Cardiopulmonary Resuscitation Feedback Research Articles

Association of Real-Time Feedback and Cardiopulmonary-Resuscitation Quality Delivered by Ambulance Personnel for Out-of-Hospital Cardiac Arrest.

Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) (P=0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively (P<0.001). Median chest compression rate per minute was 111 and 109 (P<0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% (P<0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% (P<0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) (P<0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252.

Feedback Devices for Cardiopulmonary Resuscitation: A Narrative Review

The application of feedback devices for cardiopulmonary resuscitation (CPR) can effectively enhance the quality of life-saving treatment during CPR. This article is a narrative review that selects literature on feedback devices used in chest compression and provides a comprehensive review and analysis of the development and current research status of feedback devices used in CPR. The development status of visual–auditory feedback devices used in chest compression at home and abroad and the advantages and disadvantages of existing feedback devices are the main points of discussion. Based on existing devices and technologies, this article explores the difficulties and deficiencies of current feedback device development. Finally, we propose the future development direction of CPR feedback equipment combined with physiological information data-monitoring devices.

Pediatric Chest Compression Improvement Via Augmented Reality Cardiopulmonary Resuscitation Feedback in Community General Emergency Departments: A Mixed-Methods Simulation-Based Pilot Study

BackgroundYearly, more than 20,000 children experience a cardiac arrest. High-quality pediatric cardiopulmonary resuscitation (CPR) is generally challenging for community hospital teams, where pediatric cardiac arrest is infrequent. Current feedback systems are insufficient. Therefore, we developed an augmented reality (AR) CPR feedback system for use in many settings. ObjectiveWe aimed to evaluate whether AR-CPR improves chest compression (CC) performance in non–pediatric-specialized community emergency departments (EDs). MethodsWe performed an unblinded, randomized, crossover simulation-based study. A convenience sample of community ED nonpediatric nurses and technicians were included. Each participant performed three 2-min cycles of CC during a simulated pediatric cardiac arrest. Participants were randomized to use AR-CPR in one of three CC cycles. Afterward, participants participated in a qualitative interview to inquire about their experience with AR-CPR. ResultsOf 36 participants, 18 were randomized to AR-CPR in cycle 2 (group A) and 18 were randomized to AR-CPR in cycle 3 (group B). When using AR-CPR, 87–90% (SD 12–13%) of all CCs were in goal range, analyzed as 1-min intervals, compared with 18–21% (SD 30–33%) without feedback (p < 0.001). Analysis of qualitative themes revealed that AR-CPR may be usable without a device orientation, be effective at cognitive offloading, and reduce anxiety around and enhance confidence in the CC delivered. ConclusionsThe novel CPR feedback system, AR-CPR, significantly changed the CC performance in community hospital non–pediatric-specialized general EDs from 18–21% to 87–90% of CC epochs at goal. This study offers preliminary evidence suggesting AR-CPR improves CC quality in community hospital settings.

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).

Paediatric chest compression performance improves via novel augmented-reality cardiopulmonary resuscitation feedback system: A mixed-methods pilot study in a simulation-based setting

AimMore than 20,000 children experience a cardiac arrest event each year in the United States. Most children do not survive. High-quality cardiopulmonary resuscitation (CPR) has been associated with improved outcomes yet adherence to guidelines is poor. We developed and tested an augmented reality head mounted display chest compression (CC) feedback system (AR-CPR) designed to provide real-time CC feedback and guidance. MethodsWe conducted an unblinded randomized crossover simulation-based study to determine whether AR-CPR changes a user's CC performance. A convenience sample of healthcare providers who perform CC on children were included. Subjects performed three two-minute cycles of CC during a simulated 18-minute paediatric cardiac arrest. Subjects were randomized to utilize AR-CPR in the second or third CC cycle. After, subjects participated in a qualitative portion to inquire about their experience with AR-CPR and offer criticisms and suggestions for future development. ResultsThere were 34 subjects recruited. Sixteen subjects were randomly assigned to have AR-CPR in cycle two (Group A) and 18 subjects were randomized to have AR-CPR in cycle three (Group B). There were no differences between groups CC performance in cycle one (baseline). In cycle two, subjects in Group A had 73% (SD 18%) perfect CC epochs compared to 17% (SD 26%) in Group B (p < 0.001). Overall, subjects enjoyed using AR-CPR and felt it improved their CC performance. ConclusionThis novel AR-CPR feedback system showed significant CC performance change closer to CC guidelines. Numerous hardware, software, and user interface improvements were made during this pilot study.

