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Assessing the quality of CPR performed by a single lifeguard, two lifeguards and a lifeguard with a bystander after water rescue: a quasi-experimental trial
  1. Shuang Li1,
  2. Ting Kan2,
  3. Zijian Guo3,
  4. Chulin Chen1,
  5. Li Gui1
  1. 1 Emergency Nursing Department, Second Military Medical University Department of Nursing Science, Shanghai, China
  2. 2 Second Medical Center, General Hospital of People's Liberation Army, Beijing, Beijing, China
  3. 3 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
  1. Correspondence to Dr Li Gui, Emergency Nursing Department, Second Military Medical University Department of Nursing Science, Shanghai 200433, China; shiny0820{at}


Background High-quality cardiopulmonary resuscitation (CPR) could improve survival of drowning victims. The purpose of the study is to assess the impact of fatigue caused by water rescue on subsequent CPR quality and the influence of a bystander’s participation on CPR quality in a lifeguard rescue.

Methods This was a simulated quasi-experimental study with a sample of 14 lifeguards and 13 laypersons. Each lifeguard performed 2 min single-rescuer CPR as baseline measurement. In three separate trials, a single lifeguard swam 50 m to perform a water rescue in a pool and returned with the manikin another 50 m. After each rescue, 10 min of CPR was performed by a single lifeguard, two lifeguards or a lifeguard with a layperson with no CPR training. Paired t-test and repeated analysis of variance were used to analyse CPR quality variables.

Results Baseline CPR quality was adequate for most measures except compression depth and re-expansion. After water rescue, the single lifeguard trial showed no significant differences compared with baseline. CPR score and ventilation score of the single-lifeguard trial was higher than that of the lifeguard-bystander trial (p=0.027, p<0.001). Both the two-lifeguard trial (p=0.025), and lifeguard-bystander trial (p=0.010) had a lower percentage of breaths with correct ventilation volume and higher percentage of breaths with excessive ventilation volume (p=0.007, p=0.011, respectively) than the single-lifeguard trial. No-flow time of the lifeguard-bystander trial was longer than other trials (p<0.001).

Conclusions Although CPR given by the lifeguard was not optimal, fatigue generated by a water rescue has no impact on the quality of subsequent CPR performed by a trained lifeguard for 10 min. Untrained bystanders assisting in CPR in a drowning event is unlikely to be helpful.

  • resuscitation
  • cardiac arrest
  • quality

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  • SL and TK are joint first authors.

  • Correction notice This paper has been updated since first published to update that Shuang Li and Ting Kan are joint first authors.

  • Contributors I worked with my team to conduct our research. This paper adopted an experimental design for LG and SL. SL was responsible for the study conception and design, the analysis and interpretation of the data and the drafting of the manuscript. TK also participated in the implementing experiment and the analysis of the data. ZG and CC performed the data collection of the research. LG, TK and SL made critical revisions for important intellectual content of the paper. LG supervised the study and provided administrative support.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.