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‘Count on me Singapore’ on par with standard method for CPR

Stephen Padilla
03 Sep 2019

The use of songs as mental metronomes for cardiopulmonary resuscitation (CPR) is accepted by contemporary guidelines, and the National Day song ‘Count on me Singapore’ (COMS) is not an exception, with a recent study finding it noninferior to standard ‘one-and-two-and-three’ counting (standard CPR) in terms of participants delivering a guideline-compliant rate of chest compression.

“Compared to standard CPR, COMS CPR was not inferior in terms of the proportion of participants delivering a guideline-compliant rate of chest compression,” the researchers said. “However, attention should be given to achieving sufficient depth.”

This prospective randomized crossover trial recruited 90 individuals and randomly assigned them to group A (n=46) and group B (n=44) after a familiarization session to demonstrate noninferiority in the CPR rate. Group A performed one cycle of standard CPR, while group B did one cycle of COMS CPR. Participants then swapped to perform the other method.

CPR quality was measured using the Laerdal SkillReporter. Four weeks later, participants attended a test scenario and performed standard or COMS CPR (randomly assigned).

Baseline characteristics were similar between the two groups. Of the participants, 41.1 percent in the COMS CPR and 28.9 percent in the standard CPR groups achieved 100–120 compressions/minute (p=0.028). [Proceedings of Singapore Healthcare 2019;28:159-166]

Mixed effects logistic regression showed significantly more COMS vs standard CPR performed at 100–120/minute (odds ratio, 2.44, 95 percent CI, 1.01–5.9; p=0.047), but COMS CPR had a higher proportion of insufficient depth (80.59 percent vs 68.01 percent; p<0.001).

No differences were observed in other aspects of CPR quality. Furthermore, CPR quality between COMS and standard CPR were similar during follow-up.

“CPR timed using a popular song COMS was not inferior to that timed using the conventional … method in terms of the proportion of subjects achieving a guideline-compliant rate of chest compression, the researchers said. “However, it was associated with a higher proportion of subjects not achieving sufficient depth of compression.” [Circulation 2015;132(Suppl. 2):S315-S367]

These findings support those of previous studies that tested popular songs as mental metronomes for CPR. For instance, Rawlins and colleagues assessed the use of the song That’s the Way (I like It) on 130 participants and found that individuals randomized to be taught using the song were more likely to provide CPR at an appropriate rate. However, the proportion of compression with correct depth decreases as the compression rate increases. [BMJ 2009;339:b4707]

“A possible explanation for the reduced depth is that the intervention group was focused on achieving the correct rate, as briefed by the trial administrators, at the expense of achieving the correct depth,” the researchers said. “We propose that adequate depth needs to be emphasized to trainees if popular songs are to be used.”

In addition, COMS CPR may find its use in layman CPR education, including mass education events and schools, according to the researchers.

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