A Smartphone application to provide real-time cardiopulmonary resuscitation quality feedback

BackgroundQuality of cardiopulmonary resuscitation (CPR) contributes significantly to outcomes. Key determinants of CPR quality pertaining to chest compressions are compression rate, compression depth, duration of interruptions, and chest recoil. Several studies have demonstrated that real-time audiovisual feedback improves CPR quality. We hypothesize that a mobile application using sensor data from built-in accelerometers in smartphones can provide accurate chest compression quality feedback in real time. This study aims to develop and validate an application for smartphone which can provide real-time audiovisual and haptic feedback on determinants of CPR quality. MethodsA mobile application was developed to detect the compression depth and compression rate in real time using data captured from a smartphone's intrinsic accelerometer. The mobile device was placed on an adult manikin's chest at the point of compressions. In a simulated environment, data obtained using the application was compared directly to data obtained from a validated standard CPR quality tool. ResultsCPR quality parameters were obtained from the application and industry standard for 60, 30s-long sessions. Bland-Altman plot analysis for compression depth showed agreement between the app measurements and standard within ±4 mm (<10% error). The interclass correlation for agreement in the measurement of compression count was 0.92 (95% CI: 0.88–0.95), indicative of very strong agreement. ConclusionsSmart device applications using acceleration sensor data derived from smart phones can accurately provide real-time CPR quality feedback. With further development and validation, they can provide a ubiquitously available CPR feedback tool valuable for out-of-hospital arrests and in-hospital arrests in under-privileged areas.

Effectiveness of Innovation Basic Life Support Training Devices to Layperson: A Randomized Controlled Trial

Objectives: The use of a cardiopulmonary resuscitation feedback device and automated external defibrillator trainer is beneficial in basic life support (BLS) training. Nevertheless, Thailand lacks these devices in BLS support training. This study aimed to compare the efficacy of the Chiang Mai BLS training devices with conventional training devices in BLS training for laypeople.Material and Methods: A randomized controlled trial was conducted to compare the efficacy of the Chiang Mai device group with the conventional device group, by assessing the theory and practical examination scores of the participants; who were adult, laypeople attending the BLS provider course endorsed by the Thai Resuscitation Council. Evaluating instructors were blinded from both groups of participants.Results: A total of 60 adult, laypeople participants were divided into two groups: 32 and 28 participants of the Chiang Mai device group and conventional device group, respectively. Overall examination scores of included participants were very high. The participants in the Chiang Mai device group had a higher median score of multiple-choice question assessment [9.0/9.0 (8.5-9.0) vs 8.5/9.0 (8.0-9.0) points, p-value=0.134] as well as a higher median score of practical examination [26.0/26.0 (24.3-26.0) vs 25.0/26.0 (24.0-26.0) points, p-value=0.278] when compared to those using conventional BLS training devices. However, there was no statistical significance between both groups.Conclusion: The effectiveness of the Chiang Mai BLS training device in basic life support training for adult laypeople is comparable to conventional BLS training devices.

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.

EEG-Based Prediction of the Recovery of Carotid Blood Flow during Cardiopulmonary Resuscitation in a Swine Model.

The recovery of cerebral circulation during cardiopulmonary resuscitation (CPR) is important to improve the neurologic outcomes of cardiac arrest patients. To evaluate the feasibility of an electroencephalogram (EEG)-based prediction model as a CPR feedback indicator of high- or low-CBF carotid blood flow (CBF), the frontal EEG and hemodynamic data including CBF were measured during animal experiments with a ventricular fibrillation (VF) swine model. The most significant 10 EEG parameters in the time, frequency and entropy domains were determined by neighborhood component analysis and Student’s t-test for discriminating high- or low-CBF recovery with a division criterion of 30%. As a binary CBF classifier, the performances of logistic regression, support vector machine (SVM), k-nearest neighbor, random forest and multilayer perceptron algorithms were compared with eight-fold cross-validation. The three-order polynomial kernel-based SVM model showed the best accuracy of 0.853. The sensitivity, specificity, F1 score and area under the curve of the SVM model were 0.807, 0.906, 0.853 and 0.909, respectively. An automated CBF classifier derived from non-invasive EEG is feasible as a potential indicator of the CBF recovery during CPR in a VF swine model.

