Cardiopulmonary Resuscitation Feedback Devices Research Articles

Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest

BackgroundQuality of chest compressions (CC) during cardiopulmonary resuscitation (CPR) often do not meet guideline recommendations for rate and depth. This may be due to the fatiguing nature of physically compressing a patient’s chest, meaning that CPR quality reduces over time. ObjectiveThis analysis investigates the effect of CPR duration on the performance of continuous CCs delivered by firefighters equipped with CPR feedback devices. MethodsData were collected from a first responder group which used CPR feedback and automatic external defibrillator devices when attending out-of-hospital cardiac arrest events. Depth and rate of CC were analysed for 134 patients. Mean CC depth and rate were calculated every 5 s during two-minute episodes of CPR. Regression models were created to evaluate the relationship between applied CC depth and rate as a function of time. ResultsMean (SD) CC depth during the investigation was 48 (9) mm. An inverse relationship was observed between CC depth and CPR duration, where CC depth decreased by 3.39 mm, over two-minutes of CPR (p < 0.001). Mean (SD) CC rate was 112.06 (5.87) compressions per minute. No significant relationship was observed between CC rate and CPR duration (p = 0.077). Mean depth was within guideline range for 33.58% of patient events, while guideline rate was observed in 92.54% of cases. ConclusionsA reduction in CC depth was observed during two-minutes of continuous CCs while CC rate was not affected. One third of patients received a mean CC depth within guideline range (50 to 60 mm).

Characterization of Infant Cardiopulmonary Resuscitation Delivery with Range Sensor Feedback on Performance

Cardiac arrest (CA) in infants is an issue worldwide, which causes significant morbidity and mortality rates. Cardiopulmonary resuscitation (CPR) is a technique performed in case of CA to save victims’ lives. However, CPR is often not performed effectively, even when delivered by qualified rescuers. Therefore, international guidelines have proposed applying a CPR feedback device to achieve high-quality application of CPR to enhance survival rates. Currently, no feedback device is available to guide learners through infant CPR performance in contrast to a number of adult CPR feedback devices. This study presents a real-time feedback system to improve infant CPR performance by medical staff and laypersons using a commercial CPR infant manikin. The proposed system uses an IR sensor to compare CPR performance obtained with no feedback and with a real-time feedback system. Performance was validated by analysis of the CPR parameters actually delivered against the recommended target parameters. Results show that the real-time feedback system significantly improves the quality of chest compression parameters. The two-thumb compression technique is the achievable and appropriate mechanism applied to infant subjects for delivering high-quality CPR. Under the social distancing constraints imposed by the SARS-CoV-2 pandemic, the results from the training device were sent to a CPR training center and provided each participant with CPR proficiency.

Application of Cardiopulmonary Resuscitation Mechanism in Infant Population: A Short Review

Cardiac arrest (CA) is a significant issue in infants worldwide, which causes disagreeable morbidity and mortality ratios. Thus, cardiopulmonary resuscitation (CPR) is a technique performed in case of cardiac arrest to save victims’ lives. The aim of CPR is to follow the blood flow promoting to the vital organs during the external chest provisional compressions. This technique has been reported to develop CA results. It was reported that CPR was not performed in high quality even when highly qualified rescuers delivered by CPR. Therefore, international guidelines have proposed for applying a CPR feedback device to release high-quality CPR to enhance survival rates. There is currently no feedback device available to guide learners through infant CPR performance compared to the adequate number of the adult in CPR feedback device. This study establishes a background knowledge to understand the CPR technique in infant populations by reviewing the following: the critical role of chest compression and rescue breath during the CPR process, the CPR standards, increasing the cardiac arrest survival rate by performing high-quality CPR, the effect of feedback on CPR performance., outlining the effect of different compression techniques on all the hemodynamic outcomes for delivering high-quality infant CPR.

