CPR quality among paramedics and ambulance officers: a cross-sectional simulation study


cardiopulmonary resuscitation
cardiac arrest
CPR quality

How to Cite

Talikowska M, Ball S, Rose D, Bailey P, Brink D, Stewart K, Doyle M, Davids L, Finn J. CPR quality among paramedics and ambulance officers: a cross-sectional simulation study. Australasian Journal of Paramedicine [Internet]. 2020Oct.12 [cited 2023May28];17. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/842



High quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest, yet CPR quality is often suboptimal, even among trained rescuers. St John Western Australia sought to gather anonymous baseline data on CPR performance by paramedics and ambulance officers in a simulation setting.


In a cross-sectional study, participants performed 2 minutes of CPR on a manikin. CPR quality was recorded and compared to recommended standards. Comparisons were also made between women and men.


The final cohort comprised 1320 participants; 56% paramedics, 20% transport officers and 18% volunteer emergency medical technicians and emergency medical assistants. More than half achieved an overall score of 90% or greater. The median compression score was 96% (IQR 83–99%) while the median ventilation score was 94% (76–99%). Participants achieved the recommended chest compression fraction of ≥60% in 98% of cases. More than half of participants had 99% or more of their compressions reach a depth of ≥50 mm. Two-thirds (68%) recorded a mean compression rate in the range 100–120 compressions per minute. Although there were significant differences in the percentage of compressions deep enough (p<0.01) and the 2-minute mean compression depth (p<0.01) between men and women, the effect size was small. However, men were less likely than women to fully release pressure on the chest after compressions (p<0.01).


This study provides useful baseline data about CPR quality in a manikin model. Participants achieved relatively high scores for most CPR quality metrics and complied with CPR guidelines in the majority of cases.



Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation 2006;71:270-1.

Nolan J. European Resuscitation Council guidelines for resuscitation 2005. Section 1. Introduction. ibid. 2005;67(Suppl 1):S3-6.

Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE. Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985;3:114-9.

Stiell IG, Wells GA, DeMaio VJ, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS study phase 1 results. Ann Emerg Med 1999;33:44-50.

Holmberg M, Holmberg S, Herlitz J. Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation 2000;47:59-70.

Bækgaard Josefine S, Viereck S, et al. The effects of public access defibrillation on survival after out-of-hospital cardiac arrest. Circulation 2017;136:954-65.

Blom MT, Beesems SG, Homma PCM, et al. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. ibid. 2014;130:1868-75.

Berdowski J, Blom MT, Bardai A, et al. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. ibid. 2011;124:2225-32.

Talikowska M, Tohira H, Finn J. Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: a systematic review and meta-analysis. Resuscitation 2015;96:66-77.

Kramer-Johansen J, Myklebust H, Wik L, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. ibid. 2006;71:283-92.

Stiell IG, Brown SP, Nichol G, et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation 2014;130:1962-70.

Idris AH, Guffey D, Pepe PE, et al. Chest compression rates and survival following out-of-hospital cardiac arrest. Crit Care Med 2015;43:840-8.

Vadeboncoeur T, Stolz U, Panchal A, et al. Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation 2014;85:182-8.

Stiell IG, Brown SP, Christenson J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012;40:1192-8.

Christenson J, Andrusiek D, Everson-Stewart S, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009;120:1241-7.

Vaillancourt C, Everson-Stewart S, Christenson J, et al. The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation. Resuscitation 2011;82:1501-7.

Cheskes S, Schmicker RH, Christenson J, et al. Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 2011;124:58-66.

Cheskes S, Schmicker RH, Verbeek PR, et al. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation 2014;85:336-42.

Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: adult basic life support and cardiopulmonary resuscitation quality. Circulation 2015;132(Suppl 2):S414-35.

Perkins GD, Handley AJ, Koster RW, et al. European Resuscitation Council guidelines for resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015;95:81-99.

Meaney PA, Bobrow BJ, Mancini ME, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital. Circulation 2013;128:417-35.

Oermann MH, Krusmark MA, Kardong-Edgren S, Jastrzembski TS, Gluck KA. Training interval in cardiopulmonary resuscitation. PLOS ONE 2020;15:e0226786.

Körber MI, Köhler T, Weiss V, Pfister R, Michels G. Quality of basic life support - a comparison between medical students and paramedics. J Clin Diagn Res 2016;10:OC33-7.

Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005;293:299-304.

St John Western Australia. Out-of-hospital cardiac arrest report 2018. Belmont, Western Australia: SJWA; 2018. Available at: https://stjohnwa.com.au/about-us/corporate-publications

Laerdal Medical. SimPad PLUS with SkillReporter. 2020. Available at: www.laerdal.com/au/products/simulation-training/resuscitation-training/simpad-plus-with-skillreporter/

St John Western Australia. Clinical practice guidelines for ambulance care in Western Australia Version 35.2. Belmont, Western Australia: SJWA; 2020.

Australian Bureau of Statistics. Western Australia STE. 2015 [updated 31 March 2017]. Available at: https://itt.abs.gov.au/itt/r.jsp?RegionSummary&region=5&geoconcept=REGION&dataset=ABS_REGIONAL_ASGS&datasetLGA=ABS_NRP9_LGA&datasetASGS=ABS_REGIONAL_ASGS&regionLGA=REGION&regionASGS=REGION

St John Western Australia. Annual report 2018/2019. Belmont, Western Australia: SJWA; 2019. Available at: https://stjohnwa.com.au/about-us/corporate-publications

Laerdal Medical. CPR scoring explained (revised 15 April). 2015. Available at: http://cdn.laerdal.com/downloads-test/f3784/Att_2_to_00021778.pdf

Australian and New Zealand Committee of Resuscitation. Guideline 8- cardiopulmonary resuscitation. Melbourne: ANZCOR; 2016. Available at: https://resus.org.au/guidelines/

Peberdy MA, Silver A, Ornato JP. Effect of caregiver gender, age, and feedback prompts on chest compression rate and depth. Resuscitation 2009;80:1169-74.

Dyson K, Bray JE, Smith K, et al. Paramedic exposure to out-of-hospital cardiac arrest resuscitation is associated with patient survival. Circ Cardiovasc Qual Outcomes 2016;9:154-60.