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


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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    • "The use of simulated OHCA training scenarios is one aspect of best practice sharing that PH-SIG can help facilitate. In recent years, training to improve quality in CPR has benefited from the introduction of devices and manikins, which provide real time measurement of key metrics in CPR[8,9]. The key metrics of CPR performance are chest compression depth and rate, full release between compressions (leaning), no-flow time and ventilation volume and rate. "
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    ABSTRACT: Previous 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. Ten 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. Overall 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. The 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.
    Full-text · Article · Dec 2015 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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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.
    Full-text · Article · Dec 2014
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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)
    Full-text · Article · Jul 2013 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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