New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest

doi:10.1016/j.resuscitation.2009.10.005

Resuscitation

Volume 81, Issue 1, January 2010, Pages 53-58

https://doi.org/10.1016/j.resuscitation.2009.10.005 Get rights and content

Abstract

Introduction

Quality of external chest compression (ECC) is a key component of Basic Life Support. Different approaches to improve rescuers’ performance have been evaluated, but few attempts have been made to invent simple devices to improve performance. This study evaluates a new visual feedback system for ECC for healthcare professionals.

Methods

Ninety-three healthcare professionals volunteered (14 emergency medical technicians, 45 paramedics, 34 physicians; age 32 ± 7.2 (range 21–61); 72% male) in this randomized cross-over study. All subjects were tested on a manikin (Skillreporter ResusciAnne^®, Laerdal, Stavanger, Norway) in identical mock cardiac arrest scenario and asked to perform 2 min of continuous ECC (secured airway): Group A (n = 46): ECC with device first, followed by ECC without device a minimum of 45 min later; group B (n = 47): vice versa. Primary endpoints: mean compression rate 90–120 min⁻¹; mean compression depth 38–51 mm. Data were analyzed using repeated measure logistic regression model for binary categorized endpoints and repeated measure ANOVA test for continuous endpoints.

Results

Correct compression depth was achieved by 45.2% of subjects (95%-CI: 30.5–64.9 mm) without vs. 73.1% (95%-CI: 40.3–57.4 mm) with device (p < 0.001); correct compression rate was achieved by 62.4% (95%-CI: 78–147.8 min⁻¹) without vs. 94.6% (95%-CI: 87.3–126.6 min⁻¹) with device (p < 0.001). Overall, 85% of the subjects thought the feedback system was helpful and 80.6% would use it if available.

Conclusions

The new visual feedback device significantly improved ECC performance (compression rate and depth) by healthcare professionals in simulated cardiac arrest. Most participants found the device easy to use.

Introduction

It is unquestioned that well-performed external chest compression (ECC) is key for improved outcomes in cardiopulmonary resuscitation (CPR). While there is little evidence about the best method, it is likely that 2005 guidelines’ recommendations1, 2 are a feasible compromise.

Published data show extremely poor ECC performance by healthcare professionals, especially regarding rate and depth of compressions. Recently Wik et al. observed a mean compression depth of 34 mm in out-of-hospital resuscitations, and only 28% of compressions within 38–51 mm.³ In addition, Aufderheide et al. found that healthcare professionals in simulated cardiac arrest demonstrated poor performance in compression depth in an assessment of different manual chest compression–decompression techniques.⁴

Improvement in CPR quality was determined to be beneficial in combination with defibrillation using real-time feedback with CPR,⁵ but this technology has not been well-established in out-of- or in-hospital settings. In both settings, especially at the beginning of resuscitation, the use of automated external defibrillators (AED) is of increasing importance, but monitoring and providing feedback on CPR quality is not currently standard of care. The development and evaluation of a stand-alone system used by professionals or trained first responders seem necessary to strengthen the chain of survival.

The present study evaluates a new feedback system in simulated cardiac arrest based on improvement in ECC performance and acceptance by healthcare workers.

Section snippets

Materials and methods

As no potential harm to study participants was expected, the local institutional review committee solely required informed consent from each participant prior to the study. Each subject was informed about the study via standardized leaflet and told that their performance would be evaluated. Each participant provided written consent for data acquisition and analysis.

Study population

Out of 94 potential subjects, 93 (age 32 ± 7.2 (range 21–61) years; 72% male) were included (one subject excluded due to physical impairments). The resulting sample was composed of 34 EMS-physicians, 14 EMTs and 45 paramedics (demographic details Table 1). Thus, considering the anticipated drop-out rate of 10%, the calculated sample size was surpassed.

An investigation of the quality of the study design and the statistical approach did not result in any significant differences between the groups.

Discussion

With increasing evidence for the importance of ECC, methods to support and improve rescuers’ performance are gaining interest in recent research. Although different technical approaches have been evaluated,6, 7, 8 no attempts have been made to invent simple devices as stand-alone solutions to improve ECC in healthcare professionals. This study evaluated a new visual feedback system intended as a stand-alone device for healthcare professionals and laypersons for use to aid ECC. Use of the device

Conclusions

The new visual feedback device described here is able to significantly improve performance of ECC by professional healthcare workers in simulated cardiac arrest in terms of compression rate and depth as well as overall ECC sufficiency. Additionally, most users found this device to be simple and usable.

These results show that use of this ‘stand-alone’ system by professionals and trained first responders is feasible and may be useful to strengthen the second link in the chain of survival. Using

Conflict of interest statement

The authors declare that they have no competing interests. The device was supported during the study by Laerdal Medical, Munich, Germany. Laerdal Medical did not review or revise the manuscript at any stage of preparation.

Acknowledgements

We thank Laerdal Medical, Munich, Germany for loaning us the device prototype and all of the participants for volunteering for this study.

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Cited by (81)

External Cardiac Massage Training of Medical Students: A Randomized Comparison of Two Feedback Methods to Standard Training
2020, Journal of Emergency Medicine
The most recent recommendations support learning of external cardiac massage (ECM) through feedback devices.
The objective was to compare the effects on immediate and 3-month retention of ECM technical skills when using feedback devices compared with training without feedback as part of a half-day training session in medical students.
This randomized study was performed using the Resusci Anne QCPR manikin in 64 medical students. We compared the quality of ECM with nonfeedback training in the control group (group 1) vs. 2 feedback learning methods (group 2, PocketCPR and group 3, Skill Reporter each used with visual display available to the trainee). At the end of the training session and 3 months later, students performed chest compressions blindly during a 2-min assessment session. The median compression score was the primary outcome for assessing immediate and long-term retention.
Regarding immediate retention, the median compression score was significantly lower in group 1 (23%) than in groups 2 (81%) and 3 (72%) (p < 0.05) with no difference between the 2 feedback methods. At 3 months, mean compression scores remained high but not significantly different between the 2 feedback groups.
The use of a feedback device used for ECM training improves the quality of immediate retention of technical ECM skills compared with traditional teaching in medical students. At 3 months, the 2 groups with feedback retained a high level of performance. No significant difference could be demonstrated between the 2 feedback methods.
Using a Mobile Phone Application Versus Telephone Assistance During Cardiopulmonary Resuscitation: A Randomized Comparative Study
2020, Journal of Emergency Nursing
Citation Excerpt :
First, regarding the students’ previous training, none of the students had received advanced training in CPR. Several studies have shown that mobile phone apps, which offer CPR assistance, especially on the topic of chest compressions, improve the quality of the intervention if those participating have training in CPR.22,23 If they do not have previous training or experience, the app may not achieve its goal.24
In recent years, the way CPR instructions are given has changed because of the development of new technology that allows bystanders who witness a cardiac arrest to be guided in performing CPR. This study aimed to compare the effectiveness of using a mobile phone application (app) versus telephone operator assistance in performing cardiopulmonary resuscitation (CPR) techniques in simulated settings.
A comparative study was performed with 2 intervention groups: (1) mobile phone app and (2) telephone assistance. A total of 128 students participated and were distributed randomly into each intervention group. A CPR observation checklist and standard CPR quality parameter measurements were used for data collection.
The group that used the app obtained better results than the group that had telephone assistance on 5 items during CPR observation: checking if the area is secure (X²(1) = 26.81; P < 0.05), asking for help (X²(1) = 66.07; P < 0.05), opening of airways (X²(1) = 12.03; P < 0.05), checking for breathing (X²(1) = 6.10; P < 0.05), and contacting emergency services (X²(1) = 12.41; P < 0.05). Regarding the skill level of CPR, no statistically significant differences were found when comparing the 2 intervention groups (X²(1) = 0.91; P = 0.33). As for the parameters measured, there were only statistically significant differences found in the item compression fraction (U = 1,593.00; Z = −2.16; P < 0.05), with the group that used the app obtaining better results.
Better outcomes were observed in recognizing if the area was safe, asking for help, opening up the airways, checking for breathing, and calling emergency services in the mobile phone app group. However, the results indicated that there were no differences in the CPR parameters, except compression fraction, when the app was used as opposed to being guided by telephone.
Evaluation of the thoracic compression technique using APPs. Do they help or hinder cardiopulmonary resuscitation?
2020, Medicina Intensiva
Evaluar la calidad de la reanimación cardiopulmonar (RCP) de personas no expertas guiada por una aplicación móvil con retroalimentación en tiempo real.
Estudio cuasi-experimental de corte transversal.
Una muestra de 113 estudiantes de enfermería sin experiencia ni formación en RCP participaron en el estudio.
Se realizaron tres test de RCP solo manos con compresiones continuas: 1) RCP sin dispositivo; 2) RCP con el teléfono apagado, y 3) RCP guiada por APP. Se aleatorizaron tres aplicaciones diferentes (Pocket CPR®, CPR Pro® y Massage cardiaque et DSA®). Los tres test se realizaron de forma consecutiva, aleatorizados y separados 30 min entre cada uno. Se utilizó el maniquí Laerdal Resusci Anne QCPR (Stavanger, Noruega) software 2.0.0.14.
Aplicaciones utilizadas. Variables demográficas para caracterizar a la muestra. Variables independientes: media de profundidad, ritmo medio, porcentaje de posición correcta de mano, porcentaje de compresiones con reexpansión correcta, porcentaje de compresiones con profundidad correcta, porcentaje de compresiones al ritmo correcto, calidad global de la RCP.
La calidad global de la RCP fue del 33,3% ± 32,7 para Pocket CPR, del 10,9% ± 22,72 para CPR Pro y del 7,8% ± 9,2 para Massage cardiaque et DSA. Con ninguna de las APP se consiguen mejorías estadísticamente significativas. El porcentaje de tiempo que el reanimador consiguió mantener el ritmo correcto mejoró con el uso de las tres APP.
La RCP guiada por APP no mejoró la calidad global de las compresiones durante la reanimación, si bien mejoró el porcentaje de compresiones realizadas a un ritmo correcto.
To evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs).
A cross-sectional quasi-experimental study was carried out.
A sample of 113 nursing students participated in the study.
Three hands-only CPR tests with continuous compressions were performed: (i) without external help; (ii) with the mobile phone turned off; and (iii) guided by APP. Three different APPs were randomly assigned (Pocket CPR®, CPR Pro®> and Massage cardiaque et DSA®). The mannequin Laerdal Resusci Anne QCPR (Stavanger, Norway) 2.0.0.14 software was used.
APPs used. Demographic variables characterizing the study sample. Independent variables: mean depth, mean rate, percentage of correct hand positioning, percentage of compressions with correct re-expansion, percentage of compressions with correct depth, percentage of compressions at the correct rate, and overall quality of CPR.
Overall CPR quality was 33.3% ± 32.7 using Pocket CPR, 10.9% ± 22.72% using CPR Pro and 7.8% ± 9.2 using Massage cardiaque et DSA. None of the APPs produced a statistically significant improvement. The percentage of time that the resuscitator managed to maintain a correct compression rate improved when using all three APPs.
Cardiopulmonary resuscitation guided by phone APPs did not improve the overall quality of compressions during resuscitation, though it improved the percentage of compressions performed at the correct rate.
Using a smartphone application (PocketCPR) to determine CPR quality in a bystander CPR scenario — A manikin trial
2019, Resuscitation
Feedback devices and dispatcher assistance increase CPR quality in bystander resuscitation. Yet, there is no data comparing both approaches with uninstructed CPR. The present prospective, randomized, controlled, manikin trial aims to determine the effects of the use of a smartphone application (PocketCPR) on CPR quality in a bystander CPR scenario compared to dispatcher-assisted telephone CPR and uninstructed CPR.
100 laypersons were included to perform 8-min CPR on a manikin. Volunteers were randomly assigned to one of four groups: (1) uninstructed CPR (uninstructed group), (2) dispatcher-assisted telephone CPR (telephone-group), (3) guidance and feedback through a smartphone application (app-group) and (4) dispatcher-assisted telephone CPR combined with the smartphone-app (telephone + app-group).
There was no significant difference in the time to first compression between the uninstructed and the app-group (p = 0.052), likewise between the telephone- and the telephone + app-group (p = 0.193). The no-flow-time of the uninstructed group was significantly longer compared to all other groups (p < 0.001). Median compression rate was significantly higher and within the recommended range in the app- and the telephone + app-group. There was no significant difference regarding correct compression depth between the four groups. Correct hand position and complete thorax release was found significantly more frequently in groups with smartphone-app support.
Feedback by a smartphone application can improve bystander CPR quality in terms of no-flow-time, compression rate, correct hand position, thorax release and does not delay CPR onset. However, the use of a smartphone application does not improve compression depth significantly.
Advantage and Limitation of Using a Visual Feedback Device during Cardiopulmonary Resuscitation Training
2020, Prehospital and Disaster Medicine
Feedback Devices for Cardiopulmonary Resuscitation: A Narrative Review
2023, Applied Sciences (Switzerland)

View all citing articles on Scopus

^☆: A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.10.005.

¹: These authors contributed equally to this work.

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Simulation and educationNew visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest☆

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Study population

Discussion

Conclusions

Conflict of interest statement

Acknowledgements

Resuscitation

Resuscitation

Resuscitation

Resuscitation

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Ann Emerg Med

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Simulation and education
New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest☆