%A Ezequiel Rey
%A Cristian Abelairas-Gómez
%A Violeta González-Salvado
%A Marcos Mecías-Calvo
%A Emilio Rodríguez-Ruiz
%A Antonio Rodríguez-Núñez
%J PLOS ONE
%N 9
%D 2018
%T Acute muscle fatigue and CPR quality assisted by visual feedback devices: A randomized-crossover simulation trial
%V 13
%P e0203576
%L uneatlantico59
%R doi:10.1371/journal.pone.0203576
%X Objective
To analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by certified basic life support providers.

Methods
Twenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group.

Results
Rectus abdominis’ contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii’s radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects.

Conclusions
Compression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer’s strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.