Elsevier

Resuscitation

Volume 80, Issue 7, July 2009, Pages 743-751
Resuscitation

Review
The use of CPR feedback/prompt devices during training and CPR performance: A systematic review

https://doi.org/10.1016/j.resuscitation.2009.04.012Get rights and content

Abstract

Objectives

In lay persons and health care providers performing cardiopulmonary resuscitation (CPR), does the use of CPR feedback/prompt devices when compared to no device improve CPR skill acquisition, retention, and real life performance?

Methods

The Cochrane database of systematic reviews; Medline (1950–Dec 2008); EmBASE (1988–Dec 2008) and Psychinfo (1988–Dec 2008) were searched using (“Prompt$” or “Feedback” as text words) AND (“Cardiopulmonary Resuscitation” [Mesh] OR “Heart Arrest” [Mesh]). Inclusion criteria were articles describing the effect of audio or visual feedback/prompts on CPR skill acquisition, retention or performance.

Results

509 papers were identified of which 33 were relevant. There were no randomised controlled studies in humans (LOE 1). Two non-randomised cross-over studies (LOE 2) and four with retrospective controls (LOE 3) in humans and 20 animal/manikin (LOE 5) studies contained data supporting the use of feedback/prompt devices. Two LOE 5 studies were neutral. Six LOE 5 manikin studies provided opposing evidence.

Conclusions

There is good evidence supporting the use of CPR feedback/prompt devices during CPR training to improve CPR skill acquisition and retention. Their use in clinical practice as part of an overall strategy to improve the quality of CPR may be beneficial. The accuracy of devices to measure compression depth should be calibrated to take account of the stiffness of the support surface upon which CPR is being performed (e.g. floor/mattress). Further studies are needed to determine if these devices improve patient outcomes.

Section snippets

Background

Survival from cardiac arrest remains poor1, 2 despite significant advances in the science of resuscitation over the last decade.3, 4 One explanation for advances in science not achieving their full therapeutic potential may be a failure to optimally implement evidence based guidelines into practice.5, 6 A number of studies have shown that the quality of CPR during training and in clinical practice is often sub-optimal, with inadequate compression depth, interruptions in chest compression,

Methods

The review was conducted in accordance with the International Liaison Committee on Resuscitation (ILCOR) 2010 evidence evaluation process. Expert review of the search strategy and findings were conducted by the worksheet evaluation experts.

Results

This search identified 509 papers. After the removal of duplicates, 350 titles were reviewed for relevance. From this 36 titles appeared relevant to the research question leading to detailed review of abstracts. Eight further articles were discarded at this phase leaving 28 articles for full review. From the review of reference lists and review articles a further 5 studies were identified. There are no published randomised controlled trials (LOE 1) in human cardiac arrests that address this

Discussion

This review has identified evidence that the use of CPR feedback/prompt systems, either in addition to or in place of instructor facilitated training, can improve basic CPR skill acquisition and retention (as tested without use of the device). Automated feedback may be less effective than instructor feedback for more complex skills (e.g. bag-valve-mask ventilation).23 The use of CPR feedback/prompt systems during CPR performance on manikins consistently improves the quality of CPR. The utility

Authors conclusion and recommendation

This review provides good evidence supporting the use of CPR feedback/prompt devices during CPR training as a strategy to improve CPR skill acquisition and retention. The evidence suggests that the use of CPR feedback/prompt devices in clinical practice as part of an overall strategy to improve the quality of CPR may be beneficial. Further studies are required to assess if the improvements in quality of CPR brought about by these devices translate into improvements in patient focused outcomes.

Disclaimer

This review includes information on resuscitation questions developed through the C2010 Consensus on Science and Treatment Recommendations process, managed by the International Liaison Committee on Resuscitation (http://www.americanheart.org/ILCOR). The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines. In general, each question was assigned to two experts to complete a detailed structured review of the literature, and complete a detailed worksheet.

Conflict of interest

JY, JS—none. GDP has published on CPR feedback devices (Q-CPR, Resusci-Anne Skill meter; CPR-Ezy). DE published on CPR feedback devices and has received research support from AHA and AHRQ, as well as research support, speaking honoraria and consulting from Philips.

Acknowledgements for funding

GDP receives support from the Department of Health National Institute of Health Research (DH NIHR) Clinician Scientist Scheme. This review has been supported in part by the DH NIHR and Research for Patient Benefit Programme.

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    A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.04.012.

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