CPR feedback device used in resuscitation training: EIT 6404 TF SR

Conflict of Interest (COI) Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none recused as no COI declared.

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: None declared a COI.

CoSTR Citation

Lin Y, Lockey A, Grief R, Donoghue A, Matsuyama T, Farquharson B, Cortegiani A, Banerjee A, Cheng A on behalf of the International Liaison Committee on Resuscitation Education, Implementation and Teams Task Force (EIT). Consensus on Science with Treatment Recommendations International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force, 2023 November 30. Available from: http://ilcor.org

Methodological Preamble and Link to Published Systematic Review

The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic literature search of virtual and augmented reality in resuscitation training as opposed to other approaches to life support course delivery conducted by an information specialist with involvement of clinical content experts. Evidence collected from the literature was reviewed and considered by the EIT Task Force. These data were taken into account when formulating the Treatment Recommendations.

Systematic Review

Publication in progress

PICOST

Prospero Registration: CRD42023376751

Consensus on Science

Recent scientific statements highlight a growing trend in the use of CPR feedback devices during resuscitation training courses.(1) While earlier reviews showed that these devices can improve short-term educational outcomes, the results have been inconsistent.(2) Additionally, there's limited evidence on how they affect learners' CPR skills, the cost-effectiveness of training, and, most importantly, patient outcomes. These factors are essential for evaluating their true effectiveness.

None of the studies examined the impact of CPR feedback device during resuscitation training on the outcomes of patient survival or quality of performance in actual resuscitation. Twenty studies examined CPR skills at the conclusion of the courses as the outcomes (Figure 1), 8 of which were rated as minor concerns for risk of bias, (3-10) 9 of them with some concerns for risk of bias, (11-19) and 3 of them with serious concerns for risk of bias.(20-22) The risk of bias assessment presented in Table 1. Three studies were conducted in lay providers(4, 7, 10) and 17 in healthcare providers.(3, 5, 6, 8, 9, 11-22)

CPR skills

Compression depth

Fifteen randomized controlled trials (RCTs) with a total of 4,185 participants (2,189 in the non-feedback group and 1,996 in the feedback group) evaluated the effect of CPR feedback devices on objectively measured mean compression depth.(3, 7-14, 16-19, 21, 22) The results indicated that participants trained with feedback devices had significantly greater mean compression depth compared to those trained without them (SMD = 0.76, 95% CI: 0.02–1.50, p = 0.04), although there was substantial heterogeneity (I² = 94%). Subgroup analysis showed that the effect of feedback device was larger in the healthcare providers (SMD 0.86, 95%CI: 0.01-1.72) than in the lay providers (SMD 0.15, 95%CI: 0.07 – 0.22), but the difference was not statistically significant (p =0.10). (Figure 2)

Additionally, 16 RCTs involving 4,304 participants (2,272 in the non-feedback group and 2,032 in the feedback group) examined the effect of CPR feedback devices during resuscitation training on compression depth compliance. (3-10, 12-16, 19-21) Compression depth compliance was quantitatively measured as the percentage of compressions meeting the resuscitation guidelines during assessment. The results showed that using CPR feedback devices during training had a large impact on depth compliance (SMD = 0.98, 95% CI: 0.10–1.87, p = 0.03, I² = 94%). Subgroup analysis showed that the effect of feedback device was larger in the healthcare providers (SMD 1.14, 95%CI: 0.04-2.24) than in the lay providers (SMD 0.17, 95%CI: 0.01 – 0.32), but the difference was not statistically significant (p =0.09). (Figure 3)

Compression rate

Seventeen randomized controlled trials (RCTs) involving a total of 4,327 participants (2,286 in the non-feedback group and 2,041 in the feedback group) evaluated the effect of CPR feedback devices on objectively measured mean compression rate. (3, 4, 6-14, 16-19, 21, 22) The results indicated that participants trained with feedback devices had a significantly lower mean compression rate compared to those trained without them, as participants in the non-feedback group tended to compress too quickly (>120 bpm) (SMD = -0.29, 95% CI: -0.49 to -0.10, p < 0.01, I² = 73%). Subgroup analysis showed the effect of the feedback device on mean compression rate was not statistically significant between healthcare providers and lay providers (p = 0.67). (Figure 4)

