The changes of symptom, EKG and hemodynamic in healty firefighters after delivering multiple cycles of cardiopulmonary resuscitation

반복적인 심폐소생술 시행 후 건강한 소방대원에서 나타나는 증상, 심전도 및 혈역학적 변화

  • Lee, Hyo-Ju (Dept. Emergency Medical Technology, Gyeongbuk Provincial College) ;
  • Kim, Ho-Jung (Dept. Emergency Medicine, Bucheon Hospital of Soonchunhyang University) ;
  • Jung, Eun-Kyung (Dept. Emergency Medical Services, Honam University)
  • 이효주 (경북도립대학교 응급구조과) ;
  • 김호중 (순천향대학교 부천병원 응급의학과) ;
  • 정은경 (호남대학교 응급구조학과)
  • Received : 2017.03.07
  • Accepted : 2017.06.09
  • Published : 2017.06.30


The CPR guidelines emphasize the delivery of effective chest compressions but do not address the effects of chest compressions on CPR providers. This study determined the effects of chest compressions on healthy adult firefighters' symptoms, hemodynamics, and electrocardiography after performing multiple cycles of CPR. Healthy adult firefighters were trained in CPR and performed CPR on mannequins. The provider vital signs, electrocardiography, and fatigue scores were determined immediately before CPR, after 5cycles of CPR, and after 10 cycles of CPR. In addition, the presence of clinical symptoms among the providers was determined after CPR; 39 firefighters participated in the study. Their mean age was $35.54{\pm}10.26years$. Many providers developed fatigue, shortness of breath, and dizziness. Significant changes in heart rate (p=0.000), respiratory rate (p=0.010), end-tidal CO2(p=0.000), O2 saturation(p=0.000), and pulse pressure (p=0.000) were observed after both 5 and 10 cycles of CPR. One participant developed sinus dysrhythmia and premature ventricular contractions after 10 cycles of CPR. The delivery of chest compression results in fatigue and hemodynamic alterations in many young healthy adults after performing 5 or 10 cycles of CPR. The CPR guidelines and education should take into consideration the effects of chest compressions on CPR providers.


Cardiopulmonary Resuscitation;Chest Compression;Fatigability;Pulse Pressure;Vital Signs


