Does real-time objective feedback and competition improve performance and quality in manikin CPR training – a prospective observational study from several European EMS

Abstract

BackgroundPrevious studies have reported that the quality of cardiopulmonary resuscitation (CPR) is important for patient survival. Real time objective feedback during manikin training has been shown to improve CPR performance. Objective measurement could facilitate competition and help motivate participants to improve their CPR performance. The aims of this study were to investigate whether real time objective feedback on manikins helps improve CPR performance and whether competition between separate European Emergency Medical Services (EMS) and between participants at each EMS helps motivation to train.MethodsTen European EMS took part in the study and was carried out in two stages. At Stage 1, each EMS provided 20 pre-hospital professionals. A questionnaire was completed and standardised assessment scenarios were performed for adult and infant out of hospital cardiac arrest (OHCA). CPR performance was objectively measured and recorded but no feedback given. Between Stage 1 and 2, each EMS was given access to manikins for 6 months and instructed on how to use with objective real-time CPR feedback available. Stage 2 was undertaken and was a repeat of Stage 1 with a questionnaire with additional questions relating to usefulness of feedback and the competition nature of the study (using a 10 point Likert score). The EMS that improved the most from Stage 1 to Stage 2 was declared the winner. An independent samples Student t-test was used to analyse the objective CPR metrics with the significance level taken as p < 0.05.ResultsOverall mean Improvement of CPR performance from Stage 1 to Stage 2 was significant. The improvement was greater for the infant assessment. The participants thought the real-time feedback very useful (mean score of 8.5) and very easy to use (mean score of 8.2). Competition between EMS organisations recorded a mean score of 5.8 and competition between participants recorded a mean score of 6.0.ConclusionsThe results suggest that the use of real time objective feedback can significantly help improve CPR performance. Competition, especially between participants, appeared to encourage staff to practice and this study suggests that competition might have a useful role to help motivate staff to perform CPR training.

Randomized crossover trial of a pressure sensing visual feedback system to improve mask fitting in noninvasive ventilation

“…However, this is more difficult to develop and apply. Medical educational studies suggest that training with real‐time visual feedback is effective in improving technical skills, for example suture‐tying, cardiopulmonary resuscitation or clinical breast examination …”

“…14 However, this is more difficult to develop and apply. Medical educational studies suggest that training with real-time visual feedback is effective in improving technical skills, for example suture-tying, 15 cardiopulmonary resuscitation 16,17 or clinical breast examination. 18 This study aimed to evaluate the impact of integrating real-time visual feedback on pressure created by the NIV mask on the nasal bridge into mask fitting training.…”

Cardiopulmonary resuscitation quality during CPR practice versus during a simulated life-saving event

“…how CPR skills deteriorate after as little as 3-6 months [15,[17][18][19]. The use of short training sessions helps to maintain CPR skills [11,17,19,20].…”

“…Although EMS personnel have education and training in CPR, several studies show low quality in prehospital CPR [11,12]. Also, Cheng et al [13] state that healthcare providers may tend to overestimate their knowledge and skills of CPR.…”

Effects of Feedback on Chest Compression Quality: A Randomized Simulation Study

“…[4][5][6][7] Therefore, in the 2015 European Resuscitation Council guidelines, it is stated that highquality chest compressions (CCs) require the following: (1) optimal hand position, (2) compressing the lower part of the sternum by at least one-third of the anterior-posterior diameter of the chest (equivalent to 4 cm in infants and 5 cm in adolescents), (3) using a compression rate of 100 to 120 CCs per minute, and (4) allowing for complete chest recoil between each CC. 8 To improve the quality of CPR, various feedback devices, including (1) the SkillReporter Resusci Anne or Resusci Baby QCPR, [9][10][11] (2) a computer-based voice advisory manikin feedback system, 12 or (3) palm-sized devices that can be placed between the trainee's hands and the manikin's or patient's chest (eg, Philips MRx Q-CPR Defibrillator Management and Feedback, 13 CPREzy-Pad, 14 and Zoll Pocket 15 ), are available. The immediate CPR feedback is then given visually (via a monitor) or verbally (eg, "slightly increase the frequency of compressions"), to either an instructor or the person providing CPR.…”