Dance teachers were right: Rhythm can save lives

TOPTENAndrea Cruz (Texas Children’s) and Michelle Macy (Michigan) presented the best PEM-related articles of 2016 at AAP this past October. If you weren’t one of the tens of thousands of people in the room that day, we’re going to be counting them down over here over the next few weeks.

Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study

Zimmerman E, Cohen N, Maniaci V, Pena B, Lozano JM, Linares M. Pediatrics. 2016.

Unmet needs addressed

Poor quality CPR contributes to poor outcomes after cardiac arrest. CPR has to be hard and fast. But “how fast and how hard” can be difficult to figure out while standing on that stool trying to save someone’s life. In adult manikins, using a metronome—that ticking device last seen in music class—during CPR can be effective in maintaining target chest compression rate. The question this study tried to address was whether using something as simple as metronome guidance could improve pediatric CPR?


This was a prospective, cross-over, randomized control trial done in a simulation setting. Medical students, residents, fellows, and nurses working in pediatrics and who had BLS training were randomized to perform two rounds of chest compressions. In one round they used an audible metronome build into the defibrillator that was set at a rate of 100 times per minute. In the other round of chest compressions they did not use a metronome.

The crossover design means that all participants used the metronome, controlling for variability of CPR skill between individuals. Study participants were blinded to the purpose of the study and performed the CPR on a simulation manikin that collected data on the quality of compressions.

Adequate compression rate was defined as being between 90 and 110 compressions per minute and an adequate depth was between 38 to 51 mm.

Main Results

Screen Shot 2017-02-08 at 2.14.38 PMMetronome use in CPR was associated with a higher percentage of compressions with an adequate rate than if the metronome was not used. Without the metronome, about 39% of compressions were too fast while the percentage of compression that were too slow wasn’t significantly different whether the metronome was used or not.

The metronome did not affect depth of compressions.

How did this make our Top Ten?

If adding an audible rhythm improves CPR then metronomes could be integrated into hospital monitors, defibrillators, and AEDs to improve pediatric resuscitation. We could incorporate metronomes into CPR training. Finally, we could finally get “Stayin’ Alive” out of our heads once and for all.

Andrea Cruz MD MPH

Andrea Cruz MD MPH

Associate Professor of Pediatrics in Emergency Medicine and Infectious Diseases at Baylor College of Medicine
Andrea is the PECARN site PI for Texas Children’s Hospital and runs the Data Center for the Pediatric Emergency Medicine Collaborative Research Committee.
Andrea Cruz MD MPH