  1. Statement by the Ad Hoc Committee on Cardiopulmonary Resuscitation of the Division of Medical Sciences, National Academy of Sciences-National Research Council. Cardiopulmonary resuscitation. JAM, vol. 198, pp. 372-379, 1966. DOI:
  2. RO Cummins, MS Eisenberg. Prehospital cardiopulmonary resuscitation: is it effective? JAMA, vol. 253, no. 16, pp. 2408-2412, 1985. DOI:
  3. International Liaison Committee on Resuscitation. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, vol. 112, no. IV, pp. 19-34, 2005. DOI:
  4. IG Stiell, GA Wells, B Field, DW Spaite, LP Nesbitt, VJ De Maio G Nichol, D Cousineau, J Bkackburn, D Munkley, L Luinstra-Toohey, T Campeau, E Dagnone, M Lyver. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med, vol. 351, pp. 647-656, 2004. DOI:
  5. M Eckstein, S Stratton, L Chan. Cardiac arrest resuscitation evaluation in Los Angeles: CARE-LA. Ann Emerg Med, vol. 45, pp. 504-509, 2005. DOI:
  6. JW Heidenreich, RA Berg, TA Higdon, GA Ewy, K B Kern, AB Sanders. Rescuer fatigue: standard versus continuous chest-compression cardiopulmonary resuscitation, Acad Emerg Med, vol. 13, no. 10, pp. 1020-1026, 2006. DOI:
  7. E Platz, Scheatzle, PE Pepe, SR Dearwater. Attitudes towards CPR training and-performance in family members of patient with heart disease. Resuscitation, vol. 47, no. 3, pp. 273-280, 2000. DOI:
  8. JM Koh, TM Kim. CPR training effect for civilian. Korean J Emerg Med Ser, vol. 16, no. 1, pp. 19-29, 2012.
  9. BC Lee, MJ Lee, SJ Shin, HW Ryoo, JK Kim, JB Park, KS Seo, The current status of cardiopulmonary resuscitation training for school. J Korean Soc Emerg Med, vol. 23, no. 4, pp. 470-478, 2012.
  10. ML Anderson, M Cox, SM AI-Khatib, G Nichol, K L Thomas, PS Chan, P Saha-Chaudhuri, EL Fosbol, B Eigel, B Clendenen, ED Peterson. Rate of cardiopulmonary resuscitation training in the United States. JAMA Intern Med, vol. 174, no. 2, pp. 194-201, 2014. DOI:
  11. OY Kwon, HJ Cho, HJ Cho, HS Choi, HP Hong, Y. G. Ko, S. C. Kim, D. P. Kim, Y. J. Kang. The educational benefits at each steps by expository cardiopulmonary resuscitation teaching and immediate remediation for non-healthcare providers in hospital. J Korean Soc Emerg Med, vol. 19, no. 3, pp. 273-281, 2008.
  12. HJ Kim, DS Lim, JO Lee, MK Lee, KY Kim, KS Lee, WJ Chang, SP Chung. Selection of target age for School education of cardiopulmonary resuscitation using Video self-instruction program. J Korean Soc Emerg Med, vol. 18, no. 3, pp. 196-201, 2007.
  13. CW Lee, JY Ahn, GC Cho, WW Lee, YD Son, HC Ahn, ME Ahn, JY Seo. E-learning can be helpful for mastering basic life support skills on public. J Korean Soc Emerg Med, vol. 21, no. 4, pp. 423-428, 2010.
  14. RA Berg, CR Hemphill, BS Abella, TP Aufderheide, DM Cave, MF Hazinski, EB lerner, TD Rea, MR Sayre, RA Swor. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, vol. 122, no. Sppul 3, pp. S685-705, 2010. DOI:
  15. KH Yi, SO Park, KR Lee, SC Kim, HS Jeong, DY Hong, KJ Baek.. Comparison of the alternating rescuer method between every minute and two minutes during continuous chest compression in cardiopulmonary resuscitation according to the 2010 guidelines. J Korea Soc Emerg Med, vol. 23, no. 4, pp. 455-459, 2012.
  16. YB Kim, SM Choi, YM Kim, WJ Lee, KN Park, MJ Lee, HJ Kim, SH Kim, SH Woo, JE Park. Effect or single-rescuer fatigue on the quality if cardiopulmonary resuscitation with 30:2 and 15:2 compression-toventilation ratios. J Korea Soc Emerg Med, vol. 17, no. 6, pp. 519-527, 2006.
  17. C Pozner, A Almozlino, S Poole, D McNamara, D Barash. Abstract P168: Early markers of rescuer's fatigue. Circulation, vol. 120, pp. S1478, 2009. DOI:
  18. UJ Choi. Physiology changes on the rescuer and efficiency of CPR in the increased chest compression. Korean J Emerg Med Ser, vol. 12, no. 3, pp. 43-53, 2008.
  19. MS Jang, YJ Tak. The variation of elapsed time on fatigue and quality of single rescuer cardiopulmonary resuscitation. Korean J Emerg Med Ser, vol. 17, no. 1, pp. 9-19, 2013.
  20. DY Hong, SO Park, KR Lee, KJ Baek, DH Shin. A different rescuer changing strategy between 30:2 cardiopulmonary resuscitation and hands-only cardiopulmonary resuscitation that considers rescuer factor: A randomized cross-over simulation study with a time-dependent analysis. Resuscitation, vol. 83, pp. 353-359, 2012. DOI:
  21. GN Kim, SS Choi, SW Choi. Comparison on the quality and fatigue of hands only CPR according to the presence or absence of verbal counting by some middle-aged women. Journal of the Korea Academia-Industrial cooperation Society, vol. 14, no. 3, pp. 1320-1329, 2013. DOI:
  22. Surveillance and quality management of out-of-hospital cardiac arrest. Centers for disease control and prevention at Seoul National University.
  23. A Lucia, JF de las Heras, M Perez, JC Elvira, A Carvajal, AJ Alvarez. JL Chicharro. "The importance of physical fitness in the performance of adequate cardiopulmonary resuscitation." Clinical Investigations in Critical Care, vol. 115, pp. 158-164, 1999.
  24. C Sandroni, MG Bocci, F Damiani, R Proiette, D Speranza. Can the body size affect students' performance during CPR training. Resuscitation, vol. 34, pp. 191, 1997. DOI:
  25. D Yannopoulos, TP Aufderheide, A Gabrielli, DG Beiser, SH BS McKnite, FG Pirrallo, J Wigginton, L Becker, TV Hoek, W Tang, VM Nadkarni, JP Klein, AH Ahamed, KG Lurie. Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Crit Care Med, vol. 34, pp. 1444-1449, 2006. DOI:
  26. FJ Ochoa, E Ramalle-Gomara, V Lisa, I Saralegui. The effect of rescuer fatigue on the quality of chest compressions. Resuscitation, vol. 37, pp. 149-152, 1998. DOI:
  27. MS Jang. The variation of elapsed time on fatigue and qualoty of single rescuer cardiopulmonary resuscitation. Unpublished master's thesis. Graduate School of Korea National University of Transportation, Chungju, Korea. 2012.
  28. DY Kim, DH Park, KH Kim. The comparison of fatigue by different exercise types under hot environment. Exercise science, vol. 17, no. 2, pp. 211-222.
  29. YJ Yu, YA Shin. The response of energy expenditure muscle activity and fatigue on wlking type. Journal of Sport and Leisure Studies, vol. 32, No. 2, pp. 767-777. 2008.
  30. GA Ewy. Cardiocerebral resuscitation: the new cardiopulmonary resuscitation. Circulation, vol. 111, pp. 2134-2142, 2005. DOI:
  31. RA Berg, R Hemphill, BS Abella, TP Aufderheide, DM Cave, MF Hazinski, EB lerner, TD Rea, MR Sayre, RA Swor. Part 5: adult basic life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2010;122(2):S685-705. DOI:
  32. SS Franklin, SA Khan, ND Wong, MG Larson, D Levy. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham study. Circulation, vol. 100, pp. 354-360, 1999. DOI:
  33. GF Mitchell, LA Moye, E Braunwald, JL Rouleau, V Bernstein, EM Geltman, C Grey, MA Flaker. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. Circulation, vol. 96, pp. 4254-4260, 1997. DOI:
  34. SW Cho. Correlation between the pulse pressure and IMT(intra-media wall thickness) of the carotid artery in hypertension patients. Unpublished master's thesis. The graduate school of Chung-Ang University, Seoul, Korea, 2005.
  35. M Domanski, J Norman, M Wolz, G Mitchell, M Pfeffer. Cardiovascular risk assessment usion pulse pressure in the first national health and nutrition examination survey (NHANES I). Hypertension, vol. 38, pp. 793-797, 2001. DOI:
  36. AR Thierbach, BB Wolcke, F Krummenauer, M Kunde, C Janig, WF Dick. Artificial ventilation for basic life support leads to hyperventilation in first aid providers. Resuscitation, vol. 57, pp. 269-277, 2003. DOI:
  37. AM Memon, JE Salzer, EC Hillman Jr, CL Marshall. Fatal myocardial infarct following CPR training: the question of risk. Ann Emerg Med, vol. 11, pp. 322-323, 1982. DOI: