Skip to main content
SpringerLink
Log in

Effect of metronome guidance on infant cardiopulmonary resuscitation

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This study was conducted to investigate the effect of metronome guidance on the performance of infant cardiopulmonary resuscitation (CPR). A total of 36 medical doctors conducted a 2-min single rescuer CPR with the two-finger technique (TFT) or two-thumb encircling hands technique (TT) on an infant manikin without metronome guidance (baseline test). After completing the baseline test, the participants were assigned to either a “guidance group” or “non-guidance group.” The guidance group performed CPR with a high-pitched sound at 110 beats/min from a metronome (test 2), while the non-guidance group performed 2-min CPR without metronome guidance (test 1). Comparison between the results of tests 1 and 2 showed that the ratio of adequate chest compression rate was significantly different in both the TFT (73% [34–93] vs. 98% [95–99], P < 0.001) and the TT (53% [32–79] vs. 99% [98–100], P = 0.010). Other parameters including average depth and the ratio of adequate depth were not significantly different between tests 1 and 2 in both the TFT and TT.

Conclusion: Metronome guidance improves the adequacy of chest compression rate during infant CPR without affecting chest compression depth in both the TFT and TT.

Trial registration: Clinical Research Information Service, KCT0002735

What is Known:

• The rate of chest compressions can be optimized by the use of metronome guidance in pediatric cardiopulmonary resuscitation (CPR).

• An adverse effect of deteriorating chest compression depth was found while using a metronome guidance during adult CPR simulations.

What is New:

• The metronome guidance improved the adequacy of the chest compression rate during infant CPR without affecting other parameters including average depth and the ratio of adequate depth in both the two-finger chest compression technique and two-thumb encircling hand technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CPR:

Cardiopulmonary resuscitation

TFT:

Two-finger technique

TT:

Two-thumb encircling hand technique

References

  1. Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, Vanden Hoek TL, Becker LB (2005) Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 293:305–310

    Article  CAS  PubMed  Google Scholar 

  2. Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, O’Hearn N, Hoek TL, Becker LB (2007) CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation 73:54–61

    Article  PubMed  Google Scholar 

  3. Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, Meaney PA, Niles DE, Samson RA, Schexnayder SM (2015) Part 11: pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132:S519–S525

    Article  PubMed  Google Scholar 

  4. Austin AL, Spalding CN, Landa KN, Myer BR, Donald C, Smith JE, Platt G, King HC (2017) A randomized control trial of cardiopulmonary feedback devices and their impact on infant chest compression quality: a simulation study. Pediatr Emerg Care In-press doi: https://doi.org/10.1097/PEC.0000000000001312

  5. Beckers SK, Skorning MH, Fries M, Bickenbach J, Beuerlein S, Derwall M, Kuhlen R, Rossaint R (2007) CPREzy improves performance of external chest compressions in simulated cardiac arrest. Resuscitation 72:100–107

    Article  PubMed  Google Scholar 

  6. Berg RA, Sanders AB, Milander M, Tellez D, Liu P, Beyda D (1994) Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children. Acad Emerg Med 1:35–40

    CAS  PubMed  Google Scholar 

  7. Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, Sinz EH, Cheng A (2015) Part 14: education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132:S561–S573

    Article  PubMed  Google Scholar 

  8. Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG, Education, implementation of resuscitation section C, Collaborators (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 10. Education and implementation of resuscitation. Resuscitation 95:288–301

    Article  PubMed  Google Scholar 

  9. Hostler D, Everson-Stewart S, Rea TD, Stiell IG, Callaway CW, Kudenchuk PJ, Sears GK, Emerson SS, Nichol G, Resuscitation Outcomes Consortium I (2011) Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ 342:d512

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kern KB, Sanders AB, Raife J, Milander MM, Otto CW, Ewy GA (1992) A study of chest compression rates during cardiopulmonary resuscitation in humans. The importance of rate-directed chest compressions. Arch Intern Med 152:145–149

    Article  CAS  PubMed  Google Scholar 

  11. Kim YS, Oh JH, Kim CW, Kim SE, Lee DH, Hong JY (2016) Which fingers should we perform two-finger chest compression technique with when performing cardiopulmonary resuscitation on an infant in cardiac arrest? J Korean Med Sci 31:997–1002

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kirkbright S, Finn J, Tohira H, Bremner A, Jacobs I, Celenza A (2014) Audiovisual feedback device use by health care professionals during CPR: a systematic review and meta-analysis of randomised and non-randomised trials. Resuscitation 85:460–471

    Article  PubMed  Google Scholar 

  13. Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T (2015) Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132:S414–S435

    Article  Google Scholar 

  14. Lee SY, Hong JY, Oh JH, Son SH (2018) The superiority of the two-thumb over the two-finger technique for single-rescuer infant cardiopulmonary resuscitation. Eur J Emerg Med 25:372–376

    Article  PubMed  Google Scholar 

  15. Maconochie IK, Bingham R, Eich C, Lopez-Herce J, Rodriguez-Nunez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Paediatric life support section C (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 95:223–248

