Fatigue and CPR quality in lifeguards: analysis after 100- and 200-meter rescues

Background: The quality of cardiopulmonary resuscitation (CPR) is crucial in aquatic rescues as it directly impacts the survival of drowning victims. Fatigue caused by long rescues may affect CPR effectiveness, especially over longer distances. This study examines how 100-meter and 200-meter rescues on a natural beach impact the quality of CPR performed by lifeguards. Methods: Twenty professional lifeguards performed 100-meter and 200-meter rescues, followed by a CPR test. The quality of CPR was evaluated using parameters such as compression rate, depth, and ventilation effectiveness. Results: The results showed a significant decrease in CPR quality compared to the baseline test (89.7 ± 10.6% vs. 78.7 ± 16.1% vs. 76.3 ± 18.6%; p = 0.003), particularly in compression rate (86.8 ± 16.8% vs. 58.5 ± 18.6% vs. 61.5 ± 18.6%; p = 0.023) and ventilation quality (87.6 ± 18.9% vs. 77.6 ± 23.5% vs. 73.5 ± 20.2%; p = 0.006). However, no differences were observed between the 100-meter and 200-meter rescues. Conclusions: Fatigue resulting from physical exertion in aquatic rescues reduces CPR quality. These findings are critical for improving lifeguard training programs and ensuring effective CPR even under fatigue conditions.

CPR quality; Fatigue; Cardiopulmonary resuscitation; Aquatic rescue; Lifeguards

[1] Perkins GD, Graesner JT, Semeraro F, Olasveengen T, Soar J, Lott C, et al. European Resuscitation Council Guidelines 2021: executive summary. Resuscitation. 2021; 161: 1–60.

[2] Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al.; CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013; 128: 417–435.

[3] Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European Resuscitation Council Guidelines 2021: basic life support. Resuscitation. 2021; 161: 98–114.

[4] Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. The New England Journal of Medicine. 2015; 372: 2307–2315.

[5] Abelairas-Gómez C, Barcala-Furelos R, Mecías-Calvo M, Rey-Eiras E, López-García S, Costas-Veiga J, et al. Prehospital emergency medicine at the beach: what is the effect of fins and rescue tubes in lifesaving and cardiopulmonary resuscitation after rescue? Wilderness & Environmental Medicine. 2017; 28: 176–184.

[6] Ruibal-Lista B, Moral-García JE, López-García S. Relationship between rescue distance and the quality of simulated CPR: a pilot study with lifeguards. Signa Vitae. 2021; 17: 137–143.

[7] Szpilman D, Webber J, Quan L, Bierens J, Morizot-Leite L, Langendorfer SJ, et al. Creating a drowning chain of survival. Resuscitation. 2014; 85: 1149–1152.

[8] Saborit JA, Soto Mdel V, Díez VG, Sanclement MA, Hernández PN, Rodríguez JE, et al. Physiological response of beach lifeguards in a rescue simulation with surf. Ergonomics. 2010; 53: 1140–1150.

[9] Barcala-Furelos R, Szpilman D, Palacios-Aguilar J, Costas-Veiga J, Abelairas-Gomez C, Bores-Cerezal A, et al. Assessing the efficacy of rescue equipment in lifeguard resuscitation efforts for drowning. The American Journal of Emergency Medicine. 2016; 34: 480–485.

[10] Moran K, Quan L, Franklin R, Bennett E. Where the evidence and expert opinion meet: a review of open-water recreational safety messages. International Journal of Aquatic Research and Education. 2011; 5: 251–270.

[11] López-García S, Ruibal-Lista B, Palacios-Aguilar J, Santiago-Alonso M, Prieto JA. Relationship between the performance in a maximum effort test for lifeguards and the time spent in a water rescue. International Journal of Environmental Research and Public Health. 2021; 18: 3407.

[12] Claesson A, Karlsson T, Thorén AB, Herlitz J. Delay and performance of cardiopulmonary resuscitation in surf lifeguards after simulated cardiac arrest due to drowning. The American Journal of Emergency Medicine. 2011; 29: 1044–1050.

[13] Barcala-Furelos R, Abelairas-Gomez C, Romo-Perez V, Palacios-Aguilar J. Effect of physical fatigue on the quality CPR: a water rescue study of lifeguards. The American Journal of Emergency Medicine. 2013; 31: 473–477.

[14] Salvador A, Penteado R, Lisboa F, Corvino R, Peduzzi E, Caputo F. Physiological and metabolic responses to rescue simulation in surf beach lifeguarding. Journal of Exercise Physiology Online. 2014; 17: 21–31.

[15] Lesener T, Pleiss LS, Gusy B, Wolter C. Physical fatigue impairs CPR quality in lifeguards. International Journal of Environmental Research and Public Health. 2020; 17: 5183.

[16] World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA Network. 2000; 284: 3043–3045.

[17] Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology. 2001; 37: 153–156.

[18] Perkins GD, Colquhoun M, Simons R. Training manikins. In Colquhoun M, Handley AJ, Evans TR (eds.) ABC of resuscitation (pp. 97–101). 5th edn. BMJ Books: London. 2004.

[19] Barcala-Furelos R, Abelairas-Gómez C, Queiroga AC, García-Soidán JL. CPR quality reduced due to physical fatigue after a water rescue in a swimming pool. Signa Vitae. 2014; 9: 25–31.

[20] Saborit JAP, Rodríguez JE, Díez VG, Sanclement MAM, Alameda JC. Determination of the energetic demand during a rescue in the sea with and without auxiliary equipment. Selección: Revista Española e Iberoamericana de Medicina de la Educación Física y el Deporte. 2001; 10: 211–220.

[21] Reilly T, Wooler A, Tipton M. Occupational fitness standards for beach lifeguards. Phase 1: the physiological demands of beach lifeguarding. Occupational Medicine. 2006; 56: 6–11.

[22] Maia F, Sousa L, Santiago P. Effects of physical fatigue on cardiopulmonary resuscitation quality by lifeguards: a systematic review and meta-analysis. International Journal of First Aid Education. 2023; 6: 70–80.

[23] Ruibal-Lista B, Diez-Fernández P, Moro-Sánchez E, López-García S. Effectiveness of a self-rotation system during paired cardiopulmonary resuscitation: a study with aquatic lifeguards. Emergencias. 2025; 37: 391–398. (In Spanish)