Rescuer fatigue in cardiopulmonary resuscitation: A review of the literature

Abstract

Introduction Provision of adequate chest compressions remains a standard of care for optimal outcome in cardiopulmonary arrest. Given the recent changes to CPR rates and a greater emphasis on pushing faster and deeper, this has raised questions surrounding rescuer fatigue and efficacy of compressions. While a body of work has been undertaken on previous CPR rates and associated fatigue levels, there is a shortage of literature on the latest CPR rates and associated rescuer fatigue in the hospital and prehospital settings. The objective of this paper was to determine the extent of fatigue associated with CPR in both the hospital and prehospital settings. Design A review of the literature using a variety of medical databases, including Cochrane Database of Systemic Reviews, Ovid MEDLINE, EMBASE, and CINAHL electronic databases. The following MeSH terms were used in the search: CPR fatigue, chest compression, compression depth, out of hospital, in-hospital, prehospital, emergency medical services. Results 21 articles met the inclusion criteria, with three of these papers being from the prehospital setting. Currently, there is low level evidence determining the most appropriate length of time in providing quality chest compression before rescuer fatigue occurs. Overall chest compressions were shallower at least half of the time due to fatigue, and the mean compression rate was found to be higher than recommended. Conclusions The findings of this study suggest that the quality of chest compressions deteriorates soon after commencing CPR, and that high quality prehospital studies are lacking.