title: The effect of a voice assist manikin (VAM) system on CPR quality among prehospital providers.
abstract: Numerous studies have documented poor cardiopulmonary resuscitation (CPR) performance among prehospital providers during both simulated and actual resuscitations. Previous studies have shown that a real-time, voice assist manikin (VAM) system may improve CPR performance.
  
  
  OBJECTIVE
  To determine whether VAM prompting would improve CPR performance by prehospital providers during simulated resuscitation.
  
  
  METHODS
  In this prospective, randomized, crossover design, 114 prehospital providers performed two 3-minute sessions of one-rescuer CPR on a VAM-resuscitation manikin: one round with the VAM feature turned on and one with the feature turned off. The primary outcomes were measured at 15-second intervals and included the fraction of correct compressions, the mean compression depth, the fraction of correct ventilations, and the mean ventilation tidal volume. Generalized estimating equations were used to analyze the repeated measures.
  
  
  RESULTS
  The VAM prompting was not directly associated with correct compressions during one-rescuer CPR in a cohort of subjects naïve to the system. However, the general decay in correct compressions seen over 3 minutes was attenuated with VAM prompting. Neither the compression depth nor the decay in compression depth over time was affected by VAM prompting. In contrast, VAM prompting did affect the fraction of correct ventilations and attenuated the time-dependent decline in correct ventilations in tidal volume.
  
  
  CONCLUSIONS
  Use of VAM did not directly improve compression or ventilation rate or quality in this cohort of prehospital providers. However, use of VAM did prevent decay of compression and ventilation performance over time.
authors.affiliation: Department of Emergency Medicine, Affiliated Emergency Medicine Residency, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. hostlerdp@upmc.edu
authors.forename: David
authors.initials: D
authors.lastname: Hostler
authors.forename: Henry
authors.initials: H
authors.lastname: Wang
authors.forename: Kevin
authors.initials: K
authors.lastname: Parrish
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Platt
authors.forename: Guy
authors.initials: G
authors.lastname: Guimond
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002983:Clinical Competence; D018592:Cross-Over Studies; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards*; D006336:Heart Massage; D006801:Humans; D008348:Manikins; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014831:Voice