Effect of rescuer heart rate changes on the quality of infant CPR: a simulation-based study

This study aimed to evaluate whether increases in heart rate-used as an objective surrogate marker of rescuer fatigue-could influence CPR performance during infant chest compressions.

This study was a manikin-based simulation study that enrolled PALS-certified pediatric emergency nurses matched by clinical experience and randomly assigned to three groups. All participants performed three 2-min cycles of infant chest compressions on a manikin (Little Baby QCPR). Each group completed a 90-s exercise protocol at different time points to induce varying degrees of heart-rate elevation. The primary outcome was the difference in CPR quality across groups according to heart-rate variation (percentage increase from baseline).

Twenty-seven nurses were enrolled and evenly allocated to Groups A, B, and C (n = 9 each). Heart rate increased immediately after exercise in all groups and gradually declined during subsequent compression cycles, with no significant between-group differences at any time point (baseline 85-100 bpm/cycle, peak 130-150 bpm/cycle). Across all cycles, CPR performance metrics-including total compression count, hand-placement accuracy, mean compression velocity, compression depth, and chest recoil-showed no significant within-group changes for any group. Similarly, no significant between-group differences were observed for any CPR parameter during any cycle. In post-hoc analyses, stratification by the median percentage increase in heart rate (> 67.7% vs. < 67.7%) revealed no statistically significant differences in CPR quality between groups.

Within this short, three-cycle simulation, exercise-induced heart-rate elevation was not associated with measurable deterioration in infant CPR quality.