Background Music has been recommended as an aid to improving chest compression quality, but research indicates the popular European tune “Nellie the Elephant” reduces the proportion of lay-persons compressing at the correct depth.

Objectives Compared to no music (NM), does listening to “Achy Breaky Heart” (ABH) or “Disco Science” (DS) increase the proportion of CPR-trained health professionals delivering compressions at the 100 bpm recommended rate and 4–5 cm depth?

Methods Randomised cross-over trial recruiting at the 2009 ACAP conference.

Findings Of 74 participants 50% were male; median age was 37; 61% were paramedics, 20% students, and 19% other health professionals. 54% had taken CPR training within 1 year. Mode and IQR for compression rate were NM 105 (99–116); ABH 120 (107–120); DS 104 (103–107). Differences between-interventions were significant for NM vs ABH and DS vs ABH (p<0.001) but not NM vs DS (p=0.478). Compression rates of 95-105 were achieved with NM, ABH, and DS for 26/74 (35%), 8/74 (11%) and 34/74 (46%) of participants respectively. Differences were significant for NM vs ABH (p=0.0005) and DS vs ABH (p<0.0001) but not NM vs DS (p=0.256). RR for a compression rate of 95-105 for ABH vs NM=0.31, for DS vs NM=1.31 (not significant) and for DS vs ABH=4.25. The number needed to harm was 5 for listening to ABH vs NM and 3 for ABH vs DS. A high proportion of compressions were too deep (NM 86%; ABH 79%; DS 77%, differences not significant).

Conclusions Listening to Disco Science while performing CPR did not increase the proportion of prehospital professionals delivering compressions correctly. Perhaps unsurprisingly, listening to Achy Breaky Heart had a negative effect. Disconcertingly, regardless of the nature or absence of musical accompaniment, the majority of participants did not compress at the recommended rate or depth.