Keeping the Beat

On my first night in Baltimore, I had a chance to talk to Dr Ray Fowler the medical director for the Dallas Fire Department.  First of all, let me say that it was an honor.  This guy is so smart, and has so many great thoughts about EMS.  The topic was CPR, and compression rates.  Dr. Fowler told me that he read a study (which I am still trying to get a hold of) that discovered two facts: 1.  a rate of compressions in CPR greater than 140/minute increases mortality.  2.  The majority of people cannot tell the difference between 120 and 140 compressions per minute.

Dr Fowler suggested that a more effective range to shoot for would be 100 beats per minute, or maybe even 110.  But how do we determine that?  I went on YouTube and found these kick drum metronome clips.  Take a listen to these two:

140 Beats per Minute

120 Beats per Minute

Could you tell the difference?  Neither could I.  Now, take a listen to this:

100 Beats per Minute

I find 100 beats to be a little more distinguishable.  This made me wonder: would the use of a metronome on a cardiac arrest improve outcomes?  Imagine, while doing compressions, your monitor would be beating right along with you, setting the rate at 110 or 120 or whatever is the final decision that produced the best outcome.  Just with setting that rate and sticking with it would not just potentially improve recoil, depth of compressions and of course rate, but it would also help signal when the compressor is tired and needs to be swapped out.  When the person running the code noticed that Joe was not keeping the beat, he could swap him out with someone else.

Now, I fully admit, I lack a considerable amount of rhythm.  Anyone who has ever seen me attempt to dance can attest to that.  But I even think that I could keep up with a set metronome, pushing rhythmically.

I am thinking about experimenting with this a bit, and I will definitely report back.  In the meantime, what does everyone else think?

Special mention to JCox98 on YouTube for the use of his metronome clips.


  1. Danny /

    It’s a great idea, Scott…some of us have been using metronomes in arrest situations for a little while now, and I’m finding that the quality of compression is greater, as measured by EtCO2. It also helps to blunt the response of adrenaline on providers at the scene by giving them a clear guide to follow. The Lifepak 15 has a metronome feature installed, so I won’t leave my iPod at the scene…

  2. Hi Scott, I have a metronome app loaded into my iPhone for setting up consistent drip sets on IVs. That’s another topic but ask me about it later and I’ll give you the full run down. Anyway, an iPhone app is easy to access, it’s always in your pocket, you can dial it to any number of beats per minute, you can even have it fire off an accent beat on a specific count. For instance; 120 bpm, accent beet every 20 beats, when the accent beat goes off the airway guy squeezes the football… Check out the app; Tempo by Frozen Ape. Cheers, KC