Downloaded from http://emj.bmj.com/ on August 21, 2015 - Published by group.bmj.com
Best Evidence Topic Reports
.
Resuscitation/ OR cardiopulmonary resuscitation.af. OR cardiopulmonary.af. OR resuscitation.af. OR cpr.af.) AND metronome.af. Results limited to English language, adults and studies in humans. 17 records 0 new relevancies The Cochrane Library Issue 12 of 12, December 2013: metronome:ti,ab,kw (Word variations have been searched) AND MeSH descriptor: [Cardiopulmonary Resuscitation] explode all trees 6 results 0 unique data.
OUTCOME
BET 3: CAN METRONOMES IMPROVE CPR QUALITY? Report by: Chris Targett, Specialty Doctor in Emergency Medicine Search checked by: Tim Harris, Professor Emergency Medicine Institution: Hinchingbrooke Hospital NHS Trust, Huntingdon, UK
Seventeen papers were found, of which 11 appeared relevant from reviewing the abstract; subsequently, two were dismissed. A further 21 papers were identified by reference in the original 11 papers; subsequently eight were dismissed leaving a total of 21 relevant papers which are summarised in the following table.
COMMENTS ABSTRACT A short cut review was carried out to establish whether metronomes can improve the quality of cardiopulmonary resuscitation. 38 papers were found using the reported searches, none of which directly addressed the problem but some 21 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are tabulated. It is concluded that the use of metronomes to guide the rate at which external chest compressions are delivered is associated with improved rates closer to those recommended in the current resuscitation guidelines. CLINICAL SCENARIO During a long resuscitation in the emergency department, you have to repeatedly remind the members of staff performing chest compressions to keep up a good rate. You recall that during previous cardiac arrests, the quality and rate of external cardiac compressions differs between operators. You wonder if a metronome could help providers by defining a set rate and so improve cardiopulmonary resuscitation (CPR) quality.
THREE-PART QUESTION In (patients receiving external chest compressions in ED) is (a metronome better than no audible prompt) at (maintaining the quality of chest compressions delivered)?
SEARCH STRATEGY Ovid MEDLINE(R) 1946 to November Week 3 2013: (Exp Cardiopulmonary Emerg Med J March 2014 Vol 31 No 3
The role of cardiopulmonary resuscitation, using closed-chest compressions and assisted or expired air ventilation, is to maintain cardiopulmonary perfusion while identifying then treating reversible causes of cardiopulmonary arrest. High-quality closed-chest compression (chest compression rate and depth) has been associated with increased survival. A large number of small studies suggest that using auditory feedback devices, such as metronomes, improve the rates of chest compression to rates closer to those recommended by the resuscitation council guidelines (100–120 compressions per minute for adults). For this reason resuscitation guidelines recommend mechanical devices to support rescuers providing chest compressions. Metronomes are an option on some monitor/defibrillators. We focussed on the use of metronomes to guide closed-chest compressions as these are cheap, can be used from smart phone apps, and are placed on some defibrillators. We have identified some studies published subsequent to the publication of the most recent resuscitation guidelines. This is important, as the rate and depth of closed-chest compressions have changed during range time of the cited studies (eg, ALS 5th Edition: rate 100/min, depth 4– 5 cm, ALS 6th Edition: rate 100–120/min, depth 5–6 cm) (Chung et al 2012, 2013). These studies add to the evidence that metronomes may assist in optimising chest compressions to optimum rates suggested by the guidelines. These studies involve a diverse range of participants from lay, medical student, nursing and medical 251
Downloaded from http://emj.bmj.com/ on August 21, 2015 - Published by group.bmj.com
Best Evidence Topic Reports Table 3 Relevant papers Author, date, country
Patient group
Study type
Outcomes
Key results
Study weaknesses
Kern et al, 1992, USA
23 adult intubated patients in cardiac arrest with or without metronome
Prospective crossover study
End tidal CO2
Small study. Difficulty of variable isolation given study design
Wik et al, 2001, Norway
24 paramedic students training with and without metronome
Compressions at 120 bpm produces better end-tidal CO2 than 80 bpm (p
Best Evidence Topic Reports
.
