The Effectiveness of the İzmir March Rhythm Compared to the International Musical Metronome (“Stayin’ Alive”) in Cardiopulmonary Resuscitation (CPR) Training for Military Personnel: A Randomized Controlled Crossover Pilot Study

Objective: Maintaining the correct chest compression rate is a critical challenge in cardiopulmonary resuscitation (CPR). Although musical metronomes such as “Stayin’ Alive” are widely used, their effectiveness may vary across cultural contexts. This pilot study evaluated whether a culturally relevant Turkish military march, The İzmir March, could serve as an alternative pacing aid for compression-only CPR training in military personnel and described within-cohort retention of the compression rate at 6 weeks.
Material and Methods: We conducted a randomized controlled crossover pilot study involving 20 male military personnel without prior healthcare training. Partici-pants were randomized to receive initial training paced by either the Izmir March (Group M, n=10) or “Stayin’ Alive” (Group S, n=10). CPR performance was recorded using a QCPR manikin at baseline, during music-paced sessions (trained and untrained after a 1-day washout crossover), and at a 6-week music-free follow-up. Paired t-tests and Wilcoxon signed-rank tests with Bonferroni correction were performed.
Results: At 6 weeks, 70% of participants (14/20) maintained a compression rate within the target range of 100–120/min. The Izmir March group achieved a higher mean compression rate than the Stayin’ Alive group (114.8±5.3 vs. 105.5±6.1 compressions/min; p<0.001). However, the Stayin’ Alive group achieved a higher proportion of compressions within the optimal 100–120/min range (adequate rate: 86.3% vs. 79.3%). No carryover effects were observed between conditions.
Conclusion: In this military cohort, within-cohort compression rates moved closer to the recommended target range of 100–120/min at 6 weeks compared with base-line. The Izmir March (115 BPM) yielded a higher mean compression rate than “Stayin’ Alive” (103 BPM), although this between-song difference is heavily confounded by beat frequency. The findings should be interpreted as differences between two music-based pacing strategies rather than as evidence that music-assisted training improves retention compared with standard training. Further trials with non-music controls are needed to evaluate the Izmir March as a culturally familiar pacing aid.

Keywords: Cardiopulmonary resuscitation; compression rate; crossover design; military personnel; music; skill retention