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

Abstract

OBJECTIVES: Our aim for this study was to test whether visual and verbal feedback compared with instructor-led feedback improve the quality of pediatric cardiopulmonary resuscitation (CPR). METHODS: There were 653 third-year medical students randomly assigned to practice pediatric CPR on 1 of 2 manikins (infant and adolescent; n = 344 and n = 309, respectively). They were further randomly assigned to 1 of 3 feedback groups: The instructor feedback (IF) group (n = 225) received traditional, instructor-led feedback without any additional feedback device. The device feedback (DF) group (n = 223) received real-time visual feedback from a feedback device. The instructor and device feedback (IDF) group (n = 205) received verbal feedback from an instructor who continuously reviewed the trainees' performance using the feedback device. After the training, participants' CPR performance was assessed on the same manikin while no feedback was being provided. RESULTS: For the primary outcome of total compression score, participants in the DF and IDF groups performed similarly, with both groups showing scores significantly (P , .001) better than those of the IF group. The same findings held for correct hand position and the proportion of complete release. For compression rate, the DF group was at the higher end of the guideline for 100 to 120 chest compressions per minute compared with the IF and IDF groups (both P , .001). No effect of feedback on compression depth was found. CONCLUSIONS: Chest compression performance significantly improved with both visual and verbal feedback compared with instructor-led feedback. Feedback devices should be implemented during pediatric resuscitation training to improve resuscitation performance. WHAT'S KNOWN ON THIS SUBJECT: High-quality chest compressions (CCs) require optimal hand position, adequate depth (one-third of the chest' s diameter), complete release, and a frequency of 100 to 120 CCs per minute. Feedback devices (visual or verbal) were shown to improve the quality of training, although evidence remains inconclusive. WHAT THIS STUDY ADDS: We provide more evidence to the topic of feedback in resuscitation trainings, including a large number of equally experienced participants, revealing that visual feedback and visual combined with verbal feedback improve CC performance compared with instructor-led training in infant and adolescent manikin settings.

Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

“…Data on the quality of 2-min CCs are presented in Table 1. Analysis of the quality of 2-min CCs showed statistically significant differences in the depth of CCs performed manually, using CPRMeter and LifeLine ARM (40 mm [38][39][40][41][42][43][44][45] vs. 45 mm [40][41][42][43][44][45][46][47][48][49][50] vs. 51 mm (50-52), respectively; p = = 0.002). Statistically significant differences in chest compression depth between manual chest compressions and CPRMeter (p = 0.031) and LifeLine ARM (p < 0.001) were shown.…”

Simulation in Neonatal Resuscitation

“…Simulation training plays an important role in the education of staff as it allows for practice of skills under direct supervision. Performance of chest compression provision improves significantly with direct feedback resulting in better hand positioning, rate of compressions and proportion of complete release (47,48).…”

The place of TrueCPR feedback device in cardiopulmonary resuscitation. Should we use it? A randomized pilot study

“…It is difficult to achieve optimal depth and chest compressions according to the resuscitation guidelines recommendations of many people's [24,25]; however, cardiopulmonary feedback devices may help [26]. In the conducted study comparing the quality of chest compressions with and without the TrueCPR device, it showed statistically significant improvement in compression parameters in relation to both depth and frequency of chest compression, as well as the correctness of its relaxation after each compression [27].…”