Impact of a Smart-Ring-Based Feedback System on the Quality of Chest Compressions in Adult Cardiac Arrest: A Randomized Preliminary Study.

This study aimed to assess the effectiveness of a novel chest compression (CC) smart-ring-based feedback system in a manikin simulation. In this randomized, crossover, controlled study, we evaluated the effect of smart-ring CC feedback on cardiopulmonary resuscitation (CPR). The learnability and usability of the tool were evaluated with the System Usability Scale (SUS). Participants were divided into two groups and each performed CCs with and without feedback 2 weeks apart, using different orders. The primary outcome was compression depth; the proportion of accurate-depth (5–6 cm) CCs, CC rate, and the proportion of complete CCs (≤1 cm of residual leaning) were assessed additionally. The feedback group and the non-feedback group showed significant differences in compression depth (52.1 (46.3–54.8) vs. 47.1 (40.5–49.9) mm, p = 0.021). The proportion of accurate-depth CCs was significantly higher in the interventional than in the control condition (88.7 (30.0–99.1) vs. 22.6 (0.0–58.5%), p = 0.033). The mean SUS score was 83.9 ± 8.7 points. The acceptability ranges were ‘acceptable’, and the adjective rating was ‘excellent’. CCs with smart-ring feedback could help achieve the ideal range of depth during CPR. The smart-ring may be a valuable source of CPR feedback.

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.

Cardiopulmonary Resuscitation Feedback: A Comparison of Device-Measured and Self-Assessed Chest Compression Quality

BackgroundHigh-quality cardiopulmonary resuscitation is the foundation of cardiac arrest care. Guidelines specify chest compression depth, recoil, and rate, but providers often fail to achieve these targets. Furthermore, providers are largely unable assess the quality of their own or other peoples’ chest compressions. Chest compression feedback devices can improve chest compression quality; their use is endorsed internationally, but they remain largely absent in clinical care.This article analyzes preclinical data collected during a quality improvement project. It describes provider demographics and perceptions about their chest compression quality and correlates them to measured chest compression quality, compares clinician perception of chest compressions to objective measures, and describes the effect of feedback on compression quality. MethodsClinicians were recruited from 2 metropolitan emergency departments. A questionnaire was used to assess participants’ levels of training and experience. A before-and-after assessment of chest compression quality was performed using a Laerdal CPRmeter 2 and a CPR mannequin. Pretest measures of chest compression quality were made by covering the device screen thereby blinding providers to feedback; repeat measures were then collected from the same participants but unblinded to feedback. Provider charecteristic were collected by survey. Correlations between blinded chest compression quality and provider charecteristics; the reliability of providers estimated compared to measured quality; and the effects of feedback on chest compression quality were assessed using Pearsons correlations, Cohens κ, and paired t testing. Results84 participants were assessed. The mean years of certification were 11.74. Ninty-five percent of the providers self-assessed as more experienced than novice and 81% reported performing cardiopulmonary resuscitation at least occasionally. The frequency of performing chest compressions was correlated with self-assessed skill (r = 0.58, P < .001). However, self-assessed skill was only weakly correlated with chest compression quality (r = 0.29, P = .01) and not at all with the frequency of performing chest compressions or years of certification. There was no agreement between self-assessed and device-measured chest compression depth (κ = −0.10, P = 0.11), recoil (κ = −0.14, P = .03), or rate (κ = 0.06, P =.30). The overall quality of compressions improved by 16.9%; the percentage of chest compressions achieving target depth by 3.58%; recoil by 22.82%; and rate by 23.66% with feedback. A total of 97.6% of the staff rated chest compression feedback helpful. ConclusionsOur findings suggest that participants’ demographics were not correlated with chest compression quality and that providers cannot reliably assess chest compression quality. The data also demonstrate that with minimal training, feedback can significantly improve chest compression quality.

