The use of CPR feedback/prompt devices during training and CPR performance: A systematic review

University of Warwick, UK.
Resuscitation (Impact Factor: 4.17). 08/2009; 80(7):743-51. DOI: 10.1016/j.resuscitation.2009.04.012
Source: PubMed

ABSTRACT In lay persons and health care providers performing cardiopulmonary resuscitation (CPR), does the use of CPR feedback/prompt devices when compared to no device improve CPR skill acquisition, retention, and real life performance?
The Cochrane database of systematic reviews; Medline (1950-Dec 2008); EmBASE (1988-Dec 2008) and Psychinfo (1988-Dec 2008) were searched using ("Prompt$" or "Feedback" as text words) AND ("Cardiopulmonary Resuscitation" [Mesh] OR "Heart Arrest" [Mesh]). Inclusion criteria were articles describing the effect of audio or visual feedback/prompts on CPR skill acquisition, retention or performance.
509 papers were identified of which 33 were relevant. There were no randomised controlled studies in humans (LOE 1). Two non-randomised cross-over studies (LOE 2) and four with retrospective controls (LOE 3) in humans and 20 animal/manikin (LOE 5) studies contained data supporting the use of feedback/prompt devices. Two LOE 5 studies were neutral. Six LOE 5 manikin studies provided opposing evidence.
There is good evidence supporting the use of CPR feedback/prompt devices during CPR training to improve CPR skill acquisition and retention. Their use in clinical practice as part of an overall strategy to improve the quality of CPR may be beneficial. The accuracy of devices to measure compression depth should be calibrated to take account of the stiffness of the support surface upon which CPR is being performed (e.g. floor/mattress). Further studies are needed to determine if these devices improve patient outcomes.

