title: Effect of feedback on delaying deterioration in quality of compressions during 2 minutes of continuous chest compressions: a randomized manikin study investigating performance with and without feedback.
abstract: BACKGROUND
  Good quality basic life support (BLS) improves outcome following cardiac arrest. As BLS performance deteriorates over time we performed a parallel group, superiority study to investigate the effect of feedback on quality of chest compression with the hypothesis that feedback delays deterioration of quality of compressions.
  
  
  METHODS
  Participants attending a national one-day conference on cardiac arrest and CPR in Denmark were randomized to perform single-rescuer BLS with (n = 26) or without verbal and visual feedback (n = 28) on a manikin using a ZOLL AED plus. Data were analyzed using Rescuenet Code Review. Blinding of participants was not possible, but allocation concealment was performed. Primary outcome was the proportion of delivered compressions within target depth compared over a 2-minute period within the groups and between the groups. Secondary outcome was the proportion of delivered compressions within target rate compared over a 2-minute period within the groups and between the groups. Performance variables for 30-second intervals were analyzed and compared.
  
  
  RESULTS
  24 (92%) and 23 (82%) had CPR experience in the group with and without feedback respectively. 14 (54%) were CPR instructors in the feedback group and 18 (64%) in the group without feedback. Data from 26 and 28 participants were analyzed respectively. Although median values for proportion of delivered compressions within target depth were higher in the feedback group (0-30 s: 54.0%; 30-60 s: 88.0%; 60-90 s: 72.6%; 90-120 s: 87.0%), no significant difference was found when compared to without feedback (0-30 s: 19.6%; 30-60 s: 33.1%; 60-90 s: 44.5%; 90-120 s: 32.7%) and no significant deteriorations over time were found within the groups. In the feedback group a significant improvement was found in the proportion of delivered compressions below target depth when the subsequent intervals were compared to the first 30 seconds (0-30 s: 3.9%; 30-60 s: 0.0%; 60-90 s: 0.0%; 90-120 s: 0.0%). Significant differences were not found in secondary outcome and in other performance variables between the groups and over time
  
  
  CONCLUSIONS
  Quality of CPR was maintained during 2 minutes of continuous compressions regardless of feedback in a group of trained rescuers.
authors.affiliation: Danish Institute for Medical Simulation, Copenhagen University Hospital, Herlev Hospital, Copenhagen, Denmark. tlyngeraa@gmail.com
authors.forename: Tobias Stenbjerg
authors.initials: TS
authors.lastname: Lyngeraa
authors.forename: Peter Buhl
authors.initials: PB
authors.lastname: Hjortrup
authors.forename: Nille Birk
authors.initials: NB
authors.lastname: Wulff
authors.forename: Theis
authors.initials: T
authors.lastname: Aagaard
authors.forename: Anne
authors.initials: A
authors.lastname: Lippert
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002983:Clinical Competence; D005246:Feedback; D005260:Female; D006336:Heart Massage; D006801:Humans; D008020:Life Support Care; D008297:Male; D008348:Manikins; D008875