Audiovisual Feedback Devices for Chest Compression Quality during CPR

During cardiopulmonary resuscitation (CPR), chest compression quality is the key for patient survival. However, several studies have shown that both professionals and laypeople often apply CPR at improper rates and depths. The use of real-time feedback devices increases adherence to CPR quality guidelines. This chapter explores new alternatives to provide feedback on the quality of chest compressions during CPR. First, we describe and evaluate three methods to compute chest compression depth and rate using exclusively the chest acceleration. To evaluate the accuracy of the methods, we used episodes of simulated cardiac arrest acquired in a manikin model. One of the methods, based on the spectral analysis of the acceleration, was particularly accurate in a wide range of conditions. Then, we assessed the feasibility of using the transthoracic impedance (TI) signal acquired through defibrillation pads to provide feedback on chest compression depth and rate. For that purpose, we retrospectively analyzed three databases of out-of-hospital cardiac arrest episodes. When a wide variety of patients and rescuers were included, TI could not be used to reliably estimate the compression depth. However, compression rate could be accurately estimated. Development of simpler methods to provide feedback on CPR quality could contribute to the widespread of these devices

Effect of mattress deflection on CPR quality assessment for older children and adolescents

Appropriate chest compression (CC) depth is associated with improved CPR outcome. CCs provided in hospital are often conducted on a compliant mattress. The objective was to quantify the effect of mattress compression on the assessment of CPR quality in children. Methods: A force and deflection sensor (FDS) was used during CPR in the Pediatric Intensive Care Unit and Emergency Department of a children's hospital. The sensor was interposed between the chest of the patient and hands of the rescuer and measured CC depth. Following CPR event, each event was reconstructed with a manikin and an identical mattress/backboard/patient configuration. CCs were performed using FDS on the sternum and a reference accelerometer attached to the spine of the manikin, providing a means to Calculate the mattress deflection. Results: Twelve CPR events with 14,487 CC (11 patients, median age 14.9 years) were recorded and reconstructed: 9 on ICU beds (9296 CC), 3 on stretchers (5191 CC). Measured mean CC depth during CPR was 47 +/- 8 mm on ICU beds, and 45 +/- 7 mm on stretcher beds with overestimation of 13 +/- 4 mm and 4 +/- 1 mm, respectively, due to mattress compression. After adjusting for this, the proportion of CC that met the CPR guidelines decreased from 88.4 to 31.8% on ICU beds (p < 0.001), and 86.3 to 64.7% on stretcher (p < 0.001 The proportion of appropriate depth CC was significantly smaller on ICU beds (p < 0.001). Conclusion: CC conducted on a non-rigid surface may not be deep enough. FDS may overestimate CC depth by 28% on ICU beds, and 10% on stretcher beds

The use of automated real-time feedback devices to improve quality during CPR training and real CPR performance: a systematic review

High quality cardiopulmonary resuscitation (CPR) is imperative to improve patient outcome after a cardiac arrest. However, it has been demonstrated that CPR quality is normally of suboptimal quality in both real-life resuscitation attempts or simulated training. Automated real-time feedback (ARTF) devices have been considered a potential tool to improve the quality of CPR and maximise retention of the skills. Although previous studies have supported the usefulness of such devices during training, others have conflicting conclusions with regards to its efficacy during real-life CPR. This systematic review of the literature aims to assess the effectiveness of ARTF for improving CPR performance during simulated training and real-life resuscitation in the adult and paediatric population. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [1], articles published between January 2010 and November 2019 were searched from 7 electronic databases (SCIELO, LILACS, BVS, PubMed, Web of Science, Embase, Cochrane, Cinahl, Google Scholar) and reviewed according to the pre-defined eligibility criteria. CPR performance quality was assessed based on guideline compliance for chest compression rate, chest compression depth and complete chest recoil. 871 studies were found and 32 studies met inclusion criteria. 14 randomised controlled trials (RCTs), 08 randomised trials (RTs) and 10 randomised cross-over trials (RCOTs). Each study used ARTF devices during CPR training or real CPR to analyse the performance of healthcare professionals for paediatric or adult population. According to the studies, the use of ARTF devices enhances CPR performance in terms of achieving the recommended chest compression rate, depth and recoil. Based on the results of the studies analysed in this review, the use of ARTF can significantly help improve CPR performance during training of healthcare professionals. Further research is needed to reach the same conclusion for real-life CPR

Instructor Assessment of Adult CPR Skills: A Comparison Between Subjective and Objective Measures

Providing accurate feedback is an important component of teaching CPR skills. An important part of providing accurate feedback is being able to accurately assess specific skills. In a cross- sectional experimental design, 33 CPR instructors were recruited to assess six 2-minute pre- recorded videos of 2-person CPR skills. The subjective assessment measures were compared to the objective manikin measures from a Laerdal Resusci-Anne® QCPR manikin. Results indicated statistically significant differences between the subjective and objective measures in all skills assessed (chest compression rate, chest compression depth, chest recoil, hand placement, ventilation volume, and total cycles). Instructor teaching experience (in years and classes taught) was also discovered not to be statistically significant in instructors’ ability to accurately assess CPR skills. Results of this study appear to support the AHA’s requirement for use of chest compression depth and chest compression rate feedback devices in CPR classes beginning January 2019. Continued research on this topic is warranted

Effect Of The Cardio First Angel™ Device On CPR Indices: A Randomized Controlled Clinical Trial