Is a homemade cardiopulmonary resuscitation (CPR) trainer non-inferior to a commercially available CPR mannequin in teaching high-quality CPR? A non-inferiority randomized control trial

IntroductionStudies demonstrate that feedback devices help students achieve mastery of critical CPR skills and shorten the time from demonstration to competence. CPR feedback devices are costly and may not be available in low resource settings or in the context of online classes. We have developed a homemade feedback enabled CPR trainer. This trainer consists of a lid with two toilet rolls stacked on top. We have shown it is feasible to generate high quality CPR using this trainer, however the ability for this trainer to successfully be used in skill acquisition is unknown.Our main objective was to assess if learning CPR on a homemade toilet paper trainer was non-inferior to a commercially available mannequin when comparing post-training CPR scores. MethodsWe conducted a parallel non-inferiority randomized control trial using a variable block randomization to a 10-min training session on either a toilet paper or commercial mannequin trainer. Primary outcome was mean overall CPR score as determined by high fidelity mannequin software. A sample size of 62 per group was calculated based on a 90% power to assess for the lower limit of a two-sided 95% confidence interval above the non-inferiority limit of 10%. Results125 participants were randomized to the toilet paper (n = 64) or commercial mannequin trainer (n = 61). There was no difference between groups in age, sex, height, weight or previous CPR training. There was an absolute difference of 2% (CI 95% 3.3 to 7.3%) in mean overall CPR score between groups (toilet paper = 82% (SD 15.9%), commercial mannequin = 84% (SD 15%). ConclusionA homemade CPR trainer was non-inferior to a commercially available trainer. This study provides preliminary evidence supporting the use of a homemade, easily accessible trainer for basic compression-only CPR skill acquisition.

Quantification of Passive Ventilation Produced by Manual Chest Compressions Using a New Cardiopulmonary Resuscitation Feedback Device

AbstractSeveral studies have shown that chest compressions (CC) alone may produce in addition to blood circulation, a short-term passive ventilation. However, it is not clear whether high CC quality may produce in even greater amount of ventilation volumes. The aim of this study was to evaluate whether CC, using a new feedback device, can produce a substantial and sustainable passive volumes compared to standard CC. Thirty inexperienced volunteers performed CC for 2 min on a developed thoracic lung model and using a new feedback device. Participants were randomized into two groups that performed either CC with feedback first, followed by a trial without feedback, or vice versa. Efficient compression rate (correct CC rate and depth simultaneously) was significantly higher in feedback session (43.6% versus 25.5%; P = 0.006). As well, CC rate and depth efficiency were improved with feedback. Moreover, average tidal volumes and minute volumes that occurred during CC alone were significantly improved in feedback session (79.8 ± 5 ml versus 72.9 ± 7 ml) and (8.8 l/min versus 7.9 l/min), respectively (P &amp;lt; 0.001). Yet, no significant difference was found between the first and the 90th second interval (9.04 l/min versus 8.68 l/min, P = 0.163) in the feedback session. Conversely, a significant difference was evident after the first 15th seconds interval without feedback (8.77 l/min initially versus 8.38 l/min; P = 0.041). This study revealed that the new CPR feedback device improved CC quality in inexperienced volunteers. As well, the passive ventilation volumes were significantly increased and sustained when the device was used.

Comparing Real-Time Feedback Modalities to Support Optimal Cardiopulmonary Resuscitation for Undergraduate Nursing Students: A Quasi-Experimental Cross-Over Simulation Study

BackgroundOptimal cardiopulmonary resuscitation (CPR) is reliant on a chain of well performed interventions and skills. To investigate whether CPR feedback devices improve performance for nursing students, the effects of three feedback modalities—visual: Laerdal SimPad®; visual-embodied metaphoric: Innosonian Brayden Pro®; and visual-audio: Physio-Control TrueCPR®—was tested. MethodA quasi-experimental cross-over study compared performance metrics of participant exposure to three feedback modalities and standard adult basic life support (BLS) without feedback in a simulated environment. After baseline training, 64 participants performed adult single-rescuer BLS on a manikin for each modality and without feedback for two minutes. Effective chest compressions (correct depth, thoracic recoil, pressure point, rate, no-flow fraction) and ventilation parameters were compared using Friedman and Wilcoxon tests. ResultsSuperior technical accuracy in CPR skills performance was evident with all feedback modalities when compared with no feedback p = <.05); visual-audio feedback (TrueCPR®) was most effective (p = .005). Participants demonstrated higher technical accuracy in CPR performance (30:2 cycles; chest compression number/rate/depth; chest recoil; pressure point; correct number of ventilations) when compared with no feedback (p = .0001), despite achieving national certification three weeks before data collection. ConclusionThis appears to be the first study to explore the use of feedback modalities during CPR performance in nursing students. These feedback devices can play a major role in improving measurable parameters of BLS and psychomotor skill capability. Modalities varied in their ability to improve performance; visual-audio feedback significantly improved chest compressions, ventilation and cycle performance, whereas visual-graph–based feedback improved flow fraction and ventilations.

