External chest compressions using a mechanical feedback device: Cross-over simulation study

The effect of audiovisual feedback of monitor/defibrillators on percentage of appropriate compression depth and rate during cardiopulmonary resuscitation

BACKGROUND

High quality cardiopulmonary resuscitation (CPR) is one of the key elements of the survival chain in cardiac arrest. Audiovisual feedback of chest compressions have been suggested to be beneficial by increasing the quality of CPR in the simulated cardiac arrests.

METHODS

A prospective before and after study was performed to investigate the effect of a real-time audiovisual feedback system on CPR quality during in-hospital cardiac arrest in intensive care units from November 2018 to February 2022. In the feedback period, CPR was performed with the aid of the real-time audiovisual feedback system. The primary outcome was the percentage of compressions with both adequate depth (5.0-6.0 cm) and rate (100-120/minute).

RESULTS

A total of 27,295 compressions in 30 cardiac arrests in the no-feedback period and 27,965 compressions in 30 arrests in the feedback period were analyzed. The percentage of compressions with both adequate depth and rate was 11.8% in the feedback period and 16.8% in the no-feedback period (P < 0.01). The percentage of compressions with adequate rate in the feedback period was lower than that in the no-feedback period (67.3% vs. 75.5%, P < 0.01). The percentage of beyond-target depth with the feedback was significantly higher than that without feedback (64.2% vs. 51.4%, P < 0.01).

CONCLUSION

Real-time audiovisual feedback system did not increase CPR quality and was associated with a higher percentage of compression depth deeper than the recommended 5.0-6.0 cm. It is essential to explore more effective ways of implementing feedback in real clinical settings to improve of the quality of CPR.

TRIAL REGISTRATION

NCT03902873 (study start: Nov. 2018, initial release April 2019, retrospectively registered).

Effect of a feedback system on the quality of 2-minute chest compression-only cardiopulmonary resuscitation: a randomised crossover simulation study

OBJECTIVE

We evaluated the quality of 2-minute continuous chest compressions (CCCs) performed by emergency staff in 30-second intervals to determine the effect of a feedback system on maintaining the quality of CCCs.

METHODS

Two hundred three physicians and nurses were randomised into two groups. Each participant performed 2-minute CCCs both with and without feedback. Group A performed CCCs under the guidance of a feedback device followed by performance without feedback, and Group B performed these tasks in reverse order. The primary outcome was the proportion of optimal compressions; i.e., compressions at both the correct rate (100-120 beats/minute) and correct depth (5-6 cm).

RESULTS

During 2-minute CCCs, the proportion of optimal compressions was poor in personnel without feedback. The proportion of optimal compressions was unchanged and low from 2.4% (interquartile range, 0.0%-32.8%) in the first 30 seconds to 3.3% (0.0%-47.7%) in the last 30 seconds of the 2-minute period. Use of the feedback device significantly improved and maintained the quality of compressions from the first 30 seconds (53.3%; 29.2%-70.4%) to the last 30 seconds (82.8%; 50.8%-96.2%).

CONCLUSION

Use of the feedback device was helpful for maintaining the quality of CCCs.

Real-Time Cardiopulmonary Resuscitation Feedback and Targeted Training Improve Chest Compression Performance in a Cohort of International Healthcare Providers

BACKGROUND

Optimal cardiopulmonary resuscitation (CPR) performance is the foundation of successful cardiac arrest resuscitation. However, health care providers perform inadequate compressions. Better training techniques and real-time CPR feedback may improve compression performance.

OBJECTIVE

We sought to evaluate the impact of a targeted training program combined with real-time defibrillator CPR feedback on chest compression performance in an international cohort of health care providers.

METHODS

Physicians, nurses, respiratory therapists, and technicians from 6 hospitals in 5 countries (Taiwan, Singapore, China, Bahrain, and Kuwait) participated in a standardized resuscitation workshop. Chest compression was measured before and after didactics and activation of CPR feedback. Compressions were performed for 1 min on standard CPR manikins placed on a hospital bed and backboard and measured using ZOLL R Series defibrillators. The percentage of compressions meeting target values for depth and rate were compared before and after the workshop and activation of real-time CPR feedback. No depth maximum was defined to allow for mattress compression.

RESULTS

Chest compressions were more likely to meet targets for depth (71-95%, odds ratio [OR] 8.61 [95% confidence interval {CI} 4.42-16.77], p < 0.001), rate (41-81%, OR 6.4 [95% CI 4.2-9.8], p < 0.001), and both depth and rate (5-42%, OR 2.4 [95% CI 6.7-22.9], p < 0.001) after the workshop and activation of real-time CPR feedback.

CONCLUSIONS

A targeted training intervention combined with real-time CPR feedback improved chest compression performance among health care providers from various countries.

The impact of real-time chest compression feedback increases with application of the 2015 guidelines

BACKGROUND

Cardiac arrest survival depends upon chest compression quality. Real-time audiovisual feedback may improve compression guideline adherence, particularly with the more specific 2015 guidelines.