Resuscitation/ OR cardiopulmonary resuscitation.af. OR cardiopulmonary.af. OR resuscitation.af. OR cpr.af.) AND metronome.af. Results limited to English language, adults and studies in humans. 17 records 0 new relevancies The Cochrane Library Issue 12 of 12, December 2013: metronome:ti,ab,kw (Word variations have been searched) AND MeSH descriptor: [Cardiopulmonary Resuscitation] explode all trees 6 results 0 unique data.
OUTCOME
BET 3: CAN METRONOMES IMPROVE CPR QUALITY? Report by: Chris Targett, Specialty Doctor in Emergency Medicine Search checked by: Tim Harris, Professor Emergency Medicine Institution: Hinchingbrooke Hospital NHS Trust, Huntingdon, UK
Seventeen papers were found, of which 11 appeared relevant from reviewing the abstract; subsequently, two were dismissed. A further 21 papers were identified by reference in the original 11 papers; subsequently eight were dismissed leaving a total of 21 relevant papers which are summarised in the following table.
COMMENTS ABSTRACT A short cut review was carried out to establish whether metronomes can improve the quality of cardiopulmonary resuscitation. 38 papers were found using the reported searches, none of which directly addressed the problem but some 21 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are tabulated. It is concluded that the use of metronomes to guide the rate at which external chest compressions are delivered is associated with improved rates closer to those recommended in the current resuscitation guidelines. CLINICAL SCENARIO During a long resuscitation in the emergency department, you have to repeatedly remind the members of staff performing chest compressions to keep up a good rate. You recall that during previous cardiac arrests, the quality and rate of external cardiac compressions differs between operators. You wonder if a metronome could help providers by defining a set rate and so improve cardiopulmonary resuscitation (CPR) quality.
THREE-PART QUESTION In (patients receiving external chest compressions in ED) is (a metronome better than no audible prompt) at (maintaining the quality of chest compressions delivered)?
SEARCH STRATEGY Ovid MEDLINE(R) 1946 to November Week 3 2013: (Exp Cardiopulmonary Emerg Med J March 2014 Vol 31 No 3
The role of cardiopulmonary resuscitation, using closed-chest compressions and assisted or expired air ventilation, is to maintain cardiopulmonary perfusion while identifying then treating reversible causes of cardiopulmonary arrest. High-quality closed-chest compression (chest compression rate and depth) has been associated with increased survival. A large number of small studies suggest that using auditory feedback devices, such as metronomes, improve the rates of chest compression to rates closer to those recommended by the resuscitation council guidelines (100–120 compressions per minute for adults). For this reason resuscitation guidelines recommend mechanical devices to support rescuers providing chest compressions. Metronomes are an option on some monitor/defibrillators. We focussed on the use of metronomes to guide closed-chest compressions as these are cheap, can be used from smart phone apps, and are placed on some defibrillators. We have identified some studies published subsequent to the publication of the most recent resuscitation guidelines. This is important, as the rate and depth of closed-chest compressions have changed during range time of the cited studies (eg, ALS 5th Edition: rate 100/min, depth 4– 5 cm, ALS 6th Edition: rate 100–120/min, depth 5–6 cm) (Chung et al 2012, 2013). These studies add to the evidence that metronomes may assist in optimising chest compressions to optimum rates suggested by the guidelines. These studies involve a diverse range of participants from lay, medical student, nursing and medical 251
Downloaded from http://emj.bmj.com/ on August 21, 2015 - Published by group.bmj.com
Best Evidence Topic Reports Table 3 Relevant papers Author, date, country
Patient group
Study type
Outcomes
Key results
Study weaknesses
Kern et al, 1992, USA
23 adult intubated patients in cardiac arrest with or without metronome
Prospective crossover study
End tidal CO2
Small study. Difficulty of variable isolation given study design
Wik et al, 2001, Norway
24 paramedic students training with and without metronome
Compressions at 120 bpm produces better end-tidal CO2 than 80 bpm (p