Effect of Audiovisual Cardiopulmonary Resuscitation Feedback Device on Improving Chest Compression Quality

The one month survival rate after out-of-hospital cardiac arrest (OHCA) in the paediatric population remains low. Improving survival in paediatric OHCA by enhancing the quality of cardiopulmonary resuscitation (CPR) is important. In this study, we aimed to analyse the factors associated with CPR quality by using a real-time feedback device. Participants were prospectively divided into 4 groups: paediatric research fellows, paediatric residents, medical students (clerks), and paediatric critical care nurses. Then, the participants were asked to perform 5 cycles of CPR on a paediatric simulation manikin without prompts from feedback devices, and to repeat another 5 cycles of CPR after education with the 2015 paediatric advanced life support guidelines. A total of 75 participants were evaluated. In the overall analysis, an improvement in the percentage of participants meeting the target compression rate was observed (from 49.82% to 71.23%, P < 0.001). The percentage of participants achieving the target compression depth improved from 73.77% to 85.63% (P = 0.005). Among the 4 groups, the residents showed the most significant improvement in both compression rate (from 48.41% to 86.57%, P < 0.001) and compression depth (from 63.50% to 95.57%, P < 0.001). Inappropriate rate was a more important factor resulting in inadequate CPR performance than inappropriate depth. An excessive compression rate was also a common problem. In conclusions, the real-time CPR feedback device may help clinical physicians and nurses in improving the quality of chest compression. Excessive CPR compression rate may be a major cause of inadequate CPR performance.

Improving paediatric cardiac arrest outcomes: cpr quality improvement collaborative (CPR-QUIC)

Introduction: Cardiopulmonary Resuscitation (CPR) guidelines recommend target values for selected CPR parameters related to rate and depth of chest compressions. International experts in resuscitation science have incorporated real-time CPR feedback into clinical practice and have demonstrated improved functional outcomes after cardiac arrest. Recent technological developments using accelerometer-based measurements incorporated into defibrillator systems, allow for real-time monitoring and feedback of CPR quality during resuscitation attempts. Aims: To improve the quality of CPR delivered to cardiac arrest patients in a paediatric intensive care unit (PICU) using defibrillators with real-time CPR feedback. To determine the association between quantitative CPR measures and patient outcomes after cardiac arrest. Methods: A bedside resuscitation training program was designed for the implementation of real-time CPR feedback devices. Medical and nursing staff were taught to interpret CPR metrics (depth and rate) on task trainers and CPR quality feedback training was incorporated into simulation-based education. Real-time CPR feedback technology was implemented in February 2019 and quantitative chest compression data was collected on all cardiac arrests in PICU. The data from each CPR event, metrics and time to defibrillation, was analysed. The arrest event data was reported to an international study collaborative to help determine the association between chest compression mechanics and patient outcomes. Results: Real-time CPR feedback used during resuscitation training improved staff performance. Since implementation, real-time CPR feedback was used in four arrest events and all patients survived to discharge from intensive care. The implementation of the project led to the standardisation of resuscitation training, cardiac arrest management and facilitated local process change within the PICU. Conclusion: We were the first institution in Australia to report paediatric cardiac arrest data for international benchmarking to improve patient outcomes after cardiac arrest. The CPR data collected provided objective feedback to resuscitation teams and guided training in order to improve performance.

