Do automated real-time feedback devices improve CPR quality? A systematic review of literature.
Ontology highlight
ABSTRACT: Aim
Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the effectiveness of automated real-time feedback devices for improving CPR performance during training, simulation and real-life resuscitation attempts in the adult and paediatric population.Methods
Articles published between January 2010 and November 2020 were searched from BVS, Cinahl, Cochrane, PubMed and Web of Science, and reviewed according to a pre-defined set of eligibility criteria which included healthcare providers and randomised controlled trial studies. CPR quality was assessed based on guideline compliance for chest compression rate, chest compression depth and residual leaning.Results
The selection strategy led to 19 eligible studies, 16 in training/simulation and three in real-life CPR. Feedback devices during training and/or simulation resulted in improved acquisition of skills and enhanced performance in 15 studies. One study resulted in no significant improvement. During real resuscitation attempts, three studies demonstrated significant improvement with the use of feedback devices in comparison with standard CPR (without feedback device).Conclusion
The use of automated real-time feedback devices enhances skill acquisition and CPR performance during training of healthcare professionals. Further research is needed to better understand the role of feedback devices in clinical setting.
SUBMITTER: Gugelmin-Almeida D
PROVIDER: S-EPMC8244494 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundPrevious systematic reviews have failed to find an association between the use of real-time feedback during cardiopulmonary resuscitation (CPR) and patient outcomes. However, these reviews excluded studies examining feedback with other system changes. As part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation process, we conducted a scoping review to examine the current state of this literature and the use of real-time feedback in this form.Methods/data sourcesA protocol and search strategy was developed. We searched Medline, EMBASE, and Allied Health Literature (CINAHL) from inception to May 2024. Cochrane (Cochrane (specifically, the Cochrane Database of Systematic Reviews) is contained in Medline so was not searched separately. Studies were eligible for inclusion if they were published or unpublished (grey-literature) studies involving children or adults that examined the effect of real-time feedback or prompting on the quality of CPR following cardiac arrest. Data were extracted and audited independently. For each study, the following information were extracted: the author(s); year of publication; timeframe; study design; country; population; intervention and comparator; type of feedback or prompt; outcomes measured; main findings for CPR quality, and; main findings for patient outcomes. Reviewers also allocated key themes to each study and held a series of consensus discussions to consolidate themes across the included studies.ResultsWe screened 2,657 titles and included 60 studies. Our analysis identified five overlapping themes in the extended literature: system change and quality improvement; impact on patient outcomes; better CPR quality without improved patient outcome; CPR feedback as a generator of other CPR metrics; and CPR feedback as a potential harm. Results revealed a substantial adjacent literature, particularly on implementing high-performance CPR as part of quality improvement programs.ConclusionsThis scoping review has identified a large body of literature and specific themes of interest in relation to feedback for CPR quality. Future systematic reviews should include studies examining real-time feedback with other system changes.
| S-EPMC11341937 | biostudies-literature
Project description:To test whether real-time feedback will improve quality of endoscopic examination.
| 2404786 | ecrin-mdr-crc
Project description:ObjectiveTo analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by certified basic life support providers.MethodsTwenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group.ResultsRectus abdominis' contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii's radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects.ConclusionsCompression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer's strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.
| S-EPMC6145543 | biostudies-literature
Project description:BackgroundThe 2005 Emergency Cardiac Care guidelines for basic life support (BLS) recommend compression to ventilation ratio of 30:2. The effect of the additional exertion required to deliver more chest compressions may present a considerable physical burden on the provider.ObjectiveTo compare cardiopulmonary resuscitation (CPR) performance and perceived exertion during compression to ventilation ratios of 15:2 and 30:2 with real-time feedback during two-rescuer CPR.MethodsEighteen BLS-certified healthcare providers each performed 5 min of chest compressions on a manikin with compression to ventilation ratios of 15:2 or 30:2 on two separate sessions. Heart rate, capillary lactate, and OMNI rate of perceived exertion (RPE) were recorded before and after each session. Subjects were given continuous, automated, feedback via an accelerometer that measured rate, depth, duration, and release of compressions. Compression measurements and feedback messages were recorded continuously during each 5-min session. Data were analyzed using descriptive statistics and t-test to compare groups. Repeated measures ANOVA were used to compare data over the 5-min epoch.ResultsAfter performing external chest compressions for 5 min, peak heart rate (102+/-24 vs. 106+/-27), capillary lactate (2.2+/-0.95 vs. 2.2+/-0.96), and OMNI RPE (4.3+/-1.2 vs. 4.6+/-1.1) were higher were higher than baseline, but did not differ between 15:2 and 30:2. Compression rate (102+/-24 vs.106+/-27) and depth (38.8+/-3.6 vs. 38.2+/-2.9) did not differ between 15:2 and 30:2 groups or at any minute. Total chest compressions delivered were higher (p<0.05) in the 30:2 group (457+/-43) compared to 15:2 (379+/-28). The average no flow time was lower (p<0.05) in the 30:2 group (22+/-3.03) compared to the 15:2 group (33+/-2.64). Number of correction prompts (48+/-55 vs. 64+/-70) did not differ significantly between the 15:2 and 30:2 groups.ConclusionsIn a cohort of healthcare providers, increasing the CPR ratio from 15:2 to 30:2 did not change physical or perceived exertion during a 5-min bout of CPR when continuous, real-time feedback is provided. The 30:2 compression to ventilation ratio resulted in more chest compressions per minute without decreasing CPR quality.
