Am J Emerg Med. 2025 Dec 1;100:148-153. doi: 10.1016/j.ajem.2025.11.029. Online ahead of print.

BACKGROUND: Specific muscular fitness indicators and their predictive thresholds for high-quality CPR have not been well established. Therefore, a randomized crossover study was designed to investigate the relationship between muscular fitness and CPR performance under continuous chest compressions and 30:2 strategies, and to identify fitness-based thresholds for predicting effective chest compressions.

METHODS: Fifty-seven participants certified to perform CPR completed three muscular fitness assessments: handgrip strength, push-up, and curl-up tests. Participants performed 6 min of CPR using both continuous chest compressions and 30:2 protocols. Compression depth, force, and rate were recorded using a pressure mat and skill-reporting system. Correlation and receiver operating characteristic (ROC) analyses were conducted to determine associations between muscular fitness and CPR quality and to identify the predictive threshold of effective performance.

RESULTS: Among all muscular fitness indicators, handgrip strength showed the strongest correlation with both compression force (r = 0.59-0.68) and depth (r = 0.77-0.81) across all time intervals and CPR strategies. ROC analysis identified handgrip strength thresholds of 82.5 kg for high-quality CPR during the first 2 min, and 93.85 kg for sustained performance over 6 min (AUC = 0.85-0.94, p < 0.001). The 30:2 CPR consistently produced higher compression force and depth compared to continuous chest compressions, with increasing differences over time.

CONCLUSIONS: Handgrip strength is a robust predictor of high-quality CPR performance. The identified thresholds may inform evidence-based training, provider rotation strategies, and screening for CPR readiness, particularly in individuals at risk of fatigue-related performance decline.

PubMed:41365044 | DOI:10.1016/j.ajem.2025.11.029