Use of Capnography and Cardiopulmonary Resuscitation Feedback Devices Among Prehospital Advanced Life Support Providers.

Capnography and cardiopulmonary resuscitation (CPR) feedback devices have been shown to improve resuscitation outcomes, with the American Heart Association recommending their use during advanced life support (ALS). Little is known about the availability of these devices, their protocoled use, and the attitudes toward them in the prehospital setting. The objectives of this study were to assess the availability of capnography and CPR feedback devices among prehospital ALS agencies in New York State (NYS), to describe the protocoled use of these devices, and to evaluate the attitudes of providers toward the use of these devices. Prehospital agencies that provide ALS services in NYS were identified using an online registry. Managers in these agencies were contacted by electronic mail and asked to complete a questionnaire regarding their agency's experience with capnography and CPR feedback devices. The questionnaire included questions on the availability of capnography and CPR feedback devices, the existence of clinical protocols for using capnography, and provider opinion on the utility of capnography and CPR feedback devices for improving pediatric resuscitation. Of 710 ALS agencies, 238 (33.5%) completed the survey. Ninety-five percent and 24% of agencies reported having capnography and CPR feedback devices available aboard ambulances, respectively. Ninety-seven percent of agencies reported having capnography clinical protocols for endotracheal intubation, 63% for return of spontaneous circulation, and 54% for guiding CPR. Forty-seven percent agreed that capnography improves outcomes in the resuscitation of pediatric patients, whereas 51% of providers were neutral and 2% disagreed. Capnography is available in most NYS ALS agencies surveyed. Cardiopulmonary resuscitation feedback devices are less common. Protocols for the use of capnography mainly focused on endotracheal intubation and less for the recognition of return of spontaneous circulation and for guiding CPR. Half of the providers surveyed were neutral on whether capnography improves outcomes in the resuscitation of pediatric patients.

Real-time feedback, debriefing, and retraining system of cardiopulmonary resuscitation for out-of-hospital cardiac arrests: a study protocol for a cluster parallel-group randomized controlled trial

BackgroundThe quality of cardiopulmonary resuscitation (CPR) performed by emergency medical services (EMS) personnel affects patient outcomes after cardiac arrest. A CPR feedback device with an accelerometer mounted on a defibrillator can monitor the motion of the patient’s sternum to display and record CPR quality in real time. To evaluate the utility of real-time feedback, debriefing, and retraining using a CPR feedback device outside of the hospital, an open-label, cluster randomized controlled trial will be conducted in five municipalities of Osaka Prefecture, Japan.MethodsEach EMS station within a fire department will be randomly assigned to: 1) the treatment group with real-time feedback, debriefing, and retraining using the CPR feedback device (intervention group); or 2) the conventional treatment group without real-time feedback, debriefing, and retraining (control group). This trial will include 2850 to 3020 patients over about 4 years. The primary outcome of the trial is 1-month favorable neurological survival, defined as cerebral performance category scale score 1 or 2. Secondary outcomes are 1-month survival, survival to hospital discharge, return of spontaneous circulation, and quality of CPR including fraction, depth, tempo, and ventilation rate.DiscussionThe trial will assess whether treatment monitored by the CPR feedback device, which allows for real-time feedback, debriefing, and retraining using CPR quality data, outperforms conventional treatment without real-time feedback, debriefing, and retraining in terms of 1-month favorable neurological survival in cardiac arrest patients receiving CPR outside the hospital.Trial registrationUniversity Hospital Medical Information Network (UMIN) Clinical Trials Registry, UMIN000021431. Registered on 11 March 2016.