| S-EPMC2613429 | biostudies-literature
Project description:OBJECTIVES:'Quality Cardiopulmonary Resuscitation (QCPR) Classroom' was recently introduced to provide higher-quality Cardiopulmonary Resuscitation (CPR) training. This study aimed to examine whether novel QCPR Classroom training can lead to higher chest-compression quality than standard CPR training. DESIGN:A cluster randomised controlled trial was conducted to compare standard CPR training (control) and QCPR Classroom (intervention). SETTING:Layperson CPR training in Japan. PARTICIPANTS:Six hundred forty-two people aged over 15 years were recruited from among CPR trainees. INTERVENTIONS:CPR performance data were registered without feedback on instrumented Little Anne prototypes for 1?min pretraining and post-training. A large classroom was used in which QCPR Classroom participants could see their CPR performance on a big screen at the front; the control group only received instructor's subjective feedback. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcomes were compression depth (mm), rate (compressions per minute (cpm)), percentage of adequate depth (%) and recoil (%). Survey scores were a secondary outcome. The survey included participants' confidence regarding CPR parameters and ease of understanding instructor feedback. RESULTS:In total, 259 and 238 people in the control and QCPR Classroom groups, respectively, were eligible for analysis. After training, the mean compression depth and rate were 56.1±9.8?mm and 119.2±7.3?cpm in the control group and 59.5±7.9?mm and 116.8±5.5?cpm in the QCPR Classroom group. The QCPR Classroom group showed significantly more adequate depth than the control group (p=0.001). There were 39.0% (95% CI 33.8 to 44.2; p<0.0001) and 20.0% improvements (95%?CI 15.4 to 24.7; P<0.0001) in the QCPR Classroom and control groups, respectively. The difference in adequate recoil between pretraining and post-training was 2.7% (95% CI -1.7 to 7.1; pre 64.2±36.5%?vs post 66.9%±34.6%; p=0.23) and 22.6% in the control and QCPR Classroom groups (95%?CI 17.8 to 27.3; pre 64.8±37.5%?vs post 87.4%±22.9%; p<0.0001), respectively. CONCLUSIONS:QCPR Classroom helped students achieve high-quality CPR training, especially for proper compression depth and full recoil. For good educational achievement, a novel QCPR Classroom with a metronome sound is recommended.
| S-EPMC6576135 | biostudies-literature
Project description:IntroductionPatients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus daytime.MethodsThis is a secondary analysis of data collected from the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Study. Pediatric or Pediatric Cardiac Intensive Care Unit patients who received chest compressions for ≥1 min and who had invasive arterial BP monitoring were enrolled. Nighttime was defined as 11:00PM to 6:59AM and daytime as 7:00AM until 10:59PM. Primary outcome was attainment of DBP ≥ 25 mmHg in infants <1 year and ≥30 mmHg in older children. Secondary outcomes were mean DBP, ROSC, and survival to hospital discharge. Univariable and multivariate analyses evaluated the relationships between time (nighttime vs. daytime) and outcomes.ResultsBetween July 1, 2013 and June 30, 2016, 164 arrests met all inclusion/exclusion criteria: 45(27%) occurred at nighttime and 119(73%) during daytime. Average DBPs achieved were not different between groups (DBP: nighttime 28.3 mmHg[25.3, 36.5] vs. daytime 29.6 mmHg[21.8, 38.0], p = 0.64). Relative risk of DBP threshold met during nighttime vs. daytime was 1.27, 95%CI [0.80, 1.98], p = 0.30. There was no significant nighttime vs. daytime difference in ROSC (28/45[62%] vs. 84/119[71%] p = 0.35) or survival to hospital discharge (16/45[36%] vs. 61/119[51%], p = 0.08).ConclusionsIn this cohort of pediatric ICU patients with IHCA, there was no significant difference in DBP during CPR between nighttime and daytime.
