Simulation and educationTwo minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial

Aim of the studyWhile the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial.Methods119 teams, consisting of three to four physicians each, were randomized to receive a graphical display of the simplified circular adult BLS algorithm with the instruction to perform CPR for either 2 min or five cycles 30:2. Subsequently teams had to treat a simulated unwitnessed cardiac arrest. Data analysis was performed using video-recordings obtained during simulations. The primary endpoint was adherence, defined as being within ±20% of the instructed target (i.e. 96-144 s in the 2 min teams and 4-6 cycles in the fivex30:2 teams).Results22/62 (35%) of the “two minutes” teams and 48/57 (84%) of the “five × 30:2″ teams provided CPR within a range of ± 20% of their instructed target (P < 0.0001). The median time of CPR prior to rhythm check was 91 s and 87 s, respectively, (P = 0.59) with a significant larger variance (P = 0.023) in the “two minutes” group.ConclusionsThis randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable.