Rawlins L, Woollard M, Williams J, Hallam P
Birmingham University School of Medicine, Edgbaston, Birmingham B15 2TT.
BMJ. 2009 Dec 11;339:b4707. doi: 10.1136/bmj.b4707.
To determine whether listening to music during cardiopulmonary resuscitation (CPR) training increases the proportion of lay people delivering chest compressions of 100 per minute.
Prospective randomised crossover trial.
Large UK university.
130 volunteers (81 men) recruited on an opportunistic basis. Exclusion criteria included age under 18, trained health professionals, and cardiopulmonary resuscitation (CPR) training within the past three months.
Volunteers performed three sequences of one minute of continuous chest compressions on a skill meter resuscitation manikin accompanied by no music, repeated choruses of Nellie the Elephant (Nellie), and That's the Way (I like it) (TTW) according to a pre-randomised order.
Rate of chest compressions delivered (primary outcome), depth of compressions, proportion of incorrect compressions, and type of error.
Median (interquartile range) compression rates were 110 (93-119) with no music, 105 (98-107) with Nellie, and 109 (103-110) with TTW. There were significant differences within groups between Nellie v no music and Nellie v TTW (P<0.001) but not no music v TTW (P=0.055). A compression rate of between 95 and 105 was achieved with no music, Nellie, and TTW for 15/130 (12%), 42/130 (32%), and 12/130 (9%) attempts, respectively. Differences in proportions were significant for Nellie v no music and Nellie v TTW (P<0.001) but not for no music v TTW (P=0.55). Relative risk for a compression rate between 95 and 105 was 2.8 (95% confidence interval 1.66 to 4.80) for Nellie v no music, 0.8 (0.40 to 1.62) for TTW v no music, and 3.5 (1.97 to 6.33) for Nellie v TTW. The number needed to treat for listening to Nellie v no music was 5 (4 to 10)-that is, the number of cardiac arrests required during which lay responders listen to Nellie to facilitate one patient receiving compressions at the correct rate (v no music) would be between four and 10. A greater proportion of compressions were too shallow when participants listened to Nellie v no music (56% v 47%, P=0.022).
Listening to Nellie the Elephant significantly increased the proportion of lay people delivering compression rates at close to 100 per minute. Unfortunately it also increased the proportion of compressions delivered at an inadequate depth. As current resuscitation guidelines give equal emphasis to correct rate and depth, listening to Nellie the Elephant as a learning aid during CPR training should be discontinued. Further research is required to identify music that, when played during CPR training, increases the proportion of lay responders providing chest compressions at both the correct rate and depth.
确定在心肺复苏（CPR）培训期间听音乐是否会提高非专业人员进行每分钟100次胸外按压的比例。
前瞻性随机交叉试验。
英国大型大学。
通过机会性招募的130名志愿者（81名男性）。排除标准包括年龄在18岁以下、受过培训的卫生专业人员以及在过去三个月内接受过心肺复苏（CPR）培训的人员。
志愿者按照预先随机确定的顺序，在技能计量复苏人体模型上进行三组一分钟的持续胸外按压，分别是无音乐伴奏、重复播放《大象内莉》（Nellie）的合唱部分以及《就是这样（我喜欢）》（That's the Way (I like it)，简称TTW）。
胸外按压的速率（主要指标）、按压深度、不正确按压的比例以及错误类型。
无音乐时胸外按压的中位数（四分位间距）速率为110（93 - 119）次/分钟，播放《大象内莉》时为105（98 - 107）次/分钟，播放《就是这样（我喜欢）》时为109（103 - 110）次/分钟。在组内，播放《大象内莉》与无音乐以及播放《大象内莉》与播放《就是这样（我喜欢）》之间存在显著差异（P<0.001），但无音乐与播放《就是这样（我喜欢）》之间无显著差异（P = 0.055）。无音乐、播放《大象内莉》和播放《就是这样（我喜欢）》时，分别有15/130（12%）、42/130（32%）和12/130（9%）的尝试达到了95至105次/分钟的按压速率。播放《大象内莉》与无音乐以及播放《大象内莉》与播放《就是这样（我喜欢）》之间在比例上的差异具有统计学意义（P<0.001），但无音乐与播放《就是这样（我喜欢）》之间无统计学意义（P = 0.55）。播放《大象内莉》与无音乐相比，按压速率在95至105次/分钟之间的相对风险为2.8（95%置信区间为1.66至4.80），播放《就是这样（我喜欢）》与无音乐相比为0.8（0.40至1.62），播放《大象内莉》与播放《就是这样（我喜欢）》相比为3.5（1.97至6.33）。听《大象内莉》与不听音乐相比，需要治疗的人数为5（4至10）——也就是说，非专业急救人员在听《大象内莉》的情况下，为使一名患者以正确速率（与不听音乐相比）接受按压，需要发生心脏骤停的次数在4至10次之间。与不听音乐相比，参与者听《大象内莉》时按压过浅的比例更高（56%对47%，P = 0.022）。
听《大象内莉》显著提高了非专业人员进行接近每分钟100次按压速率的比例。不幸的是，这也增加了按压深度不足的比例。由于当前的复苏指南同样强调正确的速率和深度，在心肺复苏培训期间将听《大象内莉》作为学习辅助手段的做法应予以停止。需要进一步研究以确定在心肺复苏培训期间播放何种音乐，能够提高非专业急救人员以正确速率和深度进行胸外按压的比例。