| S-EPMC7431912 | biostudies-literature
Project description:ObjectivesTo determine the effect of a free smartphone application (TCPRLink) that provides real-time monitoring and audiovisual feedback on chest compressions (CC) on trained layperson telephone-assisted cardiopulmonary resuscitation (T-CPR) performance.DesignA manikin-based randomised controlled study.SettingThis study was conducted at a multidisciplinary university and a community centre in China.ParticipantsOne hundred and eighty-six adult participants (age 18-65 years) with T-CPR training experience were randomly assigned to the TCPRLink (n=94) and T-CPR (n=92) groups with age stratification.InterventionsWe compared the participants' performance for 6 min of CC in a simulated T-CPR scenario both at the baseline and after 3 months.Primary and secondary outcome measuresThe primary outcomes were the CC rate and proportion of adequate CC rate (100-120 min-1). The secondary outcomes included the proportion of participants counting the CC rhythm, time to first CC, CC depth, hands-off time and CC full-release ratio.ResultsParticipants in the TCPRLink feedback group more consistently performed CC with higher rate, both initially and 3 months later (median 111 (IQR 109-113) vs 108 (103-112) min-1, p=0.002 and 111 (109-113) vs 108 (105-112) min-1, p<0.001, respectively), with less need to count the rhythm (21.3% vs 41.3%, p=0.003% and 7% vs 22.6%, p=0.004, respectively) compared with the T-CPR group. There were no significant differences in time to the first CC, hands-off time or CC full-release ratio. Among 55-65 year group, the CC depth was deeper in the TCPRLink group than in the TCPR group (47.1±9.6 vs 38.5±8.7 mm, p=0.001 and 44.7±10.1 vs 39.3±10.8 mm, p=0.07, respectively).ConclusionsThe TCPRLink application improved T-CPR quality in trained laypersons to provide more effective CCs and lighten the load of counting out the CC with the dispatcher in a simulated T-CPR scenario. Further investigations are required to confirm this effectiveness in real-life resuscitation attempts.
| S-EPMC7539615 | biostudies-literature
Project description:BackgroundPrevious studies suggest that physiological feedback can be an effective method for emotion regulation (ER). However, studies on the specific effects of physiological feedback have shown conflicting results due to inconsistencies in study designs. Therefore, we present this systematic review to further validate the effectiveness of physiological feedback for ER, clarify its specific effects, as well as summarize the factors that influence its effectiveness.MethodThis systematic review following PRISMA guidelines covers all studies using physiological feedback in emotions. A literature search was conducted in Web of Science, PubMed, PsychINFO, China National Knowledge Infrastructure, and WANFANG DATA. And a standardized quality assessment was performed.ResultsWe identified 27 relevant articles (25 studies), and the majority of these studies showed a significant regulatory effect of physiological feedback on different emotions. The feedback's content, explanation, authenticity, real-time capability, and modality were the key factors that influenced its effects, and this technology will achieve its optimal ER effect when these factors are considered comprehensively.ConclusionsThese findings further confirmed the effectiveness of physiological feedback as an ER method, as well as providing key factors that should be addressed in its application. Meanwhile, due to the limitations of these studies, more well-designed studies are still needed.
| S-EPMC10213271 | biostudies-literature
Project description:Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest.The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors.All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites.This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing.ISRCTN56583860.
| S-EPMC3214886 | biostudies-other
Project description:BackgroundAnesthesiology residencies are developing trainee assessment tools to evaluate 25 milestones that map to the six core competencies. The effort will be facilitated by development of automated methods to capture, assess, and report trainee performance to program directors, the Accreditation Council for Graduate Medical Education and the trainees themselves.MethodsThe authors leveraged a perioperative information management system to develop an automated, near-real-time performance capture and feedback tool that provides objective data on clinical performance and requires minimal administrative effort. Before development, the authors surveyed trainees about satisfaction with clinical performance feedback and about preferences for future feedback.ResultsResident performance on 24,154 completed cases has been incorporated into the authors' automated dashboard, and trainees now have access to their own performance data. Eighty percent (48 of 60) of the residents responded to the feedback survey. Overall, residents "agreed/strongly agreed" that they desire frequent updates on their clinical performance on defined quality metrics and that they desired to see how they compared with the residency as a whole. Before deployment of the new tool, they "disagreed" that they were receiving feedback in a timely manner. Survey results were used to guide the format of the feedback tool that has been implemented.ConclusionThe authors demonstrate the implementation of a system that provides near-real-time feedback concerning resident performance on an extensible series of quality metrics, and which is responsive to requests arising from resident feedback about desired reporting mechanisms.
| S-EPMC3893706 | biostudies-literature