Review Of: Woollard M, Poposki J, McWhinnie B, et al. Achy breaky makey wakey heart? A randomized crossover trial of musical prompts. Emerg Med J. 2012;29(4):290–294.
This is small prospective crossover analysis of the use of musical prompts to affect the rate and depth of CPR. Researchers exposed 74 people to three different situations: no music, listening to Billy Ray Cyrus’ "Achy Breaky Heart," and listening to Mirwais’ "Disco Science." The investigators found that listening to musical prompts was better than having no musical prompts with rate of chest compressions, but they found that no musical prompts resulted in deeper chest compressions. They conclude that alternative feedback mechanisms may be more effective.
Doc Wesley: So the beat goes on. We all remember the Bee Gees’ “Stayin’ Alive” and Queen’s “Another One Bites the Dust” as the songs to sing, in our head, as we performed chest compressions. But now with the knowledge that compressions should be at a rate of at least 100 per minute and some studies indicating that a rate of 120 per minute are better, now we’re challenged to find a better tune to help us keep up the rhythm of our CPR.
Although this study may seem trite, and several other similar studies have examined such songs as KC and Sunshine Band’s “That’s The Way I Like It.” The bottom line is that without some form of external prompt, we simply fail to maintain chest compressions at the appropriate rate.
Even when the rate is adequate, we still fail to compress deeply enough. I doubt any song will improve depth compliance. All of this confirms the need for Automated External Defibrillators (AEDs) and monitor-defibrillators to incorporate technology to provide prompts both for rate and depth of compressions. Additionally, ensuring full chest recoil is vital to high-performance CPR. Yet again, technology alone can assist us in this area.
So instead of worrying about what song to sing, I recommend looking to technology to solve this problem.
Medic Marshall: When can we decide to stop with CPR research and the effects of songs with catchy beats? What this study tells us is that if you listen to a song with a beat while doing CPR that’s within the acceptable rate for chest compressions, you’re more likely to conduct compressions at that rate. However, it has absolutely no bearing on the depth of compressions (which is just as important as rate).
Secondly, a large proportion of the study subjects were healthcare providers. In fact, 80% of the group was either a paramedic or identified as an "other healthcare professional." So what bearing does that have on these healthcare providers? Absolutely none. With advances in technology, AEDs and monitor/defibrillators have metronomes built into the device, which has already proven to help control the rate. Furthermore, some devices on the market are designed to prompt depth and rate corrections. Whether they’re accurate is another discussion.
Finally, musical prompt research in CPR is really of no use—unless monitors and defibrillators are going to start playing "Staying Alive."
Objective: Compared with no music (NM), does listening to ‘Achy breaky heart’ (ABH) or ‘disco science’ (DS) increase the proportion of prehospital professionals delivering chest compressions at 2010 guideline-compliant rates of 100e120 bpm and 50e60 mm depths?
Methods: A randomised crossover trial recruiting at an Australian ambulance conference. Volunteers performed three 1-min sequences of continuous chest compressions on a manikin accompanied by NM, repeated choruses of ABH and DS, prerandomised for order.
Results: 37 of 74 participants were men; median age 37 years; 61% were paramedics, 20% students and 19% other health professionals. 54% had taken cardiopulmonary resuscitation training within 1 year. Differences in compression rate (mode, IQR) were significant for NM (105, 99e116) versus ABH (120, 107e120) and DS (104, 103e107) versus ABH (p<0.001) but not NM versus DS (p1/40.478). Differences in proportions of participants compressing at 100e120 bpm were significant for DS (61/74, 82%) versus NM (48/74, 65%, p1/40.007) and DS versus ABH (47/74, 64%, p1/40.007) but not NM versus ABH (p1/41).
Differences in compression depth were significant for NM (48 mm, 46e59 mm) versus DS (54 mm, 44e58 mm, p1/40.042) but not NM versus ABH (54 mm, 43e59 mm, p1/40.065) and DS versus ABH (p1/40.879). Differences in proportions of subjects compressing at 50e60 mm were not significant (NM 31/74 (42%); ABH 32/74 (43%); DS 29/74 (39%); all p>0.5).
Conclusions: Listening to DS significantly increased the proportion of prehospital professionals compressing at 2010 guideline-compliant rates. Regardless of intervention more than half gave compressions that were too shallow. Alternative audible feedback mechanisms may be more effective.