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Original Research

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Metronome Use Positively Affect Cardiopulmonary Resuscitation Parameters: Prospective Observational Multicenter Manikin Study

  • Necmiye Yalcin Ocak1
  • Mustafa Sever1
  • Orkun Unek1
  • Ibrahim Toker1
  • Emirhan Erdem1
  • Murat Yesilaras1
  • Ozge Duman Atilla1

1Department of Emergency Medicine, Tepecik Education and Research Hospital, Izmir, Turkey

DOI: 10.22514/sv.2020.16.0005 Vol.16,Issue 1,June 2020 pp.33-38

Published: 30 June 2020

*Corresponding Author(s): Mustafa Sever E-mail:


Objective: Clinical studies have shown that eliminating performer errors is important to ensure high quality cardiopulmonary resuscitation (CPR). Literature on the effects of metronome use on the quality of CPR is scarce. This study aimed to investigate the effect of metronome use on the quality of cardiopulmonary resuscitation. Methods: Thirty volunteer emergency physicians who were divided into 15 groups participated in this prospective, observational, multi-center, manikin study. Firstly, each participant performed conventional CPR on a manikin, and then performed metronome-guided CPR after a short break. Parameters affecting CPR quality were evaluated based on the recommendations of the 2015 American Heart Association CPR and Emergency Cardiovascular Care Guideline. In addition, the fatigue levels of participants were evaluated using the Borg Fatigue Index. Results: Metronome-guided CPR significantly improved the chest compression rate (median (Interquartile Range-IQR); 128 (22) compressions/min vs. 110 (2) compressions/min; 95%CI, p < 0.001), deep compression rate (median (IQR); 95.25 (80) compressions/min vs. 72.63 (105) compressions/min; 95%CI, p < 0.001), compression depth (median (IQR); 62.50 (11) mm vs. 60.25 (14) mm; 95%CI, p = 0.016), ventilation number (median (IQR); 11.25 (6) ventilations/min vs. 9.50 (1) ventilations/min; 95%CI, p = 0.001), high-volume ventilation count (median (IQR); 10.13 (6) ventilations/min vs. 9.50 (1) ventilations/min; 95%CI, p = 0.026), minute ventilation volume (median (IQR); 11.75 (10) L/min vs. 8.03 (3) L/min; 95%CI, p < 0.05), and fatigue levels (median (IQR); 3 (2) vs. 2 (2); in 95%CI, p < 0.05). Conclusions: Our study showed that metronome is a useful device for reaching effective CPR. Metronome guidance may change the CPR parameters positively. This study is in accordance with previous studies which have investigated the effect of metronome-guided CPR on survival.


Cardiopulmonary resuscitation, Metronome, Prospective study, Observational study, Multicenter study, Manikin study

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Necmiye Yalcin Ocak,Mustafa Sever,Orkun Unek,Ibrahim Toker,Emirhan Erdem,Murat Yesilaras,Ozge Duman Atilla. Metronome Use Positively Affect Cardiopulmonary Resuscitation Parameters: Prospective Observational Multicenter Manikin Study. Signa Vitae. 2020. 16(1);33-38.


[1] Gallagher EJ, Lombardi G, Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA. 1995;274:1922-5.

[2] Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, et al. Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group. Resuscitation 1993;26:47-52.

[3] Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:414-435.

[4] Yannopoulos D, Aufderheide TP, Gabrielli A, Beiser DG, McKnite SH, Pirrallo RG, et al. Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Crit Care Med. 2006;34:1444-9.

[5] Aufderheide TP, Sigurdsson G, Pirrallo RG, Yannopoulos D, McKnite S, von Briesen C, et al. Hiperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109:1960-5.

[6] Jäntti H, Silfvast T, Turpeinen A, Kiviniemi V, Uusaro A. Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation. 2009;80:453-7.

[7] Kern KB, Stickney RE, Gallison L, Smith RE. Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial. Resuscitation. 2010;81:206-10.

[8] Park SO, Hong CK, Shin DH, Lee JH, Hwang SY. Efficacy of metronome sound guidance via a phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomised controlled simulation study using a manikin. Emerg Med J. 2013;30:657-61.

[9] Hafner JW, Jou AC, Wang H, Bleess BB, Tham SK. Death before disco: the effectiveness of a musical metronome in layperson cardiopulmonary resuscitation training. J Emerg Med. 2015;48:43-52. Zimmerman E, Cohen N, Maniaci V, Pena B, Lozano JM, Linares M. Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study. Pediatrics. 2015;136:905-11.

[10] Zimmerman E, Cohen N, Maniaci V, Pena B, Lozano JM, Linares M. Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study. Pediatrics. 2015;136:905-11.

[11] Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA. Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. Acad Emerg Med. 1995;2:708-13.

[12] Chung TN, Kim SW, You JS, Cho YS, Chung SP, Park I. A higher chest compression rate may be necessary for metronome-guided cardiopulmonary resuscitation. Am J Emerg Med. 2012;30:226-30.

[13] Chung TN, Bae J, Kim EC, Cho YK, You JS, Choi SW, et al. Induction of a shorter compression phase is correlated with a deeper chest compression during metronome-guided cardiopulmonary resuscitation: a manikin study. Emerg Med J. 2013;30:551-4.

[14] Rasmussen SE, Nebsbjerg MA, Krogh LQ, Bjørnshave K, Krogh K, Povlsen JA, et al. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study. Resuscitation 2017;110:74-80.

[15] Bae, J, Chung TN, Je SM. Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial. BMJ Open. 2016;6:e010873.

[16] Na JU, Han SK, Choi PC, Shin DH. Effect of metronome rates on the quality of bag-mask ventilation during metronome-guided 30:2 cardiopulmonary resuscitation: A randomized simulation study. World J Emerg Med. 2017;8:136-140.

[17] Lee CJ, Chung TN, Bae J, Kim EC, Choi SW, Kim OJ. 50% duty cycle may be inappropriate to achieve a sufficient chest compression depth when cardiopulmonary resuscitation is performed by female or light rescuers. Clin Exp Emerg Med. 2015;2:9-15.

[18] Chung TN, Kim SW, You JS, Cho YS, Chung SP, Park I, et al. The specific effect of metronome guidance on the quality of one-person cardiopulmonary resuscitation and rescuer fatigue. J Emerg Med. 2012;43:1049-54.

[19] Mahler DA, Horowitz MB. Clinical evaluation of exertional dyspnea. Clin Chest Med. 1994;15:259-69.

[20] Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007;131:4S-42S. 

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