Additionally, nine RCTs involving 905 participants (460 in the non-feedback group and 445 in the feedback group) examined the effect of CPR feedback devices during resuscitation training on compression rate compliance. (3, 5, 6, 8, 10, 14, 15, 19, 20) Compression rate compliance was quantitatively measured as the percentage of compressions within the guideline-recommended rate of 100–120 bpm. The results demonstrated that using CPR feedback devices during training had a substantial impact on rate compliance (SMD = 0.45, 95% CI: 0.23–0.66, p < 0.01, I² = 61%). Subgroup analysis showed the effect of the feedback device on rate compliance was not statistically significant between healthcare providers and lay providers (p = 0.80) (Figure 5)

Chest recoil

Ten randomized controlled trials (RCTs) involving a total of 3,496 participants (1,803 in the non-feedback group and 1,693 in the feedback group) evaluated the effect of CPR feedback devices during training on chest recoil.(3, 5, 7, 10, 12, 14, 15, 17, 19, 20) Chest recoil was quantitatively measured as the percentage of compressions with full chest recoil. The results demonstrated that using CPR feedback devices during training had a significant impact on recoil compliance (SMD = 0.53, 95% CI: 0.31–0.75, p < 0.01, I² = 87%). Subgroup analysis showed that the effect of the feedback device on recoil compliance was significantly in the healthcare providers (SMD: 0.67, 95%CI: 0.52-0.82), but not statistically significant in the lay providers (SMD: 0.20, 95%CI: -0.24, 0.64). (Figure 6)

Overall quality CPR

Eight RCTs involving a total of 3261 participants (1687 in the non-feedback group and 1574 in the feedback group) evaluated the effect of CPR feedback devices on overall CPR quality during resuscitation training. (3, 6, 7, 10, 12, 14, 15, 17) Overall quality of CPR was assessed by computer software integrating all three metrics of chest compression (depth, rate and recoil) with limited validity evidence. The results showed that the use of feedback devices significantly improved the overall quality of CPR, with a pooled effect size of 0.71 (95% CI: 0.40–1.05, p < 0.01), although heterogeneity was high (I² = 86%). Subgroup analysis showed that the effect of the feedback device on the overall CPR score was significantly higher in the healthcare providers (SMD: 0.87, 95%CI: 0.53 – 1.21) than in the lay providers (SMD: 0.33, 95%CI: 0.03 – 0.63), and the difference was statistically significant (p = 0.02). (figure 7)

Three randomized controlled trials (RCTs) involving a total of 349 participants (178 in the non-feedback group and 171 in the feedback group) evaluated the effect of CPR feedback devices on overall CPR quality during resuscitation training.(5, 16, 18) CPR quality was assessed dichotomously, based on whether compression depth, rate, and recoil all met guideline standards. The results showed that the use of feedback devices significantly improved the overall quality of CPR, with a pooled effect size of 0.19 (95% CI: 0.01–0.38, p = 0.04, I² = 78%). (Figure 8)

Treatment Recommendations

We recommend the use of CPR feedback devices during resuscitation training for healthcare providers and lay providers. (Strong recommendation, moderate certainty of evidence)

Justification and Evidence to Decision Framework Highlights

In making this recommendation, the EIT taskforce considered the following:

• In the meta-analyses, we found the results strongly favor the use of feedback devices during training across all CPR quality outcomes with moderate to strong association.
• Subgroup analyses showed the effect of feedback device on resuscitation training was higher in healthcare providers than in the lay providers, but there was still a significant effect for most CPR metrics in lay providers.
• The certainty of evidence is overall moderate to high
• No undesirable effects were detected in the review
• Overall good acceptability, feasibility with negligible costs

Knowledge Gaps

We identified several knowledge gaps in the literature:

• The relative and synergistic effect of feedback device use when combined with other educational strategies and instructional design features is unclear.
• Further studies are required to examine the impact of improved CPR skills from training with feedback devices on patient outcomes is required.
• The costs associated with implementing feedback devices during resuscitation training, as well as its cost effectiveness needs to be explored further.

Summary tables and diagrams: EIT 6404 FB devices Tables and Figures Co STR Oct21, EIT 6404 Feedback device during training evidence table

EtD: EIT 6404 Et D Feedback device

References

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