Does the heart come alive to the Sound of Music?

We’ve featured the fantastic public health campaigns from the US and the UK using ‘Staying Alive’ by the Bee Gees to help get into the CPR rhythm. But does music really help awaken the heart? Gemma Morabito, who is the driving force behind Italian EM blog and website MedEmIt (, sent us this nice little summary of an Antipodean paper that seeks to answer this question. The summary was written by Andrea Vercelli and originally published in Italian here.

The aim of this article by Woollard et al is to establish if some songs are effective in improving the quality of cardiopulmonary resuscitation; it is a randomized crossover study and a review of scientific literature on the subject.

“Stayin’alive” by the Bee Gees has been used by Hafner et al to help operators to maintain the correct rate of compressions (which in 2008 was 100 bpm): the 15 professional rescuers performed chest compressions at a speed of 109 per minute whilst listening to the song and at a speed of 113 compressions per minute 5 weeks later when recalling the song.

In a training course for lay people, the children’s song “Nellie the elephant” by Ralph Butler was able to achieve a compression rate between 95 and 105 bpm in a higher percentage of participants compared to listening to “That’s the way I like it “or not listening music at all (32% vs 9% vs 12% respectively). Unfortunately the depth of compressions was significantly lower in those who listened to Nellie than those who did not listen to music at all.

In the current study, Woollard et al, have tested “Achy breaky heart” (ABH) of Billy Ray Cyrus (1992) and “Disco Science” (DS) of Mirwais (1999). During the Congress of the Australian College of Ambulance Professionals in Auckland (New Zealand), 74 participants (pre-hospital care professionals) were enrolled in the study and asked to perform 3 sequences of CPR, of one minute each, on a dummy , trying to maintain a frequency between 100 and 120 bpm, with a depth of 50-60 mm. One sequence was performed whilst listening to ABH, another whilst listening to DS and one with no music (NM). The first track has a tempo of 121 per minute, the second of 105 per minute. The order in which the participants had to perform the three sequences was randomized.

in the DS sequences, the percentage of participants reaching the established frequency of compressions was significantly higher (82% vs 64-65%), though the mode of the frequencies of compressions of all groups fell in the range of desired frequency (100 – 120 bpm). There are significant differences in the percentage of operators who perform the compressions at an average depth of between 50 and 60 mm in three different groups (DS 39% vs ABH 43% vs 42%).

If we consider together the frequency and depth of compressions, the music did not result in any benefit to the quality of CPR.

The authors suggest that this field of research of CPR, interesting, but unproductive, should be abandoned.


  • Hafner JW, Sturgell JL, Matlock DL, Bockewitz EG, Barker LT. “Stayin’ Alive”: A Novel Mental Metronome to Maintain Compression Rates in Simulated Cardiac Arrests. J Emerg Med. 2012 Mar 22. [Epub ahead of print] PubMed PMID: 22445896.
  • Rawlins L, Woollard M, Williams J, Hallam P. Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial. BMJ. 2009 Dec 11;339:b4707. PubMed PMID: 20008376; PubMed Central PMCID: PMC2792674.
  • Woollard M, Poposki J, McWhinnie B, Rawlins L, Munro G, O’Meara P. Achy breaky makey wakey heart? A randomised crossover trial of musical prompts. Emerg Med J. 2012 Apr;29(4):290-4. Epub 2011 Nov 2. PubMed PMID: 22048987.

Yet maybe the authors are asking the wrong question?

Sure, these musical accompaniments don’t seem to improve the quality of CPR significantly, but maybe their popularisation increases the chance of bystanders performing CPR in the first place. At LITFL we say get a DJ stat when the Code Blue goes out.

Also until someone studies ‘Another one bites the dust’ this research ain’t yet dead.

Over to you Ken and Vinnie…

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  1. says

    Queen is my preference too!

    One of the big benefits I see to the music is for training purposes. I can tell a class full of people to push at or more than “100 BPM,” but except for the rare drummer or human metronome, nobody knows what that means. It’s not a question of fidelity, that numeric has literally has no meaning, unless you stick out your tongue and figure “well, something like once a second, then half again that, and…” But if you tell them to follow a song that we all know, they instantly understand the target pace.

    I don’t necessarily think they need to be singing while they work a code, but if all we have to do is tell them to push to the beat of the song, *and* to make sure they push deep (hey, isn’t that what we’re generally doing nowadays?), that’s still only a two-step learning curve, and I think that’s not bad at all. Nobody said disco would be everything to everybody, just that it ain’t quite dead yet…

  2. says

    Chris -- my 2 yo loves “nellie he Elephant”, but I think the version you are proffering might leave him with some questions about the way the world functions…..
    Maybe in a few years