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Available from: Fang Gao Smith, Sep 26, 2015
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    • "An extensive body of research shows that CPR knowledge and skills decline rapidly following completion of a CPR course, while CPR psychomotor skills decline even more quickly (Hamilton, 2005 as cited in Oermann et al., 2010; Madden, 2006; Moser & Coleman, 1992). Conversely, Yeung et al. (2009) found that there was " good } } "
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    ABSTRACT: • Simulation is a teaching method used to facilitate learning of Basic life support and Defibrillation (BlsD) techniques. This study explored the potential of two ways of teaching BlsD techniques in order to understand which one could be the best between Low-Fidelity Simulation and Moderate-Fidelity Simulation. • A sample (N=127) of nursing students was selected for this two group pre- post- test conveniently randomized design with 4-month follow up to compare two methods of simulation teaching. • Students were allocated to Low-Fidelity (LF) (n=64) and Moderate-Fidelity (MF) (n=63) simulation teaching. Early evaluation immediate post intervention demonstrated an increase of knowledge in each group (LF mean pre test score = 44, immediate post test score = 62.18, MF mean pre test score = 42, immediate post test mean score = 62.18). Post-test 2 (4 months later) showed that there are no significant differences between the two groups in terms of knowledge retention (LF mean score = 65.81, MF mean score = 61.45. p=0.721). • Despite the limit of small sample size, the study showed that the two teaching methods are equally effective in acquisition and retention of information on BlsD techniques. However the low-fidelity method was more efficient and less resource intensive.
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    • "High compression fraction was independently predictive of better survival in patients who experience a prehospital ventricular fibrillation/tachycardia cardiac arrest [3,4]. However, there is little if any data demonstrating that quality controlled CPR actually improves patient outcome in out of hospital setting [21,24,25]. This may be reflected in emergency physicians’ attitudes and result in low utilisation of the quality analysis feature. "
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    ABSTRACT: Objectives: To evaluate the quality of cardiopulmonary resuscitation (CPR) in a physician staffed helicopter emergency medical service (HEMS) using a monitor-defibrillator with a quality analysis feature. As a post hoc analysis, the potential barriers to implementation were surveyed. The quality of CPR performed by the HEMS from November 2008 to April 2010 was analysed. To evaluate the implementation rate of quality analysis, the HEMS database was screened for all cardiac arrest missions during the study period. As a consequence of the observed low implementation rate, a survey was sent to physicians working in the HEMS to evaluate the possible reasons for not utilizing the automated quality analysis feature. During the study period, the quality analysis was used for 52 out of 187 patients (28%). In these cases the mean compression depth was < 40 mm in 46% and < 50 mm in 96% of the 1-min analysis intervals, but otherwise CPR quality corresponded with the 2005 resuscitation guidelines. In particular, the no-flow fraction was remarkably low 0.10 (0.07, 0.16). The most common reasons for not using quality-controlled CPR were that the device itself was not taken to the scene, or not applied to the patient, because another EMS unit was already treating the patient with another defibrillator. When quality-controlled CPR technology was used, the indicators of good quality CPR as described in the 2005 resuscitation guidelines were mostly achieved albeit with sufficient compression depth. The use of the well-described technology in improving patient care was low. Wider implementation of the automated quality control and feedback feature in defibrillators could further improve the quality of CPR on the field.Trial registration: (NCT00951704)
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 07/2013; 21(1):50. DOI:10.1186/1757-7241-21-50 · 2.03 Impact Factor
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    • "This is reflected by the fact that, in three centres, intensive training is provided in the use of special supportive devices, which are used extensively. Bonn has established LDB CPR use [37,49], ACD-CPR is applied in connection with an impedance valve in Göppingen [50] and, after intensive training and continuous scientific evaluation, a CPR feedback system is regularly used in Münster [51,52]. In this study, we found no evidence that using these mechanical or feedback devices increases CPR success. "
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    ABSTRACT: Sudden cardiac arrest is one of the most frequent causes of death in the world. In highly qualified emergency medical service (EMS) systems, including well trained emergency physicians, spontaneous circulation may be restored in up to 53% of patients at least until admission to hospital. Compared with these highly qualified EMS systems, in other systems markedly lower success rates are observed. These data clearly show that there are considerable differences between EMS systems concerning treatment success following cardiac arrest and resuscitation, although in all systems international guidelines for resuscitation are used. This study investigates the impact of response time reliability (RTR) on cardio pulmonary resuscitation (CPR) incidence and resuscitation success using return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score and data from seven German EMS systems participating in the German Resuscitation Registry. Anonymized patient data after out of hospital cardiac arrest from 2006 to 2009 of seven EMS systems in Germany were analysed to socioeconomic factors (population, area, EMS unit hours), process quality (response time reliability, CPR incidence, special CPR measures, prehospital cooling), patient factors (age, gender, cause of cardiac arrest, bystander CPR). Endpoints were defined as ROSC, admission to hospital, 24 hour survival and hospital discharge rate. For statistical analyses, chi-square, odds-ratio and Bonferroni correction were used. 2,330 prehospital CPR from seven centres were included in this analysis. Incidence of sudden cardiac arrest differs from 36.0 to 65.1/100,000 inhabitants/year. We identified two EMS systems (RTR < 70%) reaching the patients within eight minutes in 62.0% and 65.6% while the other five EMS systems (RTR > 70%) achieved 70.4 up to 95.5%. EMS systems arriving relatively later at the patients side (RTR < 70%) less frequently initiate CPR and admit fewer patients alive to hospital (calculated per 100,000 inhabitants/year) (CPR incidence (1/100,000 inhabitants/year) RTR > 70% = 57.2 vs RTR < 70% = 36.1, OR = 1.586 (99% CI = 1.383 to 1.819); P < 0.01) (admitted to hospital with ROSC (1/100,000 inhabitants/year) RTR > 70% = 24.4 vs RTR < 70% = 15.6, OR = 1.57 (99% CI = 1.274 to 1.935); P < 0.01). Using ROSC rate and the multivariate RACA score to predict outcome, the two groups did not differ, but ROSC rates were higher than predicted in both groups (ROSC RTR > 70% = 46.6% vs RTR < 70% = 47.3%, OR = 0.971 (95% CI = 0.787 to 1.196); P = n.s.) (ROSC RACA RTR > 70% = 42.4% vs RTR < 70% = 39.5%, OR = 1.127 (95% CI = 0.911 to 1.395); P = n.s.). This study demonstrates that on the level of EMS systems, faster ones will more often initiate CPR and will increase number of patients admitted to hospital alive. Furthermore it is shown that with very different approaches, all adhering to and intensely training in the ERC guidelines 2005, superior and, according to international comparison, excellent success rates following resuscitation may be achieved.
    Critical care (London, England) 11/2011; 15(6):R282. DOI:10.1186/cc10566 · 4.48 Impact Factor
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