Proof: Real-time feedback device improves CPR training

2021-12-15 00:23:59 By : Mr. Richard Wei

Rekindle your enthusiasm for EMS: Your burnout repair guide

Innovative and high-quality respiratory and airway products

Researchers measured the effects of several CPR feedback or reminder devices on chest compression depth, compression speed, recoil, and hand position

Today is the crew training day of station 27. After breakfast, the dispatcher stopped the engine and medical team from service and sent them to the training center. Today's course is a CPR refresher course.

However, this refresher course is different from any courses taught before. Today, the instructors are adding a new CPR feedback device for mannequin exercises, which will provide the crew with real-time performance data. The coach explained that these devices will help ensure that everyone provides the correct speed, depth and recoil. When chest compressions are paused for 10 seconds or more, the device will also sound an audible warning. The lecturer explained that the department will install one of these devices on every response vehicle in the city next week, with a view to fine-tuning CPR performance and improving the community’s out-of-hospital cardiac arrest survival rate. 

Initially, these devices were a bit cumbersome for the staff. No one has used it before and it takes some time to get used to it. When each firefighter and medical staff take turns using the mannequin, they will slowly begin to adjust their performance based on the feedback provided by the equipment.

However, a station worker became increasingly frustrated with the equipment. He complained that he has been CPR certified for more than 25 years, and he does not need a machine to tell him how to do CPR. He believes that his department could have saved the money for purchasing these equipment, thereby bringing greater benefits to the department.

Although the trainer's intentions are the best, the lieutenant still does not believe that the device will actually change the way he and his crew perform CPR.

Research review: CPR performance using feedback devices. Researchers used human models to measure the effects of various CPR feedback or prompt devices on specific CPR quality indicators, such as chest compression depth, compression frequency, insufficient recoil and incorrect hand position[1] . The participants were all nurses who had previous CPR experience but had never used any type of feedback or reminder device. Each nurse either works in the emergency room or as a member of the EMS team, with an average (average) work experience of 12.4 years. Before starting the research, members of the research team trained nurses to use each device correctly.

Researchers compared manual CPR without equipment (standard CPR) with CPR using each of three commonly used equipment; TrueCPR™ trainer equipment is from Physio-Control, and CPR-Ezy™ is from Health Affairs, LTD. The iCPR app from DSign Srl Random assignment determines from which device (or no device) each nurse starts. Each nurse performed a single CPR for 8 minutes using randomly assigned equipment (or no equipment).

After the end, the nurse rested for 20 minutes and then was assigned to one of the remaining options. This process continued until each nurse performed eight minutes of CPR using each of the three equipment, and eight minutes of standard CPR without equipment.

After completing all four CPR courses, each nurse also completed a survey that described the level of personal confidence, whether each device was easy to use and comfortable, and whether each device would distract attention from performing CPR.

Researchers collected data for this study in the summer of 2014, before the release of the 2015 American Heart Association guidelines for cardiopulmonary resuscitation. Therefore, the researchers compared all CPR quality measures with those recommended by the 2010 European Resuscitation Council (ERC) guidelines, which require chest compressions to be at least 5 cm (50 mm) deep and 100 to 120 compressions per compression. Minutes, full chest recoil, hands on the lower part of the breastbone [2].

Results: The only research condition for the feedback device comparison to achieve the 50 mm recommended chest compression depth was to perform CPR while using the TrueCPR™ feedback device. With this device, nurses achieve deeper chest compressions compared to using other devices or no device at all. In descending order, nurses achieved an average chest compression depth of 54.5 mm using TrueCPR™, 45.6 mm using CPR-Ezy™, 44.6 mm using standard CPR without feedback devices, and 39.6 mm using the iCPR app. Not only did the TrueCPR™ device produce deeper average chest compressions, but the device also produced the highest percentage of compressions that met the ERC depth recommendations.

All three devices have a significant impact on chest compression rate. The only condition for producing a chest compression frequency exceeding the recommended frequency (100-120 beats per minute) is the standard CPR without the use of equipment. In descending order, the average rate of nurses using standard CPR without equipment at 129 compressions per minute, TrueCPR™ 110 compressions per minute, iCPR app 104 compressions per minute, and CPR-Ezy™ 102 compressions per minute Perform CPR.

