Elsevier

Resuscitation

Volume 57, Issue 1, April 2003, Pages 57-62
Resuscitation

Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator

https://doi.org/10.1016/S0300-9572(02)00400-8Get rights and content

Abstract

Background: It has been shown that a computer-based audible feedback system can improve acquisition and retention of basic life support (BLS) skills. This system is being developed to work in association with an automated external defibrillator (AED). Aim: To determine if such a feedback system is likely to improve the quality of CPR performed by trained nurses whilst using an AED. Method: Thirty-six general nurses performed 3 min of BLS on a manikin connected to a laptop computer running an experimental software program. After initial testing they were randomly allocated to control or ‘feedback’ groups. Both groups then performed a further 3 min of BLS, but those in the feedback group received audible corrective instructions from the computer when errors of technique were detected. Results: The group receiving feedback were significantly better than the control group at performing inflations (P=0.004) and achieving the correct depth of chest compression (P<0.0005). Conclusions: The results suggest that if the feedback system were to be incorporated into an AED, it could lead to better performance of CPR during a resuscitation attempt.

Sumàrio

Contexto: Há evidência de que a utilização de um sistema de feedback sonoro baseado num computador pode melhorar a aquisição e retenção de conhecimentos/ competências práticas em Suporte Básico de Vida (SBV). Este sistema está a ser desenvolvido para ser incorporado num Desfibrilhador Automático Externo (DAE). Objectivo: Determinar se um sistema de feedback com este formato é capaz de melhorar a qualidade de RCP realizada por enfermeiros treinados quando utilizam um DAE. Método: Trinta e seis enfermeiros gerais realizaram 3 minutos de SBV num manequim ligado a um computador que utilizava um programa com software experimental. Após o teste inicial eles foram distribuı&#x0301;dos de forma randomizada por grupos de controlo ou feedback. Ambos os grupos realizaram depois mais 3 minutos de SBV, mas aqueles que pertenciam ao grupo ‘feedback’ receberam instruções audı&#x0301;veis correctoras por parte do computador quando foram detectados erros técnicos. Resultados: O grupo que recebeu feedback foi significativamente melhor do que o grupo controlo na realização das insuflações (P=0.0004) e na obtenção da profundidade adequada das compressões torácicas (P<0.0005). Conclusões: Os resultados sugerem que se for utilizado um sistema de feedback incorporado num DAE, este pode levar a um melhor desempenho de RCP durante a tentativa de reanimação.

Resumen

Antecedentes: Se ha demostrado que un sistema con retroalimentación audible computarizado mejora la adquisición y retención de destrezas de reanimación cardiopulmonar básica (BLS). Este sistema está siendo desarrollado para trabajar asociado con un desfibrilador automático externo (AED). Objetivo: determinar si este sistema con retroalimentación puede mejorar la calidad de reanimación cardiopulmonar (RCP) realizada por enfermeras entrenadas durante la utilización de un AED. Métodos: treinta y seis enfermeras generales realizaron tres minutos de RCP en un maniquı&#x0301; conectado a un computador que utilizaba un programa de software experimental de RCP. Después de una evaluación inicial se ubicaron en grupos control o retroalimentación en forma randomizada. Entonces ambos grupos realizaron otros 3 minutos de RCP, pero el grupo ‘retroalimentación’ recibió instrucciones de correción audibles cada vez que se detectaba un error en la técnica. Resultados: El grupo retroalimentación fue significativamente mejor que el grupo control en las insuflaciones (P=0.004) y en alcanzar la profundidad de compresión torácica adecuada (P<0.0005). Conclusiones: el resultado sugiere que si se agregara el sistema de retroalimentación al AED, ello llevarı&#x0301;a a un mejor desempeño de la RCP en el intento de resucitación.

Introduction

Healthcare professionals are expected to be highly proficient when called upon to deal with cardiopulmonary arrest, yet many only encounter this emergency on rare occasions. The introduction of automated external defibrillators (AEDs) to hospital wards has reduced considerably the level of training needed to manage ventricular fibrillation successfully, and has put defibrillation skills well within the range of general nurses [1]. However, basic life support (BLS) is often required as well as defibrillation. It is well recognized that the skills involved in the performance of BLS (rescue breathing and chest compression) are poorly acquired and poorly retained by healthcare professionals as well as laypersons [2], [3]. Many attempts have been made to improve the situation by employing different methods of teaching. One method that has been shown to be effective is to use a training manikin with a computer-based audible feedback system (voice advisory manikin system (VAM)) [4]. This gives corrective instructions when errors of technique are detected during CPR practice. Significant improvements in skill acquisition and skill retention have been reported [5].

Clinical studies are now underway to incorporate the VAM system into an AED. This will enable audible feedback to be given during CPR performed in association with the use of the AED (Laerdal Medical AS). The purpose of the current study was to determine if such a feedback system is likely to improve the quality of CPR performed by trained nurses.

Section snippets

Subjects

Thirty-six volunteers were recruited from the nursing staff of four medical wards at Colchester General Hospital, England. These wards receive acute general medical patients, mainly as emergency admissions from the accident and emergency department or from general practitioners. All the nurses were trained in BLS and had had some extended instruction in simple airway management and the principles of defibrillation. None, however, had attended an advanced life support course. Names were recorded

Results

Each inflation or compression was recorded as correct if it was within the limits set, or incorrect if outside these limits. The results for correct and incorrect inflations, correct and incorrect compression depth, incomplete hand release, and hand position too low were recorded as percentages of total numbers (of inflations or compressions). The raw data were used for mean compression and ventilation rates, mean compressions per minute, and compression as a percentage of duty cycle (ratio of

Discussion

The nurses who took part in this study were selected from those who would be expected to have to deal with sudden cardiac arrest in the normal course of their work, but they were not specialized in cardiac care nursing nor had they been trained in advanced life support skills. They were, therefore, representative of nursing staff for whom the provision of AEDs might be more appropriate than manual defibrillators [1].

The performance of CPR during the first 3-min test period was poor for each

Conclusions

This study confirms that even trained healthcare professionals, with a responsibility to respond to cardiac arrest, do not retain their BLS skills. An audible feedback system produces significant improvement in performance of CPR over a period even as short as 3 min. Although chest compression and ventilation were still poor at the end of this time, the results suggest that if the system were to be incorporated into an AED, it could lead to better performance of CPR during a resuscitation

Acknowledgements

The laptop computer, software and the resuscitation manikin were kindly loaned by Laerdal Medical, who also provided invaluable technical assistance. Expert statistical advice was provided by Professor Bjørn Auestad, Department of Technology and Natural Science, Stavanger University College, Norway.

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