    Article  PubMed  Google Scholar 

  16. Martin P, Theobald P, Kemp A, Maguire S, Maconochie I, Jones M (2013) Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%--a randomised controlled trial. Resuscitation 84:1125–1130

    Article  PubMed  Google Scholar 

  17. Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA (1995) Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. Acad Emerg Med 2:708–713

    Article  CAS  PubMed  Google Scholar 

  18. Minami K, Kokubo Y, Maeda I, Hibino S (2016) A flexible pressure sensor could correctly measure the depth of chest compression on a mattress. Am J Emerg Med 34:899–902

    Article  PubMed  Google Scholar 

  19. Oh JH, Lee SJ, Kim SE, Lee KJ, Choe JW, Kim CW (2008) Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway. Resuscitation 79:273–277

    Article  PubMed  Google Scholar 

  20. Oh J, Song Y, Kang B, Kang H, Lim T, Suh Y, Chee Y (2012) The use of dual accelerometers improves measurement of chest compression depth. Resuscitation 83:500–504

    Article  PubMed  Google Scholar 

  21. Park SO, Hong CK, Shin DH, Lee JH, Hwang SY (2013) Efficacy of metronome sound guidance via a phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomised controlled simulation study using a manikin. Emerg Med J 30:657–661

    Article  PubMed  Google Scholar 

  22. Perkins GD, Handley AJ, Koster RW, Castren M, Smyth MA, Olasveengen T, Monsieurs KG, Raffay V, Grasner JT, Wenzel V, Ristagno G, Soar J, Adult basic life s, automated external defibrillation section C (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 95:81–99

    Article  PubMed  Google Scholar 

  23. Rawlins L, Woollard M, Williams J, Hallam P (2009) Effect of listening to Nellie the elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial. BMJ 339:b4707

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sample Size Estimation. Centre for Clinical Research and Biostatistics, The Chinese University of Hong Kong. Available from URL: http://www2.ccrb.cuhk.edu.hk/stat/mean/tsmc_equality.htm. Accessed Jan 31, 2018

  25. Skorning M, Beckers SK, Brokmann J, Rortgen D, Bergrath S, Veiser T, Heussen N, Rossaint R (2010) New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest. Resuscitation 81:53–58

    Article  PubMed  Google Scholar 

  26. Song Y, Chee Y, Oh J, Ahn C, Lim TH (2016) Smartwatches as chest compression feedback devices: a feasibility study. Resuscitation 103:20–23

    Article  PubMed  Google Scholar 

  27. Sugerman NT, Edelson DP, Leary M, Weidman EK, Herzberg DL, Vanden Hoek TL, Becker LB, Abella BS (2009) Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study. Resuscitation 80:981–984

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tomlinson AE, Nysaether J, Kramer-Johansen J, Steen PA, Dorph E (2007) Compression force-depth relationship during out-of-hospital cardiopulmonary resuscitation. Resuscitation 72:364–370

    Article  CAS  PubMed  Google Scholar 

  29. Udassi JP, Udassi S, Theriaque DW, Shuster JJ, Zaritsky AL, Haque IU (2009) Effect of alternative chest compression techniques in infant and child on rescuer performance. Pediatr Crit Care Med 10:328–333

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wik L, Kramer-Johansen J, Myklebust H, Sorebo H, Svensson L, Fellows B, Steen PA (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 293:299–304

    Article  CAS  PubMed  Google Scholar 

  31. Yeung J, Meeks R, Edelson D, Gao F, Soar J, Perkins GD (2009) The use of CPR feedback/prompt devices during training and CPR performance: a systematic review. Resuscitation 80:743–751

    Article  PubMed  Google Scholar 

  32. Yu BG, Oh JH, Kim Y, Kim TW (2017) Accurate measurement of chest compression depth using impulse-radio ultra-wideband sensor on a mattress. PLoS One 12:e0183971

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Zimmerman E, Cohen N, Maniaci V, Pena B, Lozano JM, Linares M (2015) Use of a metronome in cardiopulmonary resuscitation: a simulation study. Pediatrics 136:905–911

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all participants from our hospital for their contribution to this study.

Funding

This research was supported by the Chung-Ang University Research Grants in 2018.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea

    Chan Woong Kim & Je Hyeok Oh

Authors
  1. Chan Woong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Je Hyeok Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Oh JH contributed to study conception and design. Oh JH contributed to data acquisition. Kim CW and Oh JH contributed to data analysis and interpretation. Oh JH contributed to acquisition of funding. Kim CW and Oh JH contributed to the drafting of the manuscript and its critical revision for important intellectual content. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Je Hyeok Oh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol and informed consent form were approved by the Institutional Review Board of our hospital on 19th February 2018 (Approval number: 1813-004-313). The study was registered at the Clinical Research Information Service on 16th March 2018 (Registration number: KCT0002735).

Informed consent

All participants provided written informed consent before participating in the study.

Additional information

Communicated by Peter de Winter

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(XLSX 36 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, C.W., Oh, J.H. Effect of metronome guidance on infant cardiopulmonary resuscitation. Eur J Pediatr 178, 795–801 (2019). https://doi.org/10.1007/s00431-019-03357-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-019-03357-0

Keywords

Search

Navigation