessary for metronome-guided cardiopulmonary resuscitation. Am J Emerg Med. 2012; 30(1): 226–230.
  31. Liu Y, Huang Z, Li H, et al. CPR feedback/prompt device improves the quality of hands-only CPR performed in manikin by laypersons following the 2015 AHA guidelines. Am J Emerg Med. 2018 [Epub ahead of print].
  32. Treptau J, Ebnet J, Akin M, et al. Angiographic detection of fatal acute aortic dissection Stanford type A under resuscitation. Cardiol J. 2016; 23(6): 620–622.
  33. Maier GW, Newton JR, et al. Jr, Wolfe JA, The influence of manual chest compression rate on hemodynamic support during cardiac arrest: high-impulse cardiopulmonary resuscitation. Circulation. 1986; 74(6 Pt 2): IV51–IV59.
  34. Lee SH, Ryu JiHo, Min MKi, et al. Optimal chest compression rate in cardiopulmonary resuscitation: a prospective, randomized crossover study using a manikin model. Eur J Emerg Med. 2016; 23(4): 253–257.
  35. Idris AH, Guffey D, Pepe PE, et al. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012; 125(24): 3004–3012.
  36. Idris AH, Guffey D, Pepe PE, et al. Chest compression rates and survival following out-of-hospital cardiac arrest. Crit Care Med. 2015; 43(4): 840–848.
  37. Talikowska M, Tohira H, Finn J. Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2015; 96: 66–77.
  38. Field RA, Soar J, Davies RP, et al. The impact of chest compression rates on quality of chest compressions - a manikin study. Resuscitation. 2012; 83(3): 360–364.
  39. Monsieurs KG, De Regge M, Vansteelandt K, et al. Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest. Resuscitation. 2012; 83(11): 1319–1323.
  40. Truszewski Z, Szarpak Ł, Smereka J, et al. Comparison of the VivaSight single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial. Am J Emerg Med. 2016; 34(5): 929–930.
  41. Smereka J, Bielski K, Ladny JR, et al. Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial. Medicine (Baltimore). 2017; 96(14): e5915.
  42. Ladny JR, Smereka J, Szarpak L. Comparison of the Trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation. Preliminary data. Am J Emerg Med. 2017; 35(4): 574–575.
  43. Szarpak Ł, Truszewski Z, Smereka J, et al. Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study. Kardiol Pol. 2016; 74(12): 1499–1504.