Background: A number of cardiopulmonary resuscitation (CPR) adjunct devices have been developed to improve the consistency and quality of manual chest compressions. We investigated whether a CPR feedback device would improve CPR quality and consistency, as well as patient survival. Methods: We conducted a randomized controlled study of patients undergoing CPR for cardiac arrest in the mixed medical-surgical intensive care units of four academic teaching hospitals. Patients were randomized to receive either standard manual CPR or CPR using the Cardio First Angel™ CPR feedback device. Recorded variables included guideline adherence, CPR quality, return of spontaneous circulation (ROSC) rates, and CPR-associated morbidity. Results: A total of 229 subjects were randomized; 149 were excluded; and 80 were included. Patient demographics were similar. Adherence to published CPR guidelines and CPR quality was significantly improved in the intervention group (p \u3c 0.0001), as were ROSC rates (72 % vs. 35 %; p = 0.001). A significant decrease was observed in rib fractures (57 % vs. 85 %; p = 0.02), but not sternum fractures (5 % vs. 17 %; p = 0.15). Conclusions: Use of the Cardio First Angel™ CPR feedback device improved adherence to published CPR guidelines and CPR quality, and it was associated with increased rates of ROSC. A decrease in rib but not sternum fractures was observed with device use. Further independent prospective validation is warranted to determine if these results are reproducible in other acute care settings

Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study

Background: The aim of the study was to compare the quality of chest compressions (CCs) carried out with and without the use of the TrueCPR device during simulated cardiopulmonary resuscitations conducted by trainee doctors. Methods: The study was a prospective, randomized, cross-over simulation study. The study involved 65 trainee doctors who were tasked with performing a 2-min cycle of uninterrupted CCs under conditions of a simulated cardiopulmonary resuscitation of adults. CC were carried out in two scenarios: with and without TrueCPR chest compression support. Participants did not have experience in the use of CCs prior to this study. Results: The depth of compressions in regard to CC techniques were varied by 45 mm (IQR 43–48) for manual CC and 53 mm (IQR 51–55) for the TrueCPR device (p &lt; 0.001). The incidence of CCs with and without TrueCPR was: 112 (IQR 103–113) vs. 129 (IQR 122–135) compressions (p = 0.002). The degree of complete chest relaxation with the TrueCPR device was 95% (IQR 76–99) and without the device, 33% (IQR 29–38) (p &lt; 0.001). Conclusions: In the simulation study performed, the use of the TrueCPR device resulted in a significant improvement in the quality of CCs in relation to frequency and depth of CCs and correctness of chest relaxation

Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Objective: To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA). Methods: We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical–surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angel™ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge. Results: One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P < 0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P < 0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones. Conclusion: Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge

The implementation of cardiac arrest treatment recommendations in English acute NHS trusts : a national survey

Purpose of the study: There are approximately 35 000 in-hospital cardiac arrests in the UK each year. Successful resuscitation requires integration of the medical science, training and education of clinicians and implementation of best practice in the clinical setting. In 2015, the International Liaison Committee on Resuscitation (ILCOR) published its latest resuscitation treatment recommendations. It is currently unknown the extent to which these treatment recommendations have been successfully implemented in practice in English NHS acute hospital trusts. Methods: We conducted an electronic survey of English acute NHS trusts to assess the implementation of key ILCOR resuscitation treatment recommendations in relation to in-hospital cardiac arrest practice at English NHS acute hospital trusts. Results: Of 137 eligible trusts, 73 responded to the survey (response rate 53.3%). The survey identified significant variation in the implementation of ILCOR recommendations. In particular, the use of waveform capnography (n=33, 45.2%) and ultrasound (n=29, 39.7%) was often reported to be available only in specialist areas. Post-resuscitation debriefing occurs following every in-hospital cardiac arrest in few trusts (5.5%, n=4), despite a strong ILCOR recommendation. In contrast, participation in a range of quality improvement strategies such as the National Cardiac Arrest Audit (90.4%, n=66) and resuscitation equipment provision/audit (91.8%, n=67) were high. Financial restrictions were identified by 65.8% (n=48) as the main barrier to guideline implementation. Conclusion: Our survey found that ILCOR treatment recommendations had not been fully implemented in most English NHS acute hospital trusts. Further work is required to better understand barriers to implementation

Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation

Objective: To determine the effect of visual feedback on rate of chest compressions, secondarily relating the forces used. / Design: Randomised crossover trial. / Setting: Tertiary teaching hospital. / Subjects: Fifty trained hospital staff. / Interventions: A thin sensor-mat placed over the manikin's chest measured rate and force. Rescuers applied compressions to the same paediatric manikin for two sessions. During one session they received visual feedback comparing their real-time rate with published guidelines. / Outcome measures: Primary: compression rate. Secondary: compression and residual forces. / Results: Rate of chest compressions (compressions per minute (compressions per minute; cpm)) varied widely (mean (SD) 111 (13), range 89–168), with a fourfold difference in variation during session 1 between those receiving and not receiving feedback (108 (5) vs 120 (20)). The interaction of session by feedback order was highly significant, indicating that this difference in mean rate between sessions was 14 cpm less (95% CI −22 to −5, p=0.002) in those given feedback first compared with those given it second. Compression force (N) varied widely (mean (SD) 306 (94); range 142–769). Those receiving feedback second (as opposed to first) used significantly lower force (adjusted mean difference −80 (95% CI −128 to −32), p=0.002). Mean residual force (18 N, SD 12, range 0–49) was unaffected by the intervention. / Conclusions: While visual feedback restricted excessive compression rates to within the prescribed range, applied force remained widely variable. The forces required may differ with growth, but such variation treating one manikin is alarming. Feedback technologies additionally measuring force (effort) could help to standardise and define effective treatments throughout childhood