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Muscular fitness as a mediator of quality cardiopulmonary resuscitation

      Abstract

      Background

      It has been hypothesized that body mass index (BMI) and muscle strength (MS) of the rescuers are predictors of adequate external chest compressions (ECC). The aims of this study were: (a) to analyze, in college students, the relationship between BMI and MS with adequate ECC parameters; and (b) to examine whether the association between BMI and adequate ECC parameters is mediated by MS.

      Methods

      A cross-sectional analysis of the evaluation of a CPR performance test involving students (n = 63). We determined BMI and MS. After previous training, participants performed cardiopulmonary resuscitation on a mannequin for 20 minutes. PROCESS macro developed by Preacher and Hayes was used to assess whether the association between BMI and ECC was mediated by MS.

      Results

      Underweight subjects achieved lower results than those with normal weight and overweight/obese in several dependent variables including: correct compression depth (P < .001) and adequate ECC (P < .001). This differences remained after adjusting for muscle strength except for the compression rate (P = .053). Moreover, participants in the low MS quartile were lower in both correct compression depth (P = .001) and adequate ECC (P < .001) than participants in the medium/high quartile after adjusting for confounding variables. The effect of BMI on adequate ECC was partially mediated by MS. Similar results were obtained in the analysis of the mediator role of MS in the relationship between BMI and correct compression depth.

      Conclusions

      The ability to provide adequate ECC is influenced by the rescuer's MS. Rescuers should be advised to exercise arm strength to improve the quality of CPR.
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      References