Monitoring chest compression quality during cardiopulmonary resuscitation: Proof-of-concept of a single accelerometer-based feedback algorithm

BackgroundThe use of real-time feedback systems to guide rescuers during cardiopulmonary resuscitation (CPR) significantly contributes to improve adherence to published resuscitation guidelines. Recently, we designed a novel method for computing depth and rate of chest compressions relying solely on the spectral analysis of chest acceleration. That method was extensively tested in a simulated manikin scenario. The purpose of this study is to report the results of this method as tested in human out-of-hospital cardiac arrest (OHCA) cases.Materials and methodsThe algorithm was evaluated retrospectively with seventy five OHCA episodes recorded by monitor-defibrillators equipped with a CPR feedback device. The acceleration signal and the compression signal computed by the CPR feedback device were stored in each episode. The algorithm was continuously applied to the acceleration signals. The depth and rate values estimated every 2-s from the acceleration data were compared to the reference values obtained from the compression signal. The performance of the algorithm was assesed in terms of the sensitivity and positive predictive value (PPV) for detecting compressions and in terms of its accuracy through the analysis of measurement error.ResultsThe algorithm reported a global sensitivity and PPV of 99.98% and 99.79%, respectively. The median (P75) unsigned error in depth and rate was 0.9 (1.7) mm and 1.0 (1.7) cpm, respectively. In 95% of the analyzed 2-s windows the error was below 3.5 mm and 3.1 cpm, respectively.ConclusionsThe CPR feedback algorithm proved to be reliable and accurate when tested retrospectively with human OHCA episodes. A new CPR feedback device based on this algorithm could be helpful in the resuscitation field.

A better understanding of ambulance personnel's attitude towards real-time resuscitation feedback.

High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. The survey was conducted in the German cities Dortmund and Münster. Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.

Kardiyopulmoner resüsitasyon eğitimi eğitimsiz kurtarıcıların acil yanıt sistemi görevlisi kılavuzluğunda uyguladığı temel yaşam desteğinin kalitesini arttırmaktadır

Objective : The people who aid patients in cardiac arrest in daily life are those who witness the event in the immediate environment. In cases of cardiac arrest, which anyone can encounter at any time and place, the application of correct and efficient basic life support by bystanders contributes significantly to the patient’s survival. In this study, our aim was to compare the efficiency of cardiopulmonary resuscitation (CPR) by untrained lay rescuers assisted by a dispatcher with CPR by the same persons without assistance from a dispatcher after they are provided with CPR training. Material and Methods : We planned the study prospectively on 5th year students of the Baskent University Faculty of Dentistry. We placed each study participant one by one in a room where there was a model of basic life support (BLS) and a CPR feedback device. We provided participants with a scenario of BLS taking place in a public space. At that time, we contacted a dispatcher who was standing in another room. We asked participants to apply one 2-min cycle of CPR consisting only of chest compression with the dispatcher’s assistance. After we recorded data on all participants, we provided them BLS training. We re-evaluated all participants’ CPR abilities immediately after this. Results : Thirty-seven 5th year Faculty of Dentistry students participated in our study. The median age of participants was 23.22±1.31. The gender distribution was 16.2% male and 83.7% female. There was a statistically significant difference between the number of chest compressions applied before (89.27±24.53) and after training (110.59±21.92) ( p <0.001). There was a statistically significant difference between the measurements of compression times, the ratio of proper compressions to all compressions, and the compression percentages before and after training ( p <0.005; <0.005 and <0.001 respectively). Conclusion : The results of our study clearly reveal that the CPR applied by trained laypersons is distinctly superior to CPR with the assistance of a dispatcher.

Paramedic-reported barriers towards use of CPR feedback devices in Perth, Western Australia

Feedback devices for cardiopulmonary resuscitation (CPR) have been introduced across a number of emergency medical services (EMS) worldwide with the intention of increasing the provision of high quality CPR. In July 2014, St. John Ambulance Western Australia (SJA-WA) introduced the Q-CPRTM device into mandatory clinical practice; however usage rates were lower than expected. Methods: A voluntary, anonymous survey was issued to a convenience sample of SJA-WA paramedics from September to December 2015 to determine the paramedic-reported barriers towards the use of Q-CP Results: Of the 264 paramedics who participated in the survey, 41% reported having used Q-CPR during their last attempted resuscitation. Among those who had not used it, the reason most commonly cited (37%) was that a mechanical chest compression device arrived on scene prior to the Q-CPR being deployed. Secondly, other interventions were prioritized above the use of Q-CPR (20%). Thirdly, pain associated with use of the Q-CPR prevented its utilization in 17% of cases. Other reasons were less frequently reported. Conclusion: Lower usage rates appeared to be primarily linked to the utilisation of other equipment and interventions in preference to the Q-CPR and to a lesser extent due to pain associated with the use of such devices.

