Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis

BACKGROUND

Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.

AIM

To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA.

METHODS

We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's "risk of bias" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05.

RESULTS

Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047].

CONCLUSION

RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.

Manual cardiopulmonary resuscitation versus mechanical cardiopulmonary resuscitation: Which one is more effective during ambulance transport?

OBJECTIVES:

Although studies in the field of emergency medical services (EMS) generally compare survival and hospital discharge rates, there are not many studies measuring the quality of cardiopulmonary resuscitation (CPR). In this study, we aimed to compare the mechanical chest compression device and paramedics in terms of CPR quality.

METHODS:

This is an experimental trial. This study was performed by the EMS of Ankara city (capital of Turkey). Twenty (ten males and ten females) paramedics participated in the study. We used LUCAS™ 2 as a mechanical chest compression device in the study. Paramedics applied chest compression in twenty rounds, whereas mechanical chest compression device applied chest compression in another set of twenty rounds. The depth, rate, and hands-off time of chest compression were measured by means of the model's recording system.

RESULTS:

The median chest compression rate was 120.1 compressions per minute (interquartile range [IQR]: 25%–75% = 117.9–133.5) for the paramedics, whereas it was 102.3 compressions per minute for the mechanical chest compression device (IQR: 25%–75% = 102.1–102.7) (P < 0.001). The median chest compression depth was 38.9 mm (IQR: 25%–75% = 32.9–45.5) for the paramedics, whereas it was 52.7 mm for the mechanical chest compression device (IQR: 25%–75% = 51.8–55.0) (P < 0.001). The median hands-off time during CPR was 6.9% (IQR: 25–75 = 5.0%–10.1%) for the paramedics and 9% for the mechanical chest compression device (IQR: 25%–75% = 8.2%–12.5%) (P = 0.09).

CONCLUSION:

During patient transport, according to the chest compression performed by the health-care professionals, it was found that those performed by the mechanical chest compression device were more suitable than that performed by the guides in terms of both speed and duration.

Bedside chest compression skills: Performance and skills retention in in-hospital trained pediatric providers. A simulation study

PURPOSE

To assess the effects of a real-time feedback device and refresher sessions in acquiring and retaining chest compression skills.

METHODS

Healthcare providers participated in refresher sessions at 3-time points (blocks) over 1-year. At each block, chest compression (CC) skills were assessed on an infant and adult task trainer, in one 2-min trial without feedback (blinded), and up to three 2-min trials with feedback (unblinded). Skills retention over time was explored at three time lags: 1-3, 3-6, >6 months. Data collected included chest compression rate (100-120/min), depth (4 cm for infants and 5 cm for adults), and recoil between compressions.

RESULTS

Among 194 participants, achievement of excellent CC (≥90% of adequate compressions for all parameters) increased with feedback. Linear mixed models found significant (p < 0.05) improvement in rate, depth, and recoil. Performance between last unblinded trial in block 1 with the following blinded trial in block 2 significantly decayed in rate on both task trainers irrespective of time passed, while depth and recoil performance were maintained only for infants.

CONCLUSIONS

A real-time visual feedback device improved CC skills with better results in infants. Skills decayed over time despite two refresher sessions with feedback.

Low compliance with the 2 minutes of uninterrupted chest compressions recommended in the 2010 International Resuscitation Guidelines

BACKGROUND

We aimed to analyze compliance with 2010 European guidelines' quality criteria for external chest compressions (ECC) during 2 minutes of uninterrupted cardiopulmonary resuscitation.

METHODS

Seventy-two healthy nurses and physicians trained in advanced cardiopulmonary resuscitation performed 2 uninterrupted minutes of ECC on a training manikin (Resusci Anne Advanced SkillTrainer; Laerdal Medical AS, Stavanger, Norway) that enabled us to measure the depth and rate of ECC. When professionals agreed to participate in the study, we recorded their age, body mass index (BMI), smoking habit, and their own subjective estimation of their physical fitness. To measure fatigue, we analyzed participants' heart rates, percentage of maximum tolerated heart rate (MHR), and subjective perception of their fatigue on a visual analog scale.

RESULTS

Nearly half (48.6%) the rescuers failed to achieve a minimum average ECC depth of 50 mm. Only 48.1% of ECCs fulfilled the 2010 guidelines' quality criteria; quality deteriorated mainly after the first minute. Poor ECC quality and deteriorating quality after the first minute were associated with BMI < 23 kg/m(2). Rescuers with BMI ≥ 23 kg/m(2) fulfilled the quality criteria throughout the 2 minutes, whereas those with BMI < 23 kg/m(2) fulfilled them for 80% of ECCs during the first minute, but for only 30% at the end of the 2 minutes.

CONCLUSIONS

Compliance with the 2010 guidelines' quality criteria is often poor, mainly due to lack of proper depth. The greater depth recommended in the 2010 guidelines with respect to previous guidelines requires greater force, so BMI < 23 kg/m(2) could hinder compliance. Limiting each rescuer's uninterrupted time doing ECC to 1 minute could help ensure compliance.

Reliability and accuracy of the thoracic impedance signal for measuring cardiopulmonary resuscitation quality metrics

AIM

To determine the accuracy and reliability of the thoracic impedance (TI) signal to assess cardiopulmonary resuscitation (CPR) quality metrics.

METHODS

A dataset of 63 out-of-hospital cardiac arrest episodes containing the compression depth (CD), capnography and TI signals was used. We developed a chest compression (CC) and ventilation detector based on the TI signal. TI shows fluctuations due to CCs and ventilations. A decision algorithm classified the local maxima as CCs or ventilations. Seven CPR quality metrics were computed: mean CC-rate, fraction of minutes with inadequate CC-rate, chest compression fraction, mean ventilation rate, fraction of minutes with hyperventilation, instantaneous CC-rate and instantaneous ventilation rate. The CD and capnography signals were accepted as the gold standard for CC and ventilation detection respectively. The accuracy of the detector was evaluated in terms of sensitivity and positive predictive value (PPV). Distributions for each metric computed from the TI and from the gold standard were calculated and tested for normality using one sample Kolmogorov-Smirnov test. For normal and not normal distributions, two sample t-test and Mann-Whitney U test respectively were applied to test for equal means and medians respectively. Bland-Altman plots were represented for each metric to analyze the level of agreement between values obtained from the TI and gold standard.

RESULTS

The CC/ventilation detector had a median sensitivity/PPV of 97.2%/97.7% for CCs and 92.2%/81.0% for ventilations respectively. Distributions for all the metrics showed equal means or medians, and agreements >95% between metrics and gold standard was achieved for most of the episodes in the test set, except for the instantaneous ventilation rate.

CONCLUSION

With our data, the TI can be reliably used to measure all the CPR quality metrics proposed in this study, except for the instantaneous ventilation rate.