Document Type : Original Article

Authors

1 Assistant professor of cardiology, Department of Internal Medicine, Isfahan university of medical sciences, Isfahan, Iran

2 Resident, Department of Internal Medicine, Isfahan university of medical sciences, Isfahan, Iran

3 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/arya.2022.39288.2840

Abstract

INTRODUCTION: Out-of-hospital cardiac arrest is a major public health problem with over 90% case fatality. Although it is known that good quality of cardiopulmonary Resuscitation (CPR) leads to improved patient outcomes, health care practitioners commonly perform sub-optimal CPR. The CPR feedback device is a small device designed to measure the number and depth of chest compressions (CC) and if the rate of compressions or the depth of the compressions is low or high, it will try to correct the CPR operation by announcing a warning to the resuscitator. The aim of this study was to evaluate the effectiveness of this device which was designed and made by the authors’ technician study group member in improving CPR operations, to determine the need for it in all hospitals on a routine basis.
METHOD: This cross-sectional study was performed on patients who have suffered from cardio-pulmonary arrest in Al-Zahra Hospital in 2020. Patients needed primary CPR for any reason, were randomly divided into two groups using random allocation software. The first group contains patients as the CPR Feedback device is on and alarm is on and warns, if resuscitation is ineffective, the second group also uses the device, but with the difference that the alarm is off. The data was analyzed by general linear model method (repeated measure ANOVA).
RESULTS:  80 patients were studied, including 63 men (79%) and 17 women (21%). Patients were divided among two groups. There was no significant difference in demographic characteristics between two groups. The results showed that there was no significant interaction between group and time for the compression depth variable and there was no significant difference in the depth of compressions between the two groups(P>0.05). For the rate of compressions, there was a significant interaction between group and time. These results indicate that turning on the CPR feedback device’s warning increases the number of compressions during CPR and, as a result, makes it more effective. The between-group effect which showed the difference in the number of compressions in the two groups, was statistically significant (P<0.001).
CONCLUSION: These results indicated that turning on the CPR feedback device’s warning increases the rate of compressions during CPR and, as a result, makes it more effective. Therefore, the use of real-time CPR feedback device during chest compression in real-time CPR improves the quality of CPR.
 

