The impact of the ILCOR 2005 CPR guidelines on a physical fitness assessment: a comparison of old and new protocols

OBJECTIVE: St. John Ambulance Australia has used the performance of CPR for 10 min as a fitness test for its members. Recent changes in international guidelines for cardiopulmonary resuscitation caused concern that the new ILCOR protocol was more strenuous than the previous one. This study compared the two protocols to determine if there were significant differences and to allow an evidence-based decision on the continuation or modification of this practice. MATERIALS AND METHODS: We studied 26 subjects performing single-rescuer cardiopulmonary resuscitation on a manikin. Every subject did 10 min cardiopulmonary resuscitation using each protocol. The study used a randomized cross-over design. The estimated maximum heart rate was calculated for each subject. Compression rate and effective ventilation (number and depth) were enforced by direct feedback. Subjective and objective measures of physical activity were recorded at regular intervals. RESULTS: The maximum percentage of estimated maximum heart rate achieved during 15:2 and 30:2 CPR was 76+/-2% and 79+/-2%, respectively (mean+/-standard error of mean; P<0.001). The rate pressure product at the end of 10 min cardiopulmonary resuscitation was 18,999+/-891 for 15:2 and 19,204+/-757 for 30:2 (ns) while the Borg rating of perceived exertion was 13.7+/-0.5 for 15:2 and 14.8+/-0.5 for 30:2 (P<0.05). CONCLUSION: The new protocol increases both objective and subjective measures of effort. While the absolute differences in workload are small, they are statistically significant. There are significant indicators of this difference in the first 3 min of assessment. Rescuers are more likely to be operating at a high-level of physical activity. To avoid increasing the demands of its mandatory fitness test, St. John should reduce the required performance time from its present 10 min.