METHODS

Subjects included healthcare providers from multiple U.S. hospitals. Compression rate and depth were recorded using standard manikins and real-time audiovisual feedback defibrillators (ZOLL R Series). Subjects were enrolled before (n = 756) and after (n = 995) release of the 2015 guidelines, which define narrower compression targets. Subjects performed 2 min of continuous compressions before and after activation of feedback. The percentage of compressions meeting appropriate rate/depth targets was determined before and after release of the 2015 guidelines.

RESULTS

An increase in compression guideline adherence was observed with use of feedback before [68.7% to 96.3%, p < .001] and after [16.6% to 94.1%, p < .001] release of the 2015 guidelines. The proportion of subjects requiring feedback to achieve adherence was higher for the 2015 guidelines [28.6% vs. 78.5%, OR 9.12, 95% CI 7.33-11.35, p < .001].

CONCLUSIONS

The use of real-time audiovisual feedback increases adherence to chest compression guidelines, particularly with application of the narrower 2015 guidelines targets for compression depth and rate.

Measuring the effectiveness of a novel CPRcard™ feedback device during simulated chest compressions by non-healthcare workers

INTRODUCTION

There is a need for a simple-to-use and easy-to-carry CPR feedback device for laypersons. We aimed to determine if a novel CPRcard™ feedback device improved the quality of chest compressions.

METHODS

We compared participants' chest compression rate and depth with and without feedback. Compression data was captured through the CPRcard™ or Resusci Anne's SimPad® SkillReporter™. Compression quality was defined based on 2010 international guidelines for rate, depth and flow fraction.

RESULTS

Overall, the CPRcard group achieved a better median compression rate (CPRcard 117 vs. control 122, p = 0.001) and proportion of compressions within the adequate rate range (CPRcard 83% vs. control 47%, p < 0.001). Compared to the no-card and blinded-card groups, the CPRcard group had a higher proportion of adequate compression rate (CPRcard 88% vs. no-card 46.8%, p = 0.037; CPRcard 73% vs. blinded-card 43%, p = 0.003). Proportion of compressions with adequate depth was similar in all groups (CPRcard 52% vs. control 48%, p = 0.957). The CPRcard group more often met targets for compression rate of 100-120/min and depth of at least 5 cm (CPRcard 36% vs. control 4%, p = 0.022). Chest compression flow fraction rate was similar but not statistically significant in all groups (92%, p = 1.0). Respondents using the CPRcard expressed higher confidence (mean 2.7 ± 2.4; 1 = very confident, 10 = not confident).

CONCLUSION

Use of the CPRcard by non-healthcare workers in simulated resuscitation improved the quality of chest compressions, thus boosting user confidence in performing compressions.

Utility of a simple lighting device to improve chest compressions learning

INTRODUCTION

The recommendations on cardiopulmonary resuscitation (CPR) emphasize the quality of the manoeuvres, especially chest compressions (CC). Audiovisual feedback devices could improve the quality of the CC during CPR. The aim of this study was to evaluate the usefulness of a simple lighting device as a visual aid during CPR on a mannequin.

MATERIAL AND METHODS

Twenty-two paediatricians who attended an accredited paediatric CPR course performed, in random order, 2min of CPR on a mannequin without and with the help of a simple lighting device, which flashes at a frequency of 100 cycles per minute. The following CC variables were analyzed using a validated compression quality meter (CPRmeter^®): depth, decompression, rate, CPR time and percentage of compressions.

RESULTS

With the lighting device, participants increased average quality (60.23±54.50 vs. 79.24±9.80%; P=.005), percentage in target depth (48.86±42.67 vs. 72.95±20.25%; P=.036) and rate (35.82±37.54 vs. 67.09±31.95%; P=.024).

CONCLUSIONS

A simple light device that flashes at the recommended frequency improves the quality of CC performed by paediatric residents on a mannequin. The usefulness of this CPR aid system should be assessed in real patients.

Performance of chest compressions with the use of a new audio-visual feedback device: a randomized manikin study in health care professionals

AIM

Optimal depth (50-60mm) and rate (100-120min(-1)) of chest compressions (CC) is the prerequisite of effective cardiopulmonary resuscitation (CPR). However, insufficient CC during CPR are common even among health care professionals. We sought to evaluate if CC are more effective with the use of a novel feedback device compared to standard CC. Primary endpoints were absolute percentage of correct CC of all CC (correct rate and correct depth, classified as "optimal" CC), and the percentage of CC in target rate and percentage of CC in target depth.

METHODS

63 healthcare professionals performed CC on a manikin with the use of a novel feedback device. The device provides audio-visual information about compression depth and rate. Each participant performed two minutes of CC with and without feedback. Participants were randomized into two groups that performed either CC with feedback first, followed by a trial without feedback, or vice versa. All participants answered a short questionnaire on self-estimation of CC performance.

RESULTS

The absolute percentage of optimal compressions of all compressions has increased from 27.9±28.8% to 47.6±33.5% (p<0.001) with use of the device. Furthermore, a significant increase of the percentage of CC in target depth (35.9±30.6% without vs. 54.8±33.5% with the device, p=0.003) and in target rate (70.5±37.7% without vs. 82.7±27.8 with the device, p=0.039) were observed.

CONCLUSION

This novel feedback device significantly improved the quality of CC in health care professionals.