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

What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature

Background: Effective training and retraining may be key to good quality paediatric cardiopulmonary resuscitation (pCPR). PCPR skills decay within months after training, making the current retraining intervals ineffective. Establishing an effective retraining strategy is fundamental to improve quality of performance and potentially enhance patient outcomes. Objective: To investigate the intervals and strategies of formal paediatric resuscitation retraining provided to healthcare professionals, and the associated outcomes including patient outcomes, quality of performance, retention of knowledge and skills and rescuer's confidence. Methods: This review was drafted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). PubMed, Medline, Cochrane, Embase, CINAHL Complete, ERIC and Web of Science were searched and studies addressing the PICOST question were selected. Results: The results indicate complex data due to significant heterogeneity among study findings in relation to study design, retraining strategies, outcome measures and length of intervention. Out of 4706 studies identified, 21 were included with most of them opting for monthly or more frequent retraining sessions. The length of intervention ranged from 2-minutes up to 3.5 hours, with most studies selecting shorter durations (<1h). All studies pointed to the importance of regular retraining sessions for acquisition and retention of pCPR skills. Conclusions: Brief and frequent pCPR retraining may result in more successful skill retention and consequent higher-quality performance. There is no strong evidence regarding the ideal retraining schedule however, with as little as two minutes of refresher training every month, there is the potential to increase pCPR performance and retain the skills for longer

The use of the Borg Rating of perceived exertion scale in cardiopulmonary resuscitation

Cardiorespiratory arrest is a critical event whose survival rate is related to the quality of resuscitation manoeuvres, combined with technology. It is important to understand the perception of tiredness during this procedure, aiming at the effectiveness of compressions and increasing the chances of survival. Goal Apply the Borg Scale to analyze the effort perceived by nurses during cardiopulmonary resuscitation manoeuvres with a feedback device. Method Experimental study with randomized distribution of nurses in a teaching hospital, simulating cardiac arrest, to assess perceived exertion using the Borg scale during cardiopulmonary resuscitation with/without a feedback device. A statistical significance level of 5% was adopted. Results Sixty-nine nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference regarding the actuation units. Conclusion The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to less effort and reduced heart rate during resuscitation manoeuvres. The low cost and ease of application favour its use in training and real-time consultations to assess performance during resuscitation, using a feedback device to reduce efforts and the perception of tiredness. It also allows reflection on the intervening factors and resources that can influence the quality of care and the chances of survival

The application of Borg scale in cardiopulmonary resuscitation: An integrative review

The study of human performance and perception of exertion constitutes a fundamental aspect for monitoring health implications and enhancing training outcomes such as cardiopulmonary resuscitation (CPR). It involves gaining insights into the varied responses and tolerance levels exhibited by individuals engaging in physical activities. To measure perception of exertion, many tools are available, including the Borg scale. In order to evaluate how the Borg scale is being used during CPR attempts, this integrative review was carried out between October/2020 and December/2023, with searches from PubMed, CINAHL, Web of Science, Embase, PsycINFO and VHL. Full publications relevant to the PICO strategy were included and letters, editorials, abstracts, and unpublished studies were excluded. In total, 34 articles were selected and categorised into three themes: a) CPR performed in different contexts; b) CPR performed in different cycles, positions, and techniques; c) CPR performed with additional technological resources. Because CPR performance is considered a strenuous physical activity, the Borg scale was used in each study to evaluate perception of exertion. The results identified that the Borg scale has been used during CPR in different contexts. It is a quick, low-cost, and easy-to-apply tool that provides important indicators that may affect CPR quality, such as perception of exertion, likely improving performance and potentially increasing the chances of survival