![]() Participants were instructed to squeeze the central part of the self-inflating bag with their right hand and to deliver inspiration over two ticks and expiration over two ticks of metronome sound, which is between 1 to 1.2 second depending on the rate of the metronome. Participants used their left hand to maintain the head-tilt/chin-lift position of the manikin and provide an air-tight seal using the single left-handed “E-C clamp” mask hold technique. An air-cushioned face mask (SOLCO Surgical Instrument, Pyungtaek-Si, Gyeonggi-Do, Korea) and self-inflating resuscitator bag (1.6 L) was used during the study. Noticeable rise of QuickLung ® of the RespiTrainer ® was used as an indicator of visible chest rise. ![]() Airway resistance was set at normal resistance of 5 cmH 2O/L/s. The manikin model used in our study was RespiTrainer ® Advance (IngMar Medical, Pittsburgh, PA, USA). Exclusion criteria were refusal to participate and health problems predicted to interfere with the capacity to perform bag-mask ventilation. The present study was carried out on the same day after the AHA BLS provider course. Participants were informed of the study brief, contents and extent of data collection, and process of the study. To ensure certain level of skill in bag-mask ventilation, participants were recruited among physicians who have attended American Heart Association (AHA) accredited BLS provider course for health care providers (HCPs). This study is a randomized crossover observational simulation study conducted in a tertiary university hospital located in Seoul, Korea. To test our hypothesis, we recruited physicians and compared tidal volumes and airway pressures among three different metronome rates (100, 110 and 120 ticks/minute) on a manikin model simulating two-person 30:2 CPR. Authors have hypothesized that the difference in speed of ventilation as a result of different metronome rates may affect the quality of ventilation. However, its effect on the quality of ventilation other than the “rate control” is not well known. The ability of metronome guidance in regulating ventilation rate has been confirmed by many previous studies. At any rate between 100 ticks/minute to 120 ticks/minute, rescuers can comply with the current guideline’s recommendation to complete 2 ventilations within 5 seconds. Thus, two ventilations can take up to 4.8 seconds at the metronome rate of 100 ticks/minute, 4.36 seconds at the metronome rate of 110 ticks/minute, and 4.0 seconds at the metronome rate of 120 ticks/minute. The rescuer can deliver inspiration over two ticks so that one inspiration takes 1.2 seconds, 1.09 seconds, or 1 second depending on whether the metronome rate is set at 100 ticks/minute, 110 ticks/minute, or 120 ticks/minute respectively. ![]() ![]() When rescuers perform metronome-guided CPR, the speed of ventilation should follow the rate of metronome. The current 2015 guideline recommends a chest compression rate between 100 to 120/minute and the rate of metronome should therefore be set between 100 to 120 ticks/minute. Furthermore, widespread use of smartphones has greatly enhanced the applicability of metronome if one can just install a free metronome application. Various feedback devices have been studied and metronome guidance is one of the most effective and feasible feedback techniques that are known to improve the quality of CPR. The quality of cardiopulmonary resuscitation (CPR) is a very important prognostic factor for cardio-pulmonary arrest. ![]()
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