title: Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing.
abstract: OBJECTIVE
  Delivery of high-quality cardiopulmonary resuscitation increases survival from cardiac arrest, yet studies have shown that cardiopulmonary resuscitation quality is often poor during actual in-hospital resuscitation. Furthermore, recent work has shown that audiovisual feedback alone during cardiopulmonary resuscitation modestly improves performance. We hypothesized that a multimodal training method comprising audiovisual feedback and immediate debriefing would improve cardiopulmonary resuscitation performance among care providers.
  
  
  METHODS
  Prospective randomized interventional study.
  
  
  METHODS
  Simulated cardiac arrests at an academic medical center.
  
  
  METHODS
  A total of 80 nurses were randomized to two groups.
  
  
  METHODS
  Each group underwent three trials of simulated cardiac arrest. The "feedback" group received real-time audiovisual feedback during the second and third trials, whereas the "debriefing-only" group performed cardiopulmonary resuscitation without feedback. Both groups received short individual debriefing after the second trial.
  
  
  METHODS
  Cardiopulmonary resuscitation quality was recorded using a cardiopulmonary resuscitation-sensing defibrillator that measures chest compression rate/depth and can deliver audiovisual feedback messages from both groups during the three trials. An adequate compression rate was defined as 90-110 compressions/min and an adequate depth as 38-51 mm.
  
  
  RESULTS
  In the debriefing-only group, the percentage of participants providing compressions of adequate depth increased after debriefing, from 38% to 68% (p = 0.015). In the feedback group, depth compliance improved from 19% to 58% (p = 0.002). Compression rate did not improve significantly with either intervention alone. The combination of feedback and debriefing improved compression rate compliance from 45% to 84% (p = 0.001) and resulted in a doubling of participants providing compressions of both adequate rate and depth, 29% vs. 64% (p = 0.005).
  
  
  CONCLUSIONS
  Significant cardiopulmonary resuscitation quality deficits exist among healthcare providers. Debriefing or feedback alone improved cardiopulmonary resuscitation quality, but the combination led to marked performance improvements. Cardiopulmonary resuscitation feedback and debriefing may serve as a powerful tool to improve rescuer training and care for cardiac arrest patients.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: C Jessica
authors.initials: CJ
authors.lastname: Dine
authors.forename: Ronna E
authors.initials: RE
authors.lastname: Gersh
authors.forename: Marion
authors.initials: M
authors.lastname: Leary
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Riegel
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bellini
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella