CPR Feedback Device and Training Improves CPR Quality in Pediatric Patients | Journal Scan

Study Questions:

Does “just-in-time” (JIT) cardiopulmonary resuscitation (CPR) training with visual feedback or real-time visual feedback during cardiopulmonary arrest (CPA) improve quality of chest compressions during simulated CPA?


A prospective, randomized, 2 x 2 factorial designed trial was performed at 10 international centers. Each three-person team was randomized to one of four permutations. The control group viewed a standardized video and underwent 2 minutes of CPR practice. The intervention groups included: 1) No JIT CPR visual feedback training before CPA and real-time visual feedback during CPA, 2) JIT CPR visual feedback training before CPA and no real-time visual feedback training during CPA, and 3) JIT CPR visual feedback training before CPA and real-time visual feedback training during CPA. The visual feedback device provided feedback using light-emitting diodes for chest compression depth and rate. All teams participated in a standardized 12-minute pediatric CPA scenario. Outcome measures included achievement of American Heart Association recommendations of chest compression rate of 100-120 per minute and chest compression depth exceeding 50 mm.


A total of 324 providers were assigned to three-person resuscitation teams (total of 108 teams). Mean depth and rate compliance were 12.7% and 27.1%, respectively, in the control group. JIT training improved depth compliance by 19.9% (p < 0.001) and rate compliance by 12% (p = 0.037). Visual feedback compared with no visual feedback improved depth compliance by 15.4% (p = 0.001) and rate compliance by 40.1% (p < 0.001). Combining both interventions showed the highest compliance, but was not statistically superior to either intervention alone. CC fraction (percentage of CPR time during arrest) was excellent (>89%) in all groups.


The authors concluded that CPR quality as performed by health care professionals is poor. JIT training and real-time visual feedback, alone or in combination, improved CPR quality.


Performing high-quality CPR should be considered a fundamental skill for health care professionals. The baseline CPR quality in the study was dismal, and although improved with the study, remained poor, with <50% of chest compressions meeting American Heart Association guidelines for depth after the intervention. Results were somewhat better for chest compression rate, with improvement to nearly 80% with visual feedback. This study supports application of the interventions described, but also needed are systemic efforts at monitoring and improving CPR quality across hospitals and health care systems.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Cardiopulmonary Resuscitation, Heart Arrest, Resuscitation, Pediatrics, Feedback, Feedback, Sensory, Outcome Assessment (Health Care), American Heart Association, Prospective Studies, Control Groups

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