Correlation between real-time heart rate and fatigue in chest compression providers during cardiopulmonary resuscitation: A simulation-based interventional study

BACKGROUND: The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable. OBJECTIVES: This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers. STUDY DESIGN: A simulation-based prospective interventional study including 110 participants. METHODS: Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated. RESULTS: With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95–0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02–1.04; P < .001). CONCLUSION: Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.