# How Performing Chest Compressions Influences Mental Arithmetic Capabilities: A Randomized Cross-Over Trial

## TL;DR

This study shows that performing chest compressions during CPR significantly reduces mental arithmetic performance and increases perceived workload.

## Contribution

The study provides empirical evidence that chest compressions impair cognitive performance and reduce CPR quality during multitasking.

## Key findings

- Correct PASAT answers were significantly lower during chest compressions compared to the control condition.
- Perceived workload increased significantly during chest compressions, as measured by the NASA TLX.
- Chest compression quality decreased during multitasking, with increased incomplete recoil.

## Abstract

Background/Objectives: Performing cardiopulmonary resuscitation (CPR) is cognitively demanding, often requiring helpers to perform cognitive and manual tasks simultaneously. While the human brain primarily switches between tasks rather than processing them simultaneously, it remains unclear whether performing repetitive, monotonous manual tasks, such as chest compressions, affects cognitive performance. This study aimed to assess the impact of chest compressions on mental arithmetic performance. Methods: In a randomized crossover trial, healthy participants trained in advanced life support (physicians, nurses, and paramedics) completed the Paced Auditory Serial Addition Test (PASAT) under two conditions: with or without performing chest compressions on a manikin. The primary outcome was the number of correct PASAT answers. Secondary outcomes included workload assessment using the NASA Task Load Index (TLX) and chest compression (CC) performance. The trial was registered at clinicaltrials.gov and approved by the local ethics committee. Results: Thirty-eight participants were included. The number of correct PASAT responses was significantly lower during chest compressions compared to the control (36.5 vs. 41; p < 0.01). NASA TLX values were significantly higher in the chest compression condition, indicating increased perceived workload. Chest compression performance showed statistically significant differences between a phase of just chest compressions and during the PASAT, especially increased levels of incomplete recoil. Conclusions: This study demonstrates that even a simple repetitive motor task like chest compressions impairs cognitive task performance significantly. Furthermore, multitasking was shown to decrease chest compression quality. These findings strongly highlight the importance of effective task allocation and minimizing multitasking during CPR to optimize performance and thereby patient outcomes.