Comparing chest compression quality in 1-min vs. 2-min rescuer rotations with and without audiovisual feedback guidance during full adult advance life support simulated scenarios: a randomized simulation study

Guidelines recommend 2-min rescuer rotations for high-quality cardiopulmonary resuscitation. However, 1-min cycles may improve performance. Their effectiveness in advanced cardiac life support, particularly with audiovisual feedback (AVF) devices, remains unclear. This study compares rotation strategies and AVF device use in a simulated advanced cardiac life support setting.

In this randomized simulation study, resuscitation teams performed a standardized scenario using either 1- or 2-min chest compression rotations, with or without AVF guidance. Manikin-derived data, including compression rate, depth, and percentage of target-compliant compressions, were compared among the four study groups. Chest compression fraction, interruption time, and rescuer fatigue were also assessed.

A total of 31 participants performed chest compressions in this study. They were randomized to complete 10 simulated CPR sessions per group, resulting in data for 30 compressors per group. AVF use significantly improved compression depth and in-target performance in both 1- and 2-min rotation strategies (median 9.7% vs 52.8% in the 1-min no-AVF and with AVF, respectively; p < 0.001, and 6.7% vs 40.0% in the 2-min no-AVF and with AVF, respectively; p = 0.03). The 1-min groups had a lower chest compression fraction than the 2-min groups, although all groups maintained a chest compression fraction >80%. The 2-min with AVF group yielded the best overall performance.

Without AVF, 1- and 2-min rotations showed comparable but suboptimal chest compression quality. AVF markedly improved performance across both strategies, with the 2-min rotation with AVF achieving the highest compression quality and chest compression fraction.