Brief Reports
“Stayin' Alive”: A Novel Mental Metronome to Maintain Compression Rates in Simulated Cardiac Arrests

Poster Presentation/Abstract: The American College of Emergency Medicine Scientific Assembly and Research Forum, Chicago, IL, October 2008.
https://doi.org/10.1016/j.jemermed.2012.01.026Get rights and content

Abstract

Background

A novel and yet untested memory aid has anecdotally been proposed for aiding practitioners in complying with American Heart Association (AHA) cardiopulmonary resuscitation (CPR) compression rate guidelines (at least 100 compressions per minute).

Objectives

This study investigates how subjects using this memory aid adhered to current CPR guidelines in the short and long term.

Methods

A prospective observational study was conducted with medical providers certified in 2005 AHA guideline CPR. Subjects were randomly paired and alternated administering CPR compressions on a mannequin during a standardized cardiac arrest scenario. While performing compressions, subjects listened to a digital recording of the Bee Gees song “Stayin' Alive,” and were asked to time compressions to the musical beat. After at least 5 weeks, the participants were retested without directly listening to the recorded music. Attitudinal views were gathered using a post-session questionnaire.

Results

Fifteen subjects (mean age 29.3 years, 66.7% resident physicians and 80% male) were enrolled. The mean compression rate during the primary assessment (with music) was 109.1, and during the secondary assessment (without music) the rate was 113.2. Mean CPR compression rates did not vary by training level, CPR experience, or time to secondary assessment. Subjects felt that utilizing the music improved their ability to provide CPR and they felt more confident in performing CPR.

Conclusions

Medical providers trained to use a novel musical memory aid effectively maintained AHA guideline CPR compression rates initially and in long-term follow-up. Subjects felt that the aid improved their technical abilities and confidence in providing CPR.

Introduction

Properly performed bystander cardiopulmonary resuscitation (CPR) doubles, and may triple, a patient's chance of survival from sudden cardiac arrest 1, 2. However, several studies have documented the lack of quality CPR among highly trained health care professionals 3, 4, 5, 6, 7. Current training techniques, primarily the American Heart Association's (AHA) Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) classes, have not translated into consistent clinical practice, as studies have shown that even after ACLS training, graduates do not reliably perform CPR in accordance with the guidelines 3, 4, 5, 6, 7.

AHA CPR guidelines emphasized the importance of quality basic CPR, especially chest compressions, in improving outcomes 1, 8. Current 2010 AHA guidelines call for a rate of at least 100 compressions per minute (1). Yet multiple studies show that this rate is often unmet or not sustained during CPR 3, 4, 5, 6, 7. Recently, a novel, yet untested, memory aid has been proposed for aiding practitioners in complying with AHA compression rate guidelines 9, 10. It has been suggested that familiar songs from popular music with beat counts of 100 per minute could be used as mental metronomes during performance of chest compressions. We hypothesized that such a musical memory aid would help to optimize the rate of chest compressions during simulated CPR scenarios. In addition, we believe that learners would retain AHA CPR rate adherence during subsequent testing, even when the music was not directly present.

Section snippets

Methods

This was a prospective observational pilot study conducted at a Midwestern tertiary academic medical center. Institutional review board approval was sought and received before initiating the study. The study population included resident physicians of all postgraduate training years from Emergency, Internal, and Family Medicine programs, as well as third- and fourth-year medical students, and subjects were enrolled from October 2008 to March 2009. Subjects were offered enrollment into the mental

Results

Fifteen subjects were enrolled in the trial (average age 29.3 years, 80% male, and 66.7% resident physicians). Resident physicians represented multiple specialties (Internal Medicine 3, Internal Medicine/Pediatrics 3, Neurology 1, Family Practice 1, Emergency Medicine 1, and Diagnostic Radiology 1). Resident physicians were of different training years (post-graduation year 1 [PGY-1]), 2 subjects; PGY-2, 3 subjects; PGY-3, 5 subjects) as were enrolled medical students (second-year medical

Discussion

Our results show that subjects using the musical memory aid performed chest compressions at rates that met current CPR guidelines. During the initial assessment, subjects effectively maintained adequate compression rates while directly listening to the musical aid. Upon secondary assessment several weeks later, subjects were not directly provided the music, but were encouraged to use the memory of the music as a mental metronome to perform chest compressions at the correct rate. All subjects

Conclusions

Medical providers were able to maintain established AHA guideline CPR compression rates utilizing a novel musical memory aid both initially and in long-term follow-up. Subjects felt that the aid improved their technical ability and confidence in providing CPR. This novel mental metronome is a cost-effective and easily implementable addition to basic CPR teaching that may help trainees more consistently perform an appropriate chest compression rate. Although the results of this pilot study are

References (15)

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  • The effects of music on the cardiac resuscitation education of nursing students

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    Various studies exist on the use of music in CPR in the context of the education of medical students, paramedics, and students from non-health-related fields. Hafner et al. (2012) and Matlock et al. (2008) used “Stayin’ Alive” during the CPR training of health personnel and medical students. Both studies show that music helped the participants perform the ideal chest compression rate (Hafner et al., 2012; Matlock et al., 2008).

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    We observed that the work applied (CC rate × CC depth) by DS was similar to controls but if we consider that prior studies have reported a link between excessive CC rate and insufficient CC depth,19 as it was the case with our DS participants, it seems clear that some additional advice and training should be needed in order to increase CC depth and avoid an excessive number of CC. Training aids like metronomes20,21 and popular songs,22,23 as well as repetitive retraining24 might be helpful in this sense. Although no prior studies have been carried out to test this hypothesis, having in mind the psychological as well as the learning and training characteristics of DS people,25 we consider that songs and other fun and focused strategies might improve CC quality and would be welcome by youngsters with DS.

  • Death before disco: The effectiveness of a musical metronome in layperson cardiopulmonary resuscitation training

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    An earlier nonrandomized observation trial using medical providers and the same music metronome demonstrated improved compliance with compression rate guidelines at 6 weeks. However, that trial utilized medical personnel, lacked a control group, and enrolled a small number of participants (19). This prospective randomized design demonstrated that laypersons trained using the musical metronome were significantly more likely to maintain compression rate guidelines at 6 weeks, compared to those who were not trained using the musical metronome, while having similar compression depth and percent correct compressions.

  • Factors modulating effective chest compressions in the neonatal period

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    The use of popular songs with beats similar to the required CV ratios as aids to ensure that these rates are actually met have been described. Songs such as Stayin' alive by the Bee Gees (Saturday Night Fever, The Original Movie Soundtrack; Polygram International Music, 1977) have been studied [52]. In an attempt to achieve the rate of 100 chest compressions/min during basic life support, pairs of subjects were asked to perform chest compressions while a second subject performed ventilations on manikins.

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This work was supported by a University of Illinois College of Medicine Resident Research Grant.

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