Effect of feedback on delaying deterioration in quality of compressions during 2 minutes of continuous chest compressions: a randomized manikin study investigating performance with and without feedback

Abstract

Background: Good quality basic life support (BLS) improves outcome following cardiac arrest. As BLS performance deteriorates over time we performed a parallel group, superiority study to investigate the effect of feedback on quality of chest compression with the hypothesis that feedback delays deterioration of quality of compressions. Methods: Participants attending a national one-day conference on cardiac arrest and CPR in Denmark were randomized to perform single-rescuer BLS with (n = 26) or without verbal and visual feedback (n = 28) on a manikin using a ZOLL AED plus. Data were analyzed using Rescuenet Code Review. Blinding of participants was not possible, but allocation concealment was performed. Primary outcome was the proportion of delivered compressions within target depth compared over a 2-minute period within the groups and between the groups. Secondary outcome was the proportion of delivered compressions within target rate compared over a 2-minute period within the groups and between the groups. Performance variables for 30-second intervals were analyzed and compared.

Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance

“…This correlates well with the results of a number of previous studies, indicating that fatigue manifests under the 2010 guidelines at a similar time point to that of previous ERC guidelines 7 9 13 14. It is, however, in contrast with a recent study conducted on a smaller cohort by Lyngeraa et al , which suggested that the quality of CPR was maintained throughout 2 min of CPR delivery by rescuers using the 2010 ERC guidelines 15.…”

“…While previous studies highlight that rescuers following pre-2010 guidelines suffered from as great as a 55% increase in compressions of insufficient depth between minutes 1 and 2, the increases in aberrant compressions described within this study are far more modest (we identified a comparatively minor 7% increase) 7 9 13 14. This must be seen in the context of the overall quality of rescuers' CPR delivery within our study.…”

“…This must be seen in the context of the overall quality of rescuers' CPR delivery within our study. The average proportion of compressions delivered correctly peaked at 52%, which was significantly lower than the 70% limit for effective circulatory support suggested by the Royal College of General Practitioners,16 and much below figures achieved by most other comparative studies 7 13 14. This is with the exception of two studies by Vaillancourt et al and Heidenreich et al , in which elderly participants achieved a maximum of only 33 and 37 adequate cpm, respectively 17 18.…”

Measuring the effectiveness of a novel CPRcard™ feedback device during simulated chest compressions by non-healthcare workers

“…(1)(2)(3)(4)(5)(6)(7)(8) However, at least one study has highlighted the potential problems of reliance on devices, and another study has concluded that there was no benefi t derived among trained responders. (9,10) In these studies, the feedback devices were attached to an automated external defi brillator (AED) or paired with a phone application; some were also hospital-based and could not be readily carried around by laymen. Also, in many of these studies, mixed results were observed in the CPR performance of healthcare workers or experienced life-savers.…”

Individualized rescuer change by a team leader during uninterrupted cardiopulmonary resuscitation: comparison with rescuer change in 2-min intervals

“…Use of a feedback system during chest compressions might motivate exhausted rescuers to improve their performance of chest compressions. However, a recent simulation study showed that live feedback had little effect on the rescuers' ability to maintain compression quality during uninterrupted 2 min chest compressions [16]. Unless objective parameters such as end-tidal CO 2 , intraarterial pressure, or central venous saturations are available, this subjective method seems to be the most practical option.…”