COMPARISON OF STANDARD CPR AND CPR FEEDBACK METHODS IN TERMS OF THE EFFECTIVENESS OF CHEST COMPRESSIONS DURING CARDIOPULMONARY RESUSCITATION: A RANDOMIZED CONTROLLED STUDY

Objectives & BackgroundThe primary purpose of the study was to compare the metrics on the effectiveness of chest compressions obtained through an advanced CPR (cardiopulmonary resuscitation) manikin and a real-time...

Cardiopulmonary resuscitation quality and beyond: the need to improve real-time feedback and physiologic monitoring.

High-quality cardiopulmonary resuscitation (CPR) has been shown to improve survival outcomes after cardiac arrest. The current standard in studies evaluating CPR quality is to measure CPR process measures—for example, chest compression rate, depth, and fraction. Published studies evaluating CPR feedback devices have yielded mixed results. Newer approaches that seek to optimize CPR by measuring physiological endpoints during the resuscitation may lead to individualized patient care and improved patient outcomes.

Effect of the Cardio First Angel™ device on CPR indices: a randomized controlled clinical trial.

BackgroundA number of cardiopulmonary resuscitation (CPR) adjunct devices have been developed to improve the consistency and quality of manual chest compressions. We investigated whether a CPR feedback device would improve CPR quality and consistency, as well as patient survival.MethodsWe conducted a randomized controlled study of patients undergoing CPR for cardiac arrest in the mixed medical-surgical intensive care units of four academic teaching hospitals. Patients were randomized to receive either standard manual CPR or CPR using the Cardio First Angel™ CPR feedback device. Recorded variables included guideline adherence, CPR quality, return of spontaneous circulation (ROSC) rates, and CPR-associated morbidity.ResultsA total of 229 subjects were randomized; 149 were excluded; and 80 were included. Patient demographics were similar. Adherence to published CPR guidelines and CPR quality was significantly improved in the intervention group (p < 0.0001), as were ROSC rates (72 % vs. 35 %; p = 0.001). A significant decrease was observed in rib fractures (57 % vs. 85 %; p = 0.02), but not sternum fractures (5 % vs. 17 %; p = 0.15).ConclusionsUse of the Cardio First Angel™ CPR feedback device improved adherence to published CPR guidelines and CPR quality, and it was associated with increased rates of ROSC. A decrease in rib but not sternum fractures was observed with device use. Further independent prospective validation is warranted to determine if these results are reproducible in other acute care settings.Trial registrationClinicalTrials.gov identifier: NCT02394977. Registered on 5 Mar 2015.

Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative

BackgroundTeam-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8–10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown. ObjectivesTo determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR. MethodsThis retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1–2. ResultsOf 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50–81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7–8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2–5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR feedback device (OR 0.47), and endotracheal intubation (OR 0.44) were associated with less likelihood for a good neurologic outcome. ConclusionIn our statewide OHCA cohort, TFCPR was associated with improved survival with good neurological outcome.

Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses

BackgroundOut-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. MethodsThis was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. ResultsComparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min−1). ConclusionsDuring the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.

Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial.

The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. The quality of CPR was poor in the control group, with 12.7% (95% CI, 5.2%-20.1%) mean depth compliance and 27.1% (95% CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9% (95% CI, 11.1%-28.7%; P < .001) and rate compliance by 12.0% (95% CI, 0.8%-23.2%; P = .037). Visual feedback compared with no VisF improved depth compliance by 15.4% (95% CI, 6.6%-24.2%; P = .001) and rate compliance by 40.1% (95% CI, 28.8%-51.3%; P < .001). Neither intervention had a statistically significant effect on CC fraction, which was excellent (>89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines but was not significantly better than either intervention in isolation. The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes. clinicaltrials.gov Identifier: NCT02075450.