Impact of an untrained CPR Coach in simulated pediatric cardiopulmonary arrest: A pilot study

AimTo determine if an untrained cardiopulmonary resuscitation (CPR) Coach, with no access to real-time CPR feedback technology, improves CPR quality. MethodsThis was a prospective randomized pilot study at a tertiary care children's hospital that aimed to integrate an untrained CPR Coach into resuscitation teams during simulated pediatric cardiac arrest. Simulation events were randomized to two arms: control (no CPR Coach) or intervention (CPR Coach). Simulations were run by pediatric intensive care unit (PICU) providers and video recorded. Scenarios focused on full cardiopulmonary arrest; neither team had access to real-time CPR feedback technology. The primary outcome was CPR quality. Secondary outcomes included workload assessments of the team leader and CPR Coach using the NASA Task Load Index and perceptions of CPR quality. ResultsThirteen simulations were performed; 5 were randomized to include a CPR Coach. There was a significantly shorter duration to backboard placement in the intervention group (median 20s [IQR 0–27s] vs. 52s [IQR 38–65s], p=0.02). There was no self-reported change in the team leader's workload between scenarios using a CPR Coach compared to those without a CPR Coach. There were no significant changes in subjective CPR quality measures. ConclusionsIn this pilot study, inclusion of an untrained CPR Coach during simulated CPR shortened time to backboard placement but did not improve most metrics of CPR quality or significantly affect team leader workload. More research is needed to better assess the value of a CPR Coach and its potential impact in real-world resuscitation.

Manual ventilation quality is improved with a real-time visual feedback system during simulated resuscitation

IntroductionManual ventilations during cardiac arrest are frequently performed outside of recommended guidelines. Real-time feedback has been shown to improve chest compression quality, but the use of feedback to guide ventilation volume and rate has not been studied. The purpose of this study was to determine whether the use of a real-time visual feedback system for ventilation volume and rate improves manual ventilation quality during simulated cardiac arrest.MethodsTeams of 2 emergency medical technicians (EMTs) performed two 8-min rounds of cardiopulmonary resuscitation (CPR) on a manikin during a simulated cardiac arrest scenario with one EMT performing ventilations while the other performed compressions. The EMTs switched roles every 2 min. During the first round of CPR, ventilation and chest compression feedback was disabled on a monitor/defibrillator. Following a 20-min rest period and a brief session to familiarize the EMTs with the feedback technology, the trial was repeated with feedback enabled. The primary outcome variables for the study were ventilations and chest compressions within target. Ventilation rate (target, 8–10 breaths/minute) and tidal volume (target, 425–575 ml) were measured using a novel differential pressure-based flow sensor. Data were analyzed using paired t tests.ResultsTen teams of 2 EMTs completed the study. Mean percentages of ventilations performed in target for rate (41% vs. 71%, p < 0.01), for volume (31% vs. 79%, p < 0.01), and for rate and volume together (10% vs. 63%, p < 0.01) were significantly greater with feedback.ConclusionThe use of a novel visual feedback system for ventilation quality increased the percentage of ventilations in target for rate and volume during simulated CPR. Real-time feedback to perform ventilations within recommended guidelines during cardiac arrest should be further investigated in human resuscitation.

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.

Emergency Department Ergonomic Redesign Improves Team Satisfaction in Cardiopulmonary Resuscitation Delivery: A Simulation-Based Quality Improvement Approach.

Delivering high-quality cardiopulmonary resuscitation (CPR) requires teams to administer highly choreographed care. The American Heart Association recommends audiovisual feedback for real-time optimization of CPR performance. In our Emergency Department (ED) resuscitation bays, ZOLL cardiac resuscitation device visibility was limited. To optimize the physical layout of our resuscitation rooms to improve cardiac resuscitation device visibility for real-time CPR feedback. A simulated case of cardiac arrest with iterative ergonomic modifications was performed four times. Variables included the locations of the cardiac resuscitation device and of team members. Participants completed individual surveys and provided qualitative comments in a group debriefing. The primary outcome of interest was participants' perception of cardiac resuscitation device visibility. The highest scoring layout placed the cardiac resuscitation device directly across from the compressor and mirrored the device screen to a television mounted at the head of the bed. Comparing this configuration to our standard configuration on a five-point Likert scale, cardiac resuscitation device visibility increased 46.7% for all team members, 150% for the team leader, and 179% for team members performing chest compressions. An iterative, multidisciplinary, simulation-based approach can improve team satisfaction with important clinical care factors when caring for patients suffering cardiac arrest in the ED.

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.