        • Perkins GD
        • Jacobs IG
        • Nadkarni VM
        • Berg RA
        • Bhanji F
        • Biarent D
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European resuscitation council, Australian and New Zealand council on resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, resuscitation Council of Southern Africa, resuscitation council of Asia); and the American Heart Association emergency cardiovascular care committee and the council on cardiopulmonary, critical care, perioperative and resuscitation.
        Circulation. 2015; 132: 1286-1300
        • Perkins GD
        • Handley AJ
        • Koster RW
        • Castrén M
        • Smyth MA
        • Olasveengen T
        • et al.
        European resuscitation council guidelines for resuscitation 2015: section 2. Adult basic life support and automated external defibrillation.
        Resuscitation. 2015; 95: 81-99
        • Vaillancourt C
        • Midzic I
        • Taljaard M
        • Chisamore B
        Performer fatigue and CPR quality comparing 30:2 to 15:2 compression to ventilation ratios in older bystanders: a randomized crossover trial.
        Resuscitation. 2011; 82: 51-56
        • Ashton A
        • McCluskey A
        • Gwinnutt C
        • Keenan A
        Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min.
        Resuscitation. 2002; 55: 151-155
        • Hansen D
        • Vranckx P
        • Broekmans T
        • Eijnde BO
        • Beckers W
        • Vandekerckhove P
        • et al.
        Physical fitness affects the quality of single operator cardiocerebral resuscitation in healthcare professionals.
        Eur J Emerg Med. 2012; 19: 28-34
        • Ochoa FJ
        • Ramalle-Gómara E
        • Lisa V
        • Saralegui I
        The effect of rescuer fatigue on the quality of chest compressions.
        Resuscitation. 1998; 37: 149-152
        • McDonald CH
        • Heggie J
        • Jones CM
        • Thorne CJ
        • Hulme J
        Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.
        Emerg Med J. 2013; 30: 623-627
        • Manders S
        • Geijsel FE
        Alternating providers during continuous chest compressions for cardiac arrest: every minute or every two minutes?.
        Resuscitation. 2009; 80: 1015-1018
        • Russo SG
        • Neumann P
        • Reinhardt S
        • Timmermann A
        • Niklas A
        • Quintel M
        • et al.
        Impact of physical fitness and biometric data on the quality of external chest compression: a randomised, crossover trial.
        BMC Emerg Med. 2011; 11: 20
        • Lopez-Gonzalez A
        • Sanchez-Lopez M
        • Rovira-Gil E
        • Ferrer-Lopez V
        • Martinez-Vizcaino V
        Influence of body mass index and physical fitness of university students on the ability to perform quality external chest compressions in manikin.
        Emergencias. 2014; 26: 195-201
        • Ock SM
        • Kim YM
        • Chung J
        • Kim SH
        Influence of physical fitness on the performance of 5-minute continuous chest compression.
        Eur J Emerg Med. 2011; 18: 251-256
        • Chandrasekaran B
        • Ghosh A
        • Prasad C
        • Krishnan K
        • Chandrasharma B
        Age and anthropometric traits predict handgrip strength in healthy normals.
        J Hand Microsurg. 2010; 2: 58-61
        • Hardy R
        • Cooper R
        • Aihie Sayer A
        • Ben-Shlomo Y
        • Cooper C
        • Deary IJ
        • et al.
        Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme.
        PLoS One. 2013; 8e56483
        • Esco MR
        • Olson MS
        • Williford HN
        The relationship between selected body composition variables and muscular endurance in women.
        Res Q Exerc Sport. 2010; 81: 272-277
        • Baron RM
        • Kenny DA
        The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.
        J Pers Soc Psychol. 1986; 51: 1173-1182
        • Koster RW
        • Baubin MA
        • Bossaert LL
        • Caballero A
        • Cassan P
        • Castrén M
        • et al.
        European resuscitation council guidelines for resuscitation 2010 section 2. Adult basic life support and use of automated external defibrillators.
        Resuscitation. 2010; 81: 1277-1292
        • Bonnie E
        • Graham N
        • Lance B
        • Tom P
        • Ahamed I
        Effectiviness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study.
        Resuscitation. 2005; 67: 43
      1. Am J Clin Nutr. 1998; 68: 899-917
        • EUROFIT
        CoEoSR.
        Handbook for the EUROFIT tests of physical fitness, Strassberg1993
        • Jaric S
        • Mirkov D
        • Markovic G
        Normalizing physical performance tests for body size: a proposal for standardization.
        J Strength Cond Res. 2005; 19: 467-474
        • Artero EG
        • Lee DC
        • LAvie CJ
        • et al.
        Effects of muscular strength on cardiovascular risk factors and prognosis.
        J Cariopulm Rehabil Prev. 2012; 32: 351-358
        • Preacher KJ
        • Hayes AF
        Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models.
        Behav Res Methods. 2008; 40: 879-891
        • Sobel M
        Asymptotic confidence intervals for indirect effects in structural equation models.
        in: Leinhardt S. Sociological methodology. Washington, DC, American Sociological Association1982: 290-312
        • Hong DY
        • Park SO
        • Lee KR
        • Baek KJ
        • Shin DH
        A different rescuer changing strategy between 30:2 cardiopulmonary resuscitation and hands-only cardiopulmonary resuscitation that considers rescuer factors: a randomised cross-over simulation study with a time-dependent analysis.
        Resuscitation. 2012; 83: 353-359
        • Plant N
        • Taylor K
        How best to teach CPR to schoolchildren: a systematic review.
        Resuscitation. 2013; 84: 415-421
        • Sayee N
        • McCluskey D
        Factors influencing performance of cardiopulmonary resuscitation (CPR) by foundation year 1 hospital doctors.
        Ulster Med J. 2012; 81: 14-18
        • Krikscionaitiene A
        • Stasaitis K
        • Dambrauskiene M
        • Dambrauskas Z
        • Vaitkaitiene E
        • Dobozinskas P
        • et al.
        Can lightweight rescuers adequately perform CPR according to 2010 resuscitation guideline requirements?.
        Emerg Med J. 2013; 30: 159-160
        • Peberdy MA
        • Silver A
        • Ornato JP
        Effect of caregiver gender, age, and feedback prompts on chest compression rate and depth.
        Resuscitation. 2009; 80: 1169-1174
        • Abelairas C
        • Romo V
        • Barcala R
        • Palacios A
        Efecto de la fatiga física del socorrista en los primeros cuatro minutos de la reanimación cardiopulmonar posrecate acuático.
        Emergencias. 2013; 25: 184-190
        • Bobrow BJ
        • Vadeboncoeur TF
        • Stolz U
        • Silver AE
        • Tobin JM
        • Crawford SA
        • et al.
        The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.
        Ann Emerg Med. 2013; 62: 47-56