In emergencies where prolonged CPR is necessary, the rescuer’s physical and mental exhaustion can impact the lifesaving measure’s effectiveness. CPR fatigue, characterized by a decline in chest compression and ventilation quality, can occur within minutes of starting the procedure.

Fortunately, it’s possible to avoid fatigue during CPR, enabling rescuers to maintain stamina and improve patient outcomes. Here’s what to know.

Understanding CPR Fatigue

CPR fatigue — also known as rescuer fatigue — is a well-documented phenomenon that can set in as early as two minutes after beginning chest compressions. It can lead to inadequate chest compression depth and rate, reducing the patient’s chances of survival and positive outcomes.

Proactive Ways to Prevent CPR Fatigue

There are several ways to prepare for an emergency situation involving CPR, so you’re ready to take action whenever need be. Here are a few ways to keep your resuscitation skills sharp and enhance your ability to respond.

• Routine CPR Practice

  Routine practice can help avoid fatigue during CPR. Adopting a low-dose, high-frequency approach to CPR training can help keep skills sharp and maintain stamina. Just as athletes train to build endurance, regular CPR practice helps build the physical and mental strength needed for real-life emergencies.

  For example, frequent practice sessions help rescuers develop CPR muscle memory, making the physical act of performing CPR more automatic and less taxing over time. Routine practice also boosts confidence, which helps rescuers manage the stress and anxiety that may contribute to fatigue. Confident rescuers are more likely to maintain high-quality compressions and effective ventilations throughout resuscitation efforts.

• High-Quality CPR Training

  High-quality CPR training focuses on technique and rhythm, both essential to preventing fatigue.

• Technique Mastery

  Proper technique is fundamental in reducing the physical strain of performing CPR. Modern training programs focus on achieving the correct hand position, compression depth (at least 2 inches in adults) and compression rate (100-120 compressions per minute).

  Using the rescuer’s body weight — rather than just the arm muscles — also helps to sustain compressions for longer periods.

• Rhythm and Consistency

  Rescuers must maintain a consistent rhythm. Training with metronomes or other timing devices can help them internalize the correct pace, reducing the likelihood of fatigue-induced errors.

• Physical Conditioning

  Rescuers can benefit from regular physical conditioning. Exercises that improve cardiovascular fitness and muscle endurance, particularly in the arms, shoulders and core, can enhance a rescuer’s ability to sustain high-quality compressions.

How to Minimize Fatigue During CPR

Several strategies can help minimize CPR fatigue during prolonged resuscitation efforts.

• Take a Team Approach

  Ideally, multiple rescuers will be available in CPR situations. When possible, rescuers should switch roles every two minutes. This ensures no single rescuer becomes overly fatigued, maintaining high-quality CPR.

• Change Positions

  If only one rescuer is available, changing positions can help relieve muscle strain and delay fatigue. Instead of solely kneeling on the patient’s bed, individuals should switch positions, like standing next to them or using a footstool.

• Use Mechanical Devices

  Mechanical CPR devices are increasingly available in many settings. These devices can take over chest compressions from rescuers, providing consistent, high-quality compressions without risking fatigue. If available, AEDs can also help support lifesaving efforts.

The Role of Mock Codes

Mock codes, or simulated cardiac arrest scenarios, are invaluable in preparing rescuers for real-life emergencies. These practice sessions replicate the high-stress environment of an actual resuscitation effort, allowing rescuers to practice their skills in a controlled yet realistic setting.

Recently, the Ohio State University Wexner Medical Center revamped its CPR training efforts with the Resuscitation Quality Improvement^® (RQI^®) Program. Setting up RQI Simulation Stations throughout the facility allowed healthcare providers to practice their CPR skills more frequently, leading to higher-quality CPR and effective compliance.

The simulation stations provide a wealth of information and skills training to staff, leading to a boost in practitioner confidence and, in turn, improved patient outcomes. This mock code training method lets Wexner Medical Center employees experience the physical and emotional demands of a real sudden cardiac arrest situation. The stations also enable rescuers to practice switching roles seamlessly, ensuring CPR quality remains high even as individual rescuers begin to tire.

Perhaps most importantly, each simulation station provides immediate feedback for everyone involved. Rescuers access information about their compression depth, rate and overall technique, allowing them to make adjustments to improve performance.

Avoiding and Preventing CPR Fatigue

CPR fatigue is a real challenge that impacts resuscitation efforts’ effectiveness. High-quality training, routine practice and mock codes all help rescuers build the stamina, skills and confidence needed to perform effective CPR for extended periods. Patient survival rates and outcomes can improve as a result.