Can infant CPR performance be improved through the provision of 'real time' feedback?

Abstract

Cardiac arrest (CA) is a significant health issue Worldwide. Paediatric sufferers have particu-larly poor outcomes, with high-rates of associated mortality and morbidity. Early cardiopulmonary-resuscitation (CPR), an emergency procedure which combines external chest-compressions with artificial-ventilations (rescue breaths), has been shown to improve CA outcomes. Researchers have, however, demonstrated CPR, even when delivered by highly-trained-rescuers is not currently being performed optimally. International guidelines have suggested the potential contribution of feedback systems (assistance), in improving the delivery of chest-compressions and rescue breaths to improve survival rates. Thus, the main focus of this research was to design and develop a real-time CPR-performance-feedback-system, to monitor and assist rescuers in producing high-quality infant-CPR (iCPR). This was conducted as follows: assessment of current compressions by Basic Life Support (BLS) and ‘lay’ rescuers, design and development of a real-time feedback and performance system and the study of its effects during iCPR. All performances were compared against benchmarked quality standards. During unassisted iCPR, BLS and ‘lay’ rescuer overall compression quality, that is those con-comitantly achieving all four iCPR quality targets, was 61.4% and >24.6%, respectively. Assistance delivered more breaths, 5-32%, more quickly, 30-84%, complying with recommendations. As-sisted compression count, after each ventilation, was 53% less than unassisted, complying with recommendations. There were no differences in the guideline compression duty cycle (DC), provided that compression time and peak depth were the same. Thesis summary iv Unassisted compressions failed to show compliance with quality targets. Assistance produced significant improvements in the overall quality of compressions, reduced the time for breaths and regulated the compression counts after each ventilation. However, lay rescuers require additional training with the feedback system and iCPR simulation. Overall the real-time feed-back system significantly improved iCPR performance, such that it could now be trialled to investigate possible improvements in clinical outcomes