![]() Recruitment, enrollment, and randomization were carried out by the authors. The participant groups were marked as groups A and B randomly by drawing lots. The participants were classified into a two-person group by the enrollment order. We excluded participants who had underlying medical problems which might cause them harm when performing CPR. The period of recruitment was from September 2017 to December 2018. We recruited sixth-year medical students and residents of any specialty from the study hospital who had completed a basic life support course within the last 2 years. Adequate compression depth was set between 50 and 60 mm and the adequate compression rate was set between 100 and 120 compressions per minute based on the Adult Basic Life Support 2015 American Heart Association Guidelines. The participants assumed the role of a health care provider performing two-rescuer CPR. A Laerdal Resusci Anne ® (Laerdal Medical, Stavanger, Norway) training manikin was used as a simulated cardiac arrest patient. ![]() The study was conducted in Songklanagarind Hospital using an adult cardiac arrest simulation. In the current study, we hypothesized that rotating the rescuers every minute would provide higher quality compressions and lower rescuer fatigue compared with a 2-minute rotation. In addition, some studies assessed chest compression quality only and did not assess rescuer fatigue or interruption times. However, most studies done before the 2015 guidelines concerning compression depth and rate were updated. Another study found no significant difference in the number of effective chest compressions between the two groups over the entire 8-minute scenario. Previous studies have been somewhat conflicting, with some studies finding a superior percentage of appropriate compression depth with lower fatigue when rescuers swapped every minute compared with every two minutes. Another report found that the percentage of correct chest compressions decreased significantly after 1 minute of compressions with a decline in adequate compression of 18.6% per minute. One report showed a significant reduction in chest compression performance from 79.7% in the first minute to 24.9% in the second. Various studies have found that the quality of chest compressions decreases dramatically after a short period. The latest basic life support guidelines from the American Heart Association recommends that rescuers should use a 2-minute chest compression rotation, or shorter if they feel fatigued, and the compression depth should be 5–6 cm with a rate of 100–120 per minute with minimal compression interruptions. Effective chest compression correlates with optimal coronary perfusion pressure and cardiac output resulting in a better chance for return of spontaneous circulation. The compression generates blood flow and oxygen delivery to the myocardium and brain by directly compressing the heart which increases intrathoracic pressure. Chest compression is the key component of cardiopulmonary resuscitation (CPR).
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