Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study



      Chest compressions require physical effort leading to increased fatigue and rapid degradation in the quality of cardiopulmonary resuscitation overtime. Despite harmful effect of interrupting chest compressions, current guidelines recommend that rescuers switch every 2 minutes. The impact on the quality of chest compressions during extended cardiopulmonary resuscitation has yet to be assessed.

      Basic procedures

      We conducted randomized crossover study on manikin (ResusciAnne; Laerdal). After randomization, 60 professional emergency rescuers performed 2 × 10 minutes of continuous chest compressions with and without a feedback device (CPRmeter). Efficient compression rate (primary outcome) was defined as the frequency target reached along with depth and leaning at the same time (recorded continuously).

      Main findings

      The 10-minute mean efficient compression rate was significantly better in the feedback group: 42% vs 21% (P< .001). There was no significant difference between the first (43%) and the tenth minute (36%; P= .068) with feedback. Conversely, a significant difference was evident from the second minute without feedback (35% initially vs 27%; P< .001). The efficient compression rate difference with and without feedback was significant every minute, from the second minute onwards. CPRmeter feedback significantly improved chest compression depth from the first minute, leaning from the second minute and rate from the third minute.

      Principal conclusions

      A real-time feedback device delivers longer effective, steadier chest compressions over time. An extrapolation of these results from simulation may allow rescuer switches to be carried out beyond the currently recommended 2 minutes when a feedback device is used.
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        • Cobb LA
        • Fahrenbruch CE
        • Walsh TR
        • Copass MK
        • Olsufka M
        • Breskin M
        • et al.
        Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation.
        JAMA. 1999; 281: 1182-1188
        • Wik L
        • Hansen TB
        • Fylling F
        • Steen T
        • Vaagenes P
        • Auestad BH
        • et al.
        Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial.
        JAMA. 2003; 289: 1389-1395
        • Link MS
        • Berkow LC
        • Kudenchuk PJ
        • Halperin HR
        • Hess EP
        • Moitra VK
        • et al.
        Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2015; 132: S444-S464
        • Ashton A
        • McCluskey A
        • Gwinnutt CL
        • Keenan AM
        Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min.
        Resuscitation. 2002; 55: 151-155
        • Peberdy MA
        • Silver A
        • Ornato JP
        Effect of caregiver gender, age, and feedback prompts on chest compression rate and depth.
        Resuscitation. 2009; 80: 1169-1174
        • Russo SG
        • Neumann P
        • Reinhardt S
        • Timmermann A
        • Niklas A
        • Quintel M
        • et al.
        Impact of physical fitness and biometric data on the quality of external chest compression: a randomised, crossover trial.
        BMC Emerg Med. 2011; 11: 20
        • Heidenreich JW
        • Berg RA
        • Higdon TA
        • Ewy GA
        • Kern KB
        • Sanders AB
        Rescuer fatigue: standard versus continuous chest-compression cardiopulmonary resuscitation.
        Acad Emerg Med. 2006; 13: 1020-1026
        • Kovic I
        • Lulic D
        • Lulic I
        CPR PRO(R) device reduces rescuer fatigue during continuous chest compression cardiopulmonary resuscitation: a randomized crossover trial using a manikin model.
        J Emerg Med. 2013; 45: 570-577
        • McDonald CH
        • Heggie J
        • Jones CM
        • Thorne CJ
        • Hulme J
        Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.
        Emerg Med J. 2013; 30: 623-627
        • Sugerman NT
        • Edelson DP
        • Leary M
        • Weidman EK
        • Herzberg DL
        • Vanden Hoek TL
        • et al.
        Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study.
        Resuscitation. 2009; 80: 981-984
        • Cunningham LM
        • Mattu A
        • O'Connor RE
        • Brady WJ
        Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation.
        Am J Emerg Med. 2012; 30: 1630-1638
        • Krarup NH
        • Terkelsen CJ
        • Johnsen SP
        • Clemmensen P
        • Olivecrona GK
        • Hansen TM
        • et al.
        Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study.
        Resuscitation. 2011; 82: 263-269
        • Souchtchenko SS
        • Benner JP
        • Allen JL
        • Brady WJ
        A review of chest compression interruptions during out-of-hospital cardiac arrest and strategies for the future.
        J Emerg Med. 2013; 45: 458-466
        • Abella BS
        • Alvarado JP
        • Myklebust H
        • Edelson DP
        • Barry A
        • O'Hearn N
        • et al.
        Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.
        JAMA. 2005; 293: 305-310
        • Wik L
        • Kramer-Johansen J
        • Myklebust H
        • Sorebo H
        • Svensson L
        • Fellows B
        • et al.
        Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.
        JAMA. 2005; 293: 299-304
        • Yeung J
        • Meeks R
        • Edelson D
        • Gao F
        • Soar J
        • Perkins GD
        The use of CPR feedback/prompt devices during training and CPR performance: A systematic review.
        Resuscitation. 2009; 80: 743-751
        • Buleon C
        • Parienti JJ
        • Halbout L
        • Arrot X
        • De Facq Regent H
        • Chelarescu D
        • et al.
        Improvement in chest compression quality using a feedback device (CPRmeter): a simulation randomized crossover study.
        Am J Emerg Med. 2013; 31: 1457-1461
        • Kirkbright S
        • Finn J
        • Tohira H
        • Bremner A
        • Jacobs I
        • Celenza A
        Audiovisual feedback device use by health care professionals during CPR: a systematic review and meta-analysis of randomised and non-randomised trials.
        Resuscitation. 2014; 85: 460-471
        • Borg GA
        Psychophysical bases of perceived exertion.
        Med Sci Sports Exerc. 1982; 14: 377-381
        • Nolan JP
        • Soar J
        • Zideman DA
        • Biarent D
        • Bossaert LL
        • Deakin C
        • et al.
        European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.
        Resuscitation. 2010; 81: 1219-1276
        • Hostler D
        • Everson-Stewart S
        • Rea TD
        • Stiell IG
        • Callaway CW
        • Kudenchuk PJ
        • et al.
        Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial.
        BMJ. 2011; 342: d512
        • Kramer-Johansen J
        • Myklebust H
        • Wik L
        • Fellows B
        • Svensson L
        • Sorebo H
        • et al.
        Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study.
        Resuscitation. 2006; 71: 283-292
        • Skorning M
        • Beckers SK
        • Brokmann J
        • Rortgen D
        • Bergrath S
        • Veiser T
        • et al.
        New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest.
        Resuscitation. 2010; 81: 53-58
        • Yang Z
        • Li H
        • Yu T
        • Chen C
        • Xu J
        • Chu Y
        • et al.
        Quality of chest compressions during compression-only CPR: a comparative analysis following the 2005 and 2010 American Heart Association guidelines.
        Am J Emerg Med. 2014; 32: 50-54
        • Sutton RM
        • Maltese MR
        • Niles D
        • French B
        • Nishisaki A
        • Arbogast KB
        • et al.
        Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents.
        Resuscitation. 2009; 80: 1259-1263
        • Nolan JP
        High-quality cardiopulmonary resuscitation.
        Curr Opin Crit Care. 2014; 20: 227-233
        • Gong Y
        • Yu T
        • Chen B
        • He M
        • Li Y
        Removal of cardiopulmonary resuscitation artifacts with an enhanced adaptive filtering method: an experimental trial.
        Biomed Res Int. 2014; 2014: 140438
        • Sladjana A
        • Gordana P
        • Ana S
        Emergency response time after out-of-hospital cardiac arrest.
        Eur J Intern Med. 2011; 22: 386-393