Keywords

1. Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010; 81(11): 1479-87. https://doi.org/10.1016/j.resuscitation.2010.08.006
2. Fischer H, Gruber J, Neuhold S, Frantal S, Hochbrugger E, Steinlechner B, ‎et al. Effects and limitations of an automated external defibrillator with audiovisual feedback for cardiopulmonary resuscitation: a randomized manikin study 2011; 15(1): 1-190. https://doi.org/10.1186/cc9716
3. Havel C, Schreiber W, Trimmel H, Malzer R, Haugk M, Richling N, et al. Quality of closed chest compression on a manikin in ambulance vehicles ‎and flying helicopters with a real time automated feedback. Resuscitation 2010; 81(1): 59-64. https://doi.org/10.1016/j.resuscitation.2009.10.007
4. Hostler D, Everson-Stewart S, Rea TD, Stiell IG, Callaway CW, Kudenchuk PJ, et al. Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial 2011; 342. https://doi.org/10.1136/bmj.d512
5. Kirkbright S, Finn J, Jacobs I, Sprivulis P, Thompson PJ. The relationship between quality of cardiopulmonary resuscitation performed by healthcare professionals and patient survival following cardiac arrest: a systematic review of randomised and non-randomised trials. 2013.
6. Kirkbright S, Finn J, Tohira H, Bremner A, Jacobs I, Celenza A. Audiovisual feedback device use by health care professionals during CPR: a systematic review and meta-analysis of randomised and non-randomised trials 2014; 85(4): 460-71. https://doi.org/10.1016/j.resuscitation.2013.12.012
7. Kong MH, Fonarow GC, Peterson ED, Curtis AB, Hernandez AF, Sanders GD, et al. Systematic Review of the Incidence of Sudden Cardiac Death in the United States. J Am Coll Cardiol 2011; 57(7): 794-801.https://doi.org/10.1016/j.jacc.2010.09.064
8. Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L, Sørebø H, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real ‎time automated feedback: A prospective interventional study. Resuscitation 2006; 71(3): 283-92. https://doi.org/10.1016/j.resuscitation.2006.05.011
9. Semeraro F, Frisoli A, Loconsole C, Bannò F, Tammaro G, Imbriaco G, et al. Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: A randomised crossover mannequin pilot study. Resuscitation 2013; 84(4): 501-7. https://doi.org/10.1016/j.resuscitation.2012.12.006
10. Skorning M, Beckers SK, Brokmann JC, Rörtgen D, Bergrath S, Veiser T, et al. New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest. Resuscitation 2010; 81(1): 53-8. https://doi.org/10.1016/j.resuscitation.2009.10.005
11. Tanaka S, Tsukigase K, Hara T, Sagisaka R, Myklebust H, Birkenes TS, et al. Effect of real-time visual feedback device ‘Quality Cardiopulmonary Resuscitation (QCPR) Classroom’ with a metronome sound on layperson CPR training in Japan: a cluster randomized control trial 2019; 9(6): e026140. https://doi.org/10.1136/bmjopen-2018-026140
12. Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, et al. Part 14: education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 2015; 132(18_suppl_2): S561-S73.https://doi.org/10.1161/CIR.0000000000000268
13. Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European Resuscitation Council Guidelines for Resuscitation ‎‎2015: Section 2. Adult basic life support and automated external ‎defibrillation 2015; 95: 81-99. https://doi.org/10.1016/j.resuscitation.2015.07.015
14. Handley AJ, Handley SA. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator 2003; 57(1): 57-62. https://doi.org/10.1016/S0300-9572(02)00400-8
15. Wik L, Thowsen J, Steen PA. An automated voice advisory manikin system for training in basic life support without an instructor. A novel ‎approach to CPR training 2001; 50(2): 167-72. https://doi.org/10.1016/S0300-9572(01)00331-8
16. Boyle AJ, Wilson AM, Connelly K, McGuigan L, Wilson J, Whitbourn R. Improvement in timing and effectiveness of external cardiac compressions with a new non-invasive device: the CPR-Ezy. 2002; 54(1): 63-7. https://doi.org/10.1016/S0300-9572(02)00049-7
17. Chiang W-C, Chen W-J, Chen S-Y, Ko PC-I, Lin C-H, Tsai M-S, et al. Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts 2005; 64(3): 297-301.https://doi.org/10.1016/j.resuscitation.2004.09.010
18. Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, et al. CPR quality improvement during in-hospital cardiac arrest using a real-time ‎audiovisual feedback system 2007; 73(1): 54-61. https://doi.org/10.1016/j.resuscitation.2006.10.027
19. Wee J, Nandakumar M, Chan YH, Yeo RS, Kaur K, Anantharaman V, et al. Effect of using an audiovisual CPR feedback device on chest compression rate and depth 2014; 43(1): 33-8. https://doi.org/10.47102/annals-acadmedsg.V43N1p33
20. Peberdy MA, Silver A, Ornato JP. Effect of caregiver gender, age, and feedback prompts on chest compression rate and depth 2009; 80(10): 1169-74.https://doi.org/10.1016/j.resuscitation.2009.07.003
21. Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest 2005; 293(3): 305-10. https://doi.org/10.1001/jama.293.3.305
22. Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder HN, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest 2005; 111(4): 428-34. https://doi.org/10.1161/01.CIR.0000153811.84257.59
23. Valenzuela TD, Kern KB, Clark LL, Berg RA, Berg MD, Berg DD, et al. Interruptions of chest compressions during emergency medical systems resuscitation 2005; 112(9): 1259-65. https://doi.org/10.1161/CIRCULATIONAHA.105.537282
24. Wik L, Kramer-Johansen J, Myklebust H, Sørebø H, Svensson L, Fellows B, et al. Quality of cardiopulmonary resuscitation during out-of-hospital ‎cardiac arrest 2005; 293(3): 299-304. https://doi.org/10.1001/jama.293.3.299
25. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest 2006; 71(2): 137-45.https://doi.org/10.1016/j.resuscitation.2006.04.008
26. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society 2006; 8(9): 746-837. https://doi.org/10.1161/CIRCULATIONAHA.106.178233