Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model

Abstract

Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 μV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 μV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

Keywords: Cardiopulmonary resuscitation; Electromyography; Emergencies; High spinal muscles; Lumbar muscles; Muscular fatigue.

Figure 1.

Position of electrodes.

Figure 2.

Muscular activity of high spinal muscles. The muscular activity at rest is near zero for both sides. At 2 minutes the muscular activity increases to 50–60 μV/ms but with a high standard deviation. At 5 minutes the activity decreases to below the maximum potential activity of high spinal muscles. At 15 minutes the muscular activity is about 30 μV/ms.

Figure 3.

Muscular activity of fifth lumbar muscles. The muscular activity at rest is near zero for both sides. At 2 minutes the muscular activity increases to near 50 μV/ms. At 5 minutes the activity is about 40 μV/ms. At 15 minutes the muscular activity decreases to below the maximum potential activity of fifth lumbar.

Figure 4.

Electromyography recording at rest, 2 minutes, 5 minutes and 15 minutes. Sample of electromyography recording of 250 ms.