Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial
- L Rawlins, medical student1,
- M Woollard, professor in prehospital and emergency care2,
- J Williams, principal lecturer3,
- P Hallam, research paramedic4
- 1Birmingham University School of Medicine, Edgbaston, Birmingham B15 2TT
- 2Pre-hospital, Emergency and Cardiovascular Care Applied Research Group, Coventry University, Coventry CV1 5FB
- 3School of Health and Emergency Professions, University of Hertfordshire, Hatfield AL10 9AB
- 4West Midlands Ambulance Service NHS Trust, Waterfront Business Park, Brierley Hill, West Midlands DY5 1LX
- Correspondence to: M Woollard Malcolm.woollard{at}coventry.ac.uk
- Accepted 4 November 2009
Abstract
Objectives To determine whether listening to music during cardiopulmonary resuscitation (CPR) training increases the proportion of lay people delivering chest compressions of 100 per minute.
Design Prospective randomised crossover trial.
Setting Large UK university.
Participants 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.
Interventions 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.
Main outcome measures Rate of chest compressions delivered (primary outcome), depth of compressions, proportion of incorrect compressions, and type of error.
Results 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).
Conclusions 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.
Footnotes
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We gratefully acknowledge the contribution of the study participants and the cooperation of Coventry University. We also express our sincere thanks to all song writers and musicians with the insight to produce music at a tempo close to 100 bpm, and to the statistical peer reviewer whose poetical comments resulted in improvements to the first submitted draft of our paper.
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Contributors: MW had the idea for the study, supervised its design and conduct, analysed the quantitative data, edited and approved the submitted manuscript, and is guarantor. LR wrote the first draft of the study protocol, collected all data, wrote the first draft of the paper, and approved the submitted manuscript. JW contributed to the design of the study, edited the study protocol, and edited and approved the submitted manuscript. PH contributed to the design of the study and data collection and edited and approved the submitted manuscript.
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Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Competing interests: None declared.
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Ethical approval: The study was approved by Coventry University. All participants gave informed written consent before taking part.
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Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at Malcolm.woollard{at}coventry.ac.uk.
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