Since ERC recommends a compression depth greater than 50 mm, the full chest recoil should also be greater than 50 mm. Using TrueCPR™ devices can significantly increase the compression ratio that meets the recommended chest recoil. In descending order, the compression ratios that meet the ERC chest recoil recommendations are TrueCPR™ 78%, CPR-Ezy™ 70%, standard CPR without equipment is 68%, and iCPR apps are 65%.

The human body model and software program used in this study can measure whether the compression point is on the lower half of the sternum (correct) or in another location, such as too far from one side or the chest too high or too low (incorrect). With TrueCPR™ equipment, the highest percentage of compressions can be performed in the correct position. In descending order, TrueCPR™ uses the correct pressure point for 98% of chest compressions, the standard CPR with no feedback device is 95%, the CPR-Ezy™ is 93%, and the iCPR app is 77%.

Finally, the researchers created a metric called effective compression, which is defined as the compression ratio that meets the ERC recommendations for depth, recoil, and hand position. TrueCPR™ is significantly better than any other conditions. In descending order, the effective chest compression ratio for TrueCPR™ is 86%, CPR-Ezy™ is 40%, the standard CPR without equipment is 38%, and the iCPR app is 33%. Regardless of whether the measurement is at the beginning (90%) or the end (76%) of the 8-minute CPR cycle, the proportion of effective chest compressions associated with TrueCPR™ is still significantly better.

In a positive comparison of the user satisfaction variables between the three devices, the study participants found that the TrueCPR™ device was the easiest and most comfortable to use. The device also provides the user with the highest level of confidence and produces the least amount of distraction.

In the multiple regression analysis, the researchers also found that the provider's experience and work location will affect the overall proportion of effective chest compressions. When performing standard CPR without equipment and using the iCPR application, experienced nurses are better than less experienced nurses. In addition, when performing standard CPR and using iCPR applications without equipment, those nurses who are mainly assigned to EMS field work performed better than those assigned to ED.

What does this mean to you The term feedback device is often used to describe various tools that have a common goal to improve the quality of CPR provided during resuscitation attempts. However, the term may or may not actually describe how the device works. Real feedback devices provide information about what rescuers are actually doing, so they can adjust CPR performance in real time. In this study, TrueCPR™ and CPR-Ezy™ devices acted as true feedback devices.

On the other hand, the notification device does not provide information about the performance of rescuers. Although rescuers can adjust CPR performance in real time based on this information, the device does not actually measure what the rescuers are doing. For example, the metronome uses sound to prompt the rescuer to perform chest compressions at a predetermined frequency, but it cannot measure whether the rescuer actually performs synchronized compressions.

Intuitively, it is reasonable to expect the feedback device to be better than the prompt device. However, all feedback devices may have different effects on performance. In this study, only one feedback device was significantly better than the prompt device. By the way, this feedback device is even better than standard non-device-assisted CPR.

Generally, CPR training using real-time feedback components can improve student performance. A group of in-hospital healthcare providers used TrueCPR™ equipment during CPR training to improve the compression rate and depth performance of the mannequin [3]. In a randomized controlled trial involving trained rescuers, one feedback device using pressure sensing technology (CPR-Ezy™) significantly improved compression depth, while the other used an accelerometer (Q-CPR™) ) Of the equipment leads to deep deterioration [4]. Researchers at the Medical University of Vienna found that when medical students received feedback during training, CPR measures were improved, but performance measurements related to mechanical equipment were no better or better than those related to feedback from trained human coaches. Worse [5].

However, the impact of this improved training on clinical outcomes is unclear. Early studies did not find a significant improvement in the outcome variables related to the use of feedback devices in the hospital [6] or outside the hospital environment [7]. Recently, a multicenter study of cardiac arrest in hospital failed to prove that adding a feedback device to standard resuscitation attempts has any survival advantage [8].

In contrast, a secondary analysis of the data collected during the CPR quality survey was related to the use of a specific real-time audiovisual feedback device during an out-of-hospital resuscitation attempt carried by helicopter, indicating that the use of this device resulted in an increase in the number of patients in the emergency room. Survival rate, but will not increase the survival rate of an additional 24 hours or increase the survival rate of discharge from the hospital [9]. Similarly, using Cardio First Angel™ CPR equipment in ICU patients instead of manual CPR without feedback devices can improve ROSC and reduce rib fractures in ICU patients [10]. In contrast, when rescuers use the Q-CPR feedback device during resuscitation, the chance of the nervous system surviving intact after an out-of-hospital cardiac arrest is reduced by approximately 50% [11].

In the largest trial to date to solve this problem, researchers from the Resuscitation Results Alliance found that the use of feedback devices during out-of-hospital cardiac arrest and resuscitation did not provide any survival advantage [12]. A recent meta-analysis of clinical trials using audiovisual feedback devices during resuscitation found no evidence that these devices can improve clinical outcomes [13].

In a pre- and post-observational study, adding real-time audiovisual feedback and targeted CPR quality training courses improved clinical CPR quality indicators, thereby increasing the probability of discharge survival and good functional outcomes [14]. However, due to the nature of this research, no one can determine whether the improved outcome measurement comes from real-time feedback, increased attention to high-quality CPR training, or some other unmeasured variable.

There are many possible reasons why no research can clearly prove the clinical improvement of using any of these devices. First, the survival rate after out-of-hospital cardiac arrest is related to time. When ROSC occurs sooner rather than later, patients usually have a more favorable outcome. In order to increase the chance of survival, the first three links in the survival chain should occur before the EMS personnel arrive on the scene. If they don’t, their chances of survival will be greatly reduced. When the EMS arrives on site and begins to use feedback devices, the window of opportunity for many of the early variables known to improve survival may have been closed.

Although simulation data shows that the use of feedback or reminder devices does improve CPR indicators, these improvements may not represent meaningful or useful data for real patients. Performing CPR on a human model under training is different from performing CPR on a human in an ICU or ED, which is still different from performing CPR in an out-of-hospital environment.

The 2015 update of the American Heart Association's guidelines for cardiopulmonary resuscitation and cardiovascular first aid recommended the use of feedback devices as an aid to CPR training [15]. If the feedback device is not available, the teacher should replace the reminder device during the CPR training.

Feedback and reminder devices appear to improve the quality of CPR obtained during simulated cardiac arrest management. However, not all devices have the same performance. EMS organizations considering adding feedback devices to the management of out-of-hospital cardiac arrest should investigate all options before choosing a specific technique.

The author has no financial interest, arrangement, or direct affiliation with any company that has a direct interest in the subject of this presentation (including the manufacturer or service provider of any of the products mentioned).

Request product information from top EMS CPR and recovery companies

By submitting your information, you agree to be contacted by the selected supplier, and the data you submit is not subject to the "Do Not Sell My Personal Information" request. Check our terms of service and privacy policy.

Kenny Navarro is the Director of EMS Educational Development in the Department of Emergency Medicine, University of Texas Southwestern School of Medicine, Dallas. He also serves as the coordinator of the AHA Training Center at Tarrant County College. Mr. Navarro serves as the Emergency Cardiovascular Care Content Consultant of the American Heart Association, serves on the two educational subcommittees of NIH-funded research projects, serves as the coordinator of the National EMS Education Standards Project, and the National EMS Education Expert Author Standards Implementation Group. 

You must enable JavaScript in your browser to view and post comments.

More EMS cardiopulmonary resuscitation and resuscitation articles

More EMS cardiopulmonary resuscitation and resuscitation offers

Copyright © 2021 EMS1. all rights reserved.

Copyright © 2021 Lexipol. all rights reserved. Do not sell my personal information

EMS1 is revolutionizing the way the EMS community finds relevant news, identifies important training information, interacts with each other, and researches product sourcing and suppliers. It has become the most comprehensive and trusted online destination for pre-hospital and emergency medical services.

Copyright © 2021 Lexipol. all rights reserved. Do not sell my personal information

Visit other EMS1 network sites:

If you need more help setting up your homepage, please check the "Help" menu of your browser