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Utility of a musical mnemonic to teach CPR compression rate based on musical skills
  1. Xian Zhao,
  2. Lindsay Nadkarni,
  3. Branden Ford,
  4. David Kessler
  1. Department of Pediatrics, Columbia University Medical Center, New York, USA
  1. Correspondence to Dr Xian Zhao, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA; szhao{at}childrensnational.org

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Summary

The aim of this study was to explore whether healthcare providers’ perceptual musical skill affects the rate at which they give chest compressions while using a popular medical mnemonic. In the authors’ experiences, medical personnel are commonly taught to administer chest compressions to the beat of the classic disco song ‘Stayin’ Alive’ by the Bee Gees, which has a rhythm of 103 beats per minute. In this observational cohort study, physicians and nurses sang ‘Stayin’ Alive’ and then performed chest compressions on a manikin. The subjects were divided into two groups depending on their performance on the rhythm and tempo subtests of the Profile of Music Perception Skills test. Those scored in the top 50th percentile and those who scored in the bottom 50th percentile spent 27% and 52% of the time, respectively, in the prescribed 100–120 compressions per minute range, with a mean difference of 25% (95% CI −4% to 53%).

Introduction

Each year, approximately 535 200 individuals experience a sudden cardiac arrest in the USA. 209 000 of these events occur in the hospital setting, where survival to hospital discharge is only 25.4%.1 Quality cardiopulmonary resuscitation (CPR), specifically deep compressions at a proper rate of at least 100 compressions per minute (cpm), improves outcomes after cardiac arrest.2 However, increasing compression rates to beyond 125 cpm can negatively impact depth and quality of the intervention and is associated with decreased rates of return of spontaneous circulation.3

Studies evaluating the effectiveness of musical mnemonics have shown mixed results. One study concluded that this technique leads to effective mean compression rates, even in long-term follow-up, while another showed that doctors and nurses continued to give compressions at faster than recommended rates even after receiving musical instruction with ‘Stayin’ Alive’.4 5

Our hypothesis was that musical skill would improve providers’ ability to accurately administer chest compressions (between 100 and 120 cpm) while singing or humming the song ‘Stayin’ Alive’.

Methods

In this prospective cohort study, medical residents and nursing staff were recruited from a single tertiary care hospital after written consent. All participants completed the rhythm and tempo subtests of the Profile of Music Perception Skills (PROMS) (Zentner Lab, Innsbruck, Austria). Participants were then asked to sing or hum ‘Stayin’ Alive’ by the Bee Gees for 2 min while being audio recorded using the native software on an iPad (Apple, Cupertino, California, USA). A researcher measured the tempo of the recording in four 30 s epochs using the BPM Tap Tempo application (Audiodog, UK). After singing, participants were asked to perform 2 min of chest compressions on a Laerdal SimMan 3G Advanced Patient Simulator (Laerdal, Stavanger, Norway). The simulator captured compression rate in twelve 10 s epochs.

Groups were analysed in two cohorts comparing participants with PROMS scores in the top 50th percentile to participants with PROMS scores in the bottom 50th percentile. Our primary outcome was chest compression rate adherence as measured by the percentage of time spent between 100 and 120 cpm.

Data analyses were performed using Excel 2011 statistical software V.14.6.6 (Microsoft Corporation, Redmond, Washington, USA). Student’s t-tests were used to compare cohorts of high-scoring and low-scoring participants. Estimates of inequality are reported as differences in means and 95% CIs.

Results

A total of 40 subjects were enrolled (87% physicians, 13% nurses). Forty-eight per cent had formal musical training. The majority had previous manikin experience. More physicians participated than nurses.

Those who scored in the top 50th percentile on the PROMS did not spend more time in the prescribed 100–120 cpm range when compared with those who scored in the bottom 50th percentile (27% vs 52%, see figure 1). The difference in these means was 25% (95% CI −4% to 53%). Additionally, the two groups had similar individual variance in compression rate over the twelve 10 s epochs (3.2 vs 2.4 cpm), with a difference in means of 0.8 cpm (95% CI 0 to 1.6 cpm).

Figure 1

Effect of PROMS score on percent of time spent between 100 and 120 cpm. There was no significant difference in the amount of time spent administering the appropriate compression rate when comparing the high-scoring and low-scoring participants on the musical skills test. cpm, compressions per minute; PROMS, Profile of Music Perception Skills.

Discussion

In this prospective cohort study, we failed to prove the hypothesis that a higher PROMS score corresponds to the ability to better deliver chest compressions in the 100–120 cpm range. Previous studies had shown variable results; we had hoped to find that providers with higher levels of musicianship would be better at using a musical mnemonic to administer chest compressions at a targeted rate. We were surprised that the average PROMS score of our subjects was higher than the general population, so it is possible that dividing our participants into the top 50th and bottom 50th percentiles did not provide enough discrimination. Yet even with this extent of musical skill, the use of a musical mnemonic did not impact consistent performance of accurate rates of chest compressions over 50% of the time.

These findings and the others that have come before it underscore the necessity of continued research to determine how best to assure ideal compression rates. Future studies should involve a larger sample size, which may include participants with greater stratification of musical ability and thereby better represent the general population. The timeliness of the song selected may also have been a factor, so this study could be repeated using a more contemporary piece of music that is easier for modern-day providers to recall.

References

Footnotes

  • Contributors All authors: conception, design, analysis and interpretation of data; final approval of the version to be published; read and approved the final manuscript. XZ, LN and BF: drafted the article. XZ and DK: revised it critically for important intellectual content.

  • Funding Columbia University Medical Center, Department of Pediatrics Resident Research Fund.

  • Competing interests None declared.

  • Ethics approval Columbia University Institutional Review Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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