A Randomized Control Trial of Cardiopulmonary Feedback Devices and Their Impact on Infant Chest Compression Quality

Abstract

Objectives In effort to improve chest compression quality among health care providers, numerous feedback devices have been developed. Few studies, however, have focused on the use of cardiopulmonary resuscitation feedback devices for infants and children. This study evaluated the quality of chest compressions with standard team-leader coaching, a metronome (MetroTimer by ONYX Apps), and visual feedback (SkillGuide Cardiopulmonary Feedback Device) during simulated infant cardiopulmonary resuscitation. Methods Seventy voluntary health care providers who had recently completed Pediatric Advanced Life Support or Basic Life Support courses were randomized to perform simulated infant cardiopulmonary resuscitation into 1 of 3 groups: team-leader coaching alone (control), coaching plus metronome, or coaching plus SkillGuide for 2 minutes continuously. Rate, depth, and frequency of complete recoil during cardiopulmonary resuscitation were recorded by the Laerdal SimPad device for each participant. American Heart Association–approved compression techniques were randomized to either 2-finger or encircling thumbs. Results The metronome was associated with more ideal compression rate than visual feedback or coaching alone (104/min vs 112/min and 113/min; P = 0.003, 0.019). Visual feedback was associated with more ideal depth than auditory (41 mm vs 38.9; P = 0.03). There were no significant differences in complete recoil between groups. Secondary outcomes of compression technique revealed a difference of 1 mm. Subgroup analysis of male versus female showed no difference in mean number of compressions (221.76 vs 219.79; P = 0.72), mean compression depth (40.47 vs 39.25; P = 0.09), or rate of complete release (70.27% vs 64.96%; P = 0.54). Conclusions In the adult literature, feedback devices often show an increase in quality of chest compressions. Although more studies are needed, this study did not demonstrate a clinically significant improvement in chest compressions with the addition of a metronome or visual feedback device, no clinically significant difference in Pediatric Advanced Life Support–approved compression technique, and no difference between compression quality between genders.

How should we teach cardiopulmonary resuscitation? Randomized multi-center study

“…Studies published by Lee et al [30] also indicate 120 CPM as the optimal chest compression rate, while noting that higher compression rates can reduce chest relaxation. Similar conclusions can also be drawn from studies by Smereka et al [8], as well as from studies by other authors [31][32][33].…”

The Use of Automated Real-Time Feedback Devices to Improve Quality During CPR Training and Real CPR Performance: A Systematic Review

“…Following removal of 196 duplicates, 681 sources were screened via titles and abstracts, resulting in 201 possible relevant studies. Upon full text analysis, 32 studies met inclusion criteria and were included in our review including 14 randomised controlled trials (RCTs) [14,17,18,20,23,24,29,32,33,38,40,42,44,45], 08 randomised trials (RTs) [25][26][27][28]31,36,37,41] and 10 randomised cross-over trials (RCOTs) [15,16,19,21,22,30,34,35,39,46]. The flow chart of the search and selection process is presented in Fig.…”

“…Metrics such as chest compression rate, chest compression depth, recoil, handoff time, fatigue reduction and general quality of CPR, significantly improved as a result of the use of ARTF during training in those studies. Conversely, few studies have demonstrated mixed effects with some results showing only modest improvements in CPR skill acquisition but not clinically significant to be considered true change [14,33,46] or no improvement at all [21] and others finding improved CPR measures with the use of ARTF but those results being no better or no worse than those associated with feedback from a trained human instructor [42].…”

“…Although previous studies have supported the usefulness of such devices during training, others have conflicting conclusions with regards to its efficacy during real-life CPR [14][15][16][17]. This systematic review of the literature aims to assess the effectiveness of ARTF for improving CPR performance during simulated training and real-life resuscitation in the adult and paediatric population.…”

Paediatric cardiopulmonary resuscitation: Knowledge and perceptions of surf lifeguards

“…The use of feedback devices in conjunction with short duration, on‐site training has been shown in other studies to improve compression depth and rate compliance . A recent study that looked at the quality of simulated infant CPR, however, showed no clinically significant difference in technique or chest compression quality when instructor‐led training was compared with use of a metronome or feedback device …”