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Masterson S, Norii T, Yabuki M, Ikeyama T, Nehme Z, Bray J. Real-time feedback for CPR quality - A scoping review. Resusc Plus 2024; 19:100730. [PMID: 39185285 PMCID: PMC11341937 DOI: 10.1016/j.resplu.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 08/27/2024] Open
Abstract
Background Previous systematic reviews have failed to find an association between the use of real-time feedback during cardiopulmonary resuscitation (CPR) and patient outcomes. However, these reviews excluded studies examining feedback with other system changes. As part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation process, we conducted a scoping review to examine the current state of this literature and the use of real-time feedback in this form. Methods/Data sources A protocol and search strategy was developed. We searched Medline, EMBASE, and Allied Health Literature (CINAHL) from inception to May 2024. Cochrane (Cochrane (specifically, the Cochrane Database of Systematic Reviews) is contained in Medline so was not searched separately. Studies were eligible for inclusion if they were published or unpublished (grey-literature) studies involving children or adults that examined the effect of real-time feedback or prompting on the quality of CPR following cardiac arrest. Data were extracted and audited independently. For each study, the following information were extracted: the author(s); year of publication; timeframe; study design; country; population; intervention and comparator; type of feedback or prompt; outcomes measured; main findings for CPR quality, and; main findings for patient outcomes. Reviewers also allocated key themes to each study and held a series of consensus discussions to consolidate themes across the included studies. Results We screened 2,657 titles and included 60 studies. Our analysis identified five overlapping themes in the extended literature: system change and quality improvement; impact on patient outcomes; better CPR quality without improved patient outcome; CPR feedback as a generator of other CPR metrics; and CPR feedback as a potential harm. Results revealed a substantial adjacent literature, particularly on implementing high-performance CPR as part of quality improvement programs. Conclusions This scoping review has identified a large body of literature and specific themes of interest in relation to feedback for CPR quality. Future systematic reviews should include studies examining real-time feedback with other system changes.
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Affiliation(s)
- Siobhán Masterson
- National Ambulance Service, Health Service Executive, Limerick, Ireland
- Discipline of General Practice, University of Galway, Ireland
- School of Medicine, University College Cork, Ireland
| | - Tatsuya Norii
- School of Medicine, University of New Mexico, Albuquerque, United States
| | - Mio Yabuki
- Faculty of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takaya Ikeyama
- Center for Pediatric Emergency and Critical Care Medicine, Aichi Children’s Health and Medical Center, Japan
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Australia
| | - the BLS ILCOR Task Force
- National Ambulance Service, Health Service Executive, Limerick, Ireland
- Discipline of General Practice, University of Galway, Ireland
- School of Medicine, University College Cork, Ireland
- School of Medicine, University of New Mexico, Albuquerque, United States
- Faculty of Medicine, Nippon Medical School, Tokyo, Japan
- Center for Pediatric Emergency and Critical Care Medicine, Aichi Children’s Health and Medical Center, Japan
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Japan
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Australia
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Kahsay DT, Salanterä S, Tommila M, Liukas T, Rosio R, Diji AKA, Peltonen LM. User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation. Comput Inform Nurs 2024; 42:583-592. [PMID: 38470258 DOI: 10.1097/cin.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices. Semistructured interviews were conducted with healthcare professionals involved in lifesaving activities. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework for the study. The Unified Theory of Acceptance and Use of Technology model has four constructs: performance expectancy, effort expectancy, social influence, and facilitating factors. Ten themes were identified under the four constructs. The performance expectancy constructs include three themes: perceived usefulness, outcome expectation, and applicability in diverse situations. The effort expectancy construct encompasses two themes: user-friendliness and complexity. The social influence construct has two themes: social and organizational factors. Lastly, the facilitating factors construct includes three themes: staff competence, perceived cost, and compatibility of devices. Exploring the needs and factors influencing the acceptability of audiovisual feedback devices used during cardiopulmonary resuscitation will inform healthcare providers, managers, manufacturers, and procurers on how to improve the efficiency and use of these devices.
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Affiliation(s)
- Desale Tewelde Kahsay
- Author Affiliations: Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Turku (Mr Kahsay); Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland (Drs Salanterä and Peltonen), and Department of Perioperative Services, Intensive Care Medicine and Pain Management (Dr Tommila), Turku University Hospital and University of Turku; and Department of Nursing Science, Faculty of Medicine, University of Turku (Ms Liukas), Finland; Department of Nursing, Kwame Nkrumah, University of Science and Technology, Ghana (Dr Diji)
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Kahsay DT, Peltonen LM, Rosio R, Tommila M, Salanterä S. The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2024; 23:11-20. [PMID: 37154435 DOI: 10.1093/eurjcn/zvad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
AIMS Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training. METHOD AND RESULT Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices. CONCLUSION The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands. REGISTRATION PROSPERO: CRD42020205754.
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Affiliation(s)
- Desale Tewelde Kahsay
- Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | | | - Riitta Rosio
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Miretta Tommila
- Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
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Picard C, Drew R, Norris CM, O’Dochartaigh D, Burnett C, Keddie C, Douma MJ. Cardiac Arrest Quality Improvement: A Single-Center Evaluation of Resuscitations Using Defibrillator, Feedback Device, and Survey Data. J Emerg Nurs 2022; 48:224-232.e8. [DOI: 10.1016/j.jen.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 10/18/2022]
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Yuksen C, Savatmongkorngul S, Chumkot S, Atiksawedparit P, Jenpanitpong C, Watcharakitpaisan S, Kaninworapan P, Maijan K. Comparison of chest compression quality between 2-minute switch and rescuer fatigue switch: A randomized controlled trial. Int J Crit Illn Inj Sci 2022; 12:22-27. [PMID: 35433400 PMCID: PMC9008289 DOI: 10.4103/ijciis.ijciis_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/28/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Rescuers performing chest compressions (CCs) should be rotated every 2 min or sooner if rescuers become fatigued. Is it preferable to switch rescuers when they become fatigued in such cases? This study was performed to compare the quality of CCs between two scenarios in hospitalized patients with cardiac arrest: 2-minute rescuer switch and rescuer fatigue switch. Methods: This randomized controlled trial involved 144 health-care providers, randomized to switch CC on the manikin model with 2-minute or rescuer fatigue. We recorded the CC quality for 20 min. Results: There were no significant differences in the percentage of target compressions, mean depth of compressions, or mean compression rate between the two groups. However, the rescuer fatigue switch group showed a significantly lower frequency of interruptions (4 vs. 9 times, P < 0.001) and a longer duration of each compression cycle (237 vs. 117 sec, P < 0.001). The change in the respiratory rate from before to after performing compressions was significantly greater in the 2-minute switch group (12 vs. 8 bpm, P = 0.036). Conclusion: The use of a rescuer fatigue switch CC approach resulted in no decrease in the quality of CC, suggesting that it may be used as an alternate strategy for managing in-hospital cardiac arrest.
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Goharani R, Vahedian-Azimi A, Pourhoseingholi MA, Amanpour F, Rosano GMC, Sahebkar A. Survival to intensive care unit discharge among in-hospital cardiac arrest patients by applying audiovisual feedback device. ESC Heart Fail 2021; 8:4652-4660. [PMID: 34716684 PMCID: PMC8712865 DOI: 10.1002/ehf2.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
Aims Survival rates after in‐hospital cardiac arrest remain very low. Although there is evidence that the use of audiovisual feedback devices can improve compression components, there are no data on patient survival. Therefore, we conducted this study to analyse the survival rate of patients with in‐hospital cardiac arrest after discharge from the intensive care unit. Methods and results This study was a secondary analysis of a prospective, randomized, controlled, parallel study of patients who received either standard manual chest compression or a real‐time feedback device. Parametric and semi‐parametric models were fitted to the data. Different survival time of length of stay was investigated by univariate and multiple analyses. Pearson's correlation between length of stay and hospital length of stay was obtained. A total of 900 patients with a mean survival time of 35 days were included. Intervention was associated with a higher length of stay. Relative time was significant in adjusted fitted log‐normal regression for intervention group, female gender, and cardiopulmonary resuscitation in the night shift. A positive correlation between length of stay and hospital length of stay was found. Conclusions Implementation of feedback device improved survival and length of stay. Cardiopulmonary resuscitation performance during the night shift decreased the survival time, which could be due to the inexperienced staff available outside working hours.
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Affiliation(s)
- Reza Goharani
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Department of Health System Research, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Amanpour
- Department of Health System Research, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giuseppe M C Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, via della Pisana, 235, Rome, 00163, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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