Selected Topics: Prehospital Care| Volume 48, ISSUE 1, P43-52, January 2015

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Death Before Disco: The Effectiveness of a Musical Metronome in Layperson Cardiopulmonary Resuscitation Training



      A novel musical memory aid has been proposed for aiding laypersons in complying with the American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines of 100 compressions per minute (cpm).


      This study tested usefulness of such a memory aid to improve layperson long-term compliance with CPR compression rate guidelines.


      A prospective randomized controlled trial was conducted using CPR-untrained laypersons. Subjects received either a standard CPR educational experience (AHA Heartsaver® CPR class) or an experimental CPR educational experience (AHA Heartsaver® CPR class augmented with a musical metronome). Experimental group subjects were taught to perform compressions to the cadence of a pop music song (The Bee Gees “Stayin’ Alive”; Saturday Night Fever, The Original Movie Soundtrack; Polygram International Music, 1977) with a tempo of 100 beats/min. Compression rates, depth of compressions, and correct compressions were measured initially and upon retesting ≥6 weeks post-training.


      Control subjects had a higher mean compression rate both immediately (121 [standard deviation {SD} = 21] vs. 109 [SD = 15] cpm; 95% confidence interval [CI] of mean difference 4−19; p = 0.002) and at follow-up (120 [SD = 20] vs. 111 [SD = 13] cpm; 95% CI of mean difference 2−16; p = 0.014). Compression rates stratified to 100−120 cpm demonstrated no difference between groups initially (39% vs. 48%; p = 0.382), but more experimental subjects maintained these rates at follow-up (43% vs. 74%; p = 0.003).


      Subjects trained to use a musical metronome more often maintained a compression rate of 100−120 cpm at ≥6-week follow-up, suggesting the memory aid may improve long-term guideline adherence.


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        • Rosamond W.
        • Flegal K.
        • Furie K.
        • et al.
        Heart disease and stroke statistics: 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2008; 117: e25-146
        • Nichol G.
        • Thomas E.
        • Callaway C.W.
        • et al.
        Regional variation in out-of-hospital cardiac arrest incidence and outcome.
        JAMA. 2008; 300: 1423-1431
        • Stiell I.G.
        • Wells G.A.
        • Field B.
        • et al.
        Advanced cardiac life support in out-of-hospital cardiac arrest.
        N Engl J Med. 2004; 351: 647-656
        • Vaillancourt C.
        • Stiell I.G.
        • Wells G.A.
        Understanding and improving low bystander CPR rates: a systematic review of the literature.
        CJEM. 2008; 10: 51-65
        • Sayre M.R.
        • Berg R.A.
        • Cave D.M.
        • Page R.L.
        • Potts J.
        • White R.D.
        Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee.
        Circulation. 2008; 117: 2162-2167
        • Wik L.
        • Steen P.A.
        • Bircher N.G.
        Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest.
        Resuscitation. 1994; 28: 195-203
        • Gallagher E.J.
        • Lombardi G.
        • Gennis P.
        Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest.
        JAMA. 1995; 274: 1922-1925
        • Van Hoeyweghen R.J.
        • Bossaert L.L.
        • Mullie A.
        • et al.
        Quality and efficiency of bystander CPR: Belgian Cerebral Resuscitation Study Group.
        Resuscitation. 1993; 26: 47-52
        • American Heart Association
        Part 4: Adult Basic Life Support. AHA guidelines for CPR and emergent cardiovascular care.
        Circulation. 2005; 112: IV-19-IV-34
        • Yannopoulous D.
        Clinical and hemodynamic comparisons of 15:2 and 30:2 compression-ventilation ratios for CPR.
        Crit Care Med. 2006; 34: 1444-1449
        • Kern K.B.
        • Hillwig R.W.
        • Sanders A.B.
        • Ewy G.A.
        Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario.
        Circulation. 2002; 105: 645-649
        • Komelasky A.L.
        The effect of nursing home visits on parental anxiety and CPR knowledge retention of parents of apnea monitored infants.
        J Pediatr Nurs. 1990; 5: 387-392
        • Handley J.A.
        • Handley A.J.
        Four-step CPR-improving skill retention.
        Resuscitation. 1998; 36: 3-8
        • Weaver F.J.
        • Ramirez A.G.
        • Dorfman S.B.
        • Raizner A.E.
        Trainees' retention of cardiopulmonary resuscitation. How quickly they forget.
        JAMA. 1979; 241: 901-903
        • Dine C.J.
        • Gersh R.E.
        • Leary L.
        • Riegel B.J.
        • Bellini L.M.
        • Abella B.S.
        Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing.
        Crit Care Med. 2008; 36: 2817-2822
        • Handley A.J.
        • Handley S.A.
        Improving CPR performance using an audible feedback system suitable for incorporation into an automatic external defibrillator.
        Resuscitation. 2003; 57: 57-62
        • Kern K.B.
        • Stickney R.E.
        • Gallison L.
        • Smith R.E.
        • Chapman F.W.
        Compression/ventilation metronome prevents hyperventilation by professional rescuers.
        Circulation. 2008; 111: S766
      1. Brouhard M. First aid. Stayin' alive with CPR. Use music to keep CPR fast enough. Available at: Accessed December 30, 2012.

        • Hafner J.W.
        • Sturgell J.L.
        • Matlock D.
        • Bockewitz E.G.
        • Barker L.T.
        “Stayin' alive”: a novel mental metronome to maintain compression rates in simulated cardiac arrests.
        J Emerg Med. 2012; 43: e373-e377
        • Rawlins L.
        • Woollard M.
        • Williams J.
        • Hallam P.
        Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial.
        BMJ. 2009; 339: b4707
        • Handley J.A.
        • Handley A.J.
        Four-step CPR improving skill retention.
        Resuscitation. 1998; 36: 3-8
        • Komelasky A.L.
        The effect of home nursing visits on parental anxiety and CPR knowledge retention of parents of apnea-monitored children.
        J Pediatr Nurs. 1990; 5: 387-392
        • Rea T.D.
        • Stickney R.E.
        • Doherty A.
        • Lank P.
        Performance of chest compressions by laypersons during the public access defibrillation trial.
        Resuscitation. 2010; 81: 293-296
        • Wollard M.
        • Whitefield R.
        • Smith A.
        • et al.
        Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study.
        Resuscitation. 2004; 60: 17-28
        • Hedges J.R.
        • Sehra R.
        • Van Zile J.W.
        • et al.
        Automated external defibrillator program does not impair cardiopulmonary resuscitation initiation in the public access defibrillation trial.
        Acad Emerg Med. 2006; 31: 25-29
        • Abella B.S.
        • Sandbo N.
        • Vassilatos P.
        • et al.
        Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest.
        Circulation. 2005; 111: 428-434
        • Abella B.S.
        • Aufderheide T.P.
        • Eigel B.
        • et al.
        Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation: a scientific statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation.
        Circulation. 2008; 117: 704-709
        • Oh J.H.
        • Lee S.J.
        • Kim S.E.
        • Lee K.J.
        • Choe J.W.
        • Kim C.W.
        Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway.
        Resuscitation. 2008; 79: 273-277
        • Woollard M.
        • Poposki J.
        • McWhinnie B.
        • Rawlins L.
        • Munro G.
        • O’Meara P.
        Achy breaky makey wakey heart? A randomized crossover trial of musical prompts.
        Emerg Med J. 2012; 29: 290-294
        • Chung T.N.
        • Kim S.W.
        • You J.S.
        • et al.
        The specific effect of metronome guidance on the quality of one-person cardiopulmonary resuscitation and rescuer fatigue.
        J Emerg Med. 2012; 43: 1049-1054
        • Fitzgerald K.R.
        • Babbs C.F.
        • Frissora H.A.
        • Davis R.W.
        • Silver D.I.
        Cardiac output during cardiopulmonary resuscitation at various compression rates and durations.
        Am J Physiol. 1981; 241: H442-H448
        • Wolfe J.A.
        • Maier G.W.
        • Newton Jr., J.R.
        • et al.
        Physiologic determinants of coronary blood flow during external cardiac massage.
        J Thorac Cardiovasc Surg. 1988; 95: 523-532
        • Wégria R.
        • Frank C.W.
        • Wang H.H.
        • Lammerant J.
        The effect of atrial and ventricular tachycardia on cardiac output, coronary blood flow and mean arterial blood pressure.
        Circ Res. 1958; 6: 624-652
        • Monsieurs K.G.
        • De Regge M.
        • Vansteelandt K.
        • et al.
        Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest.
        Resuscitation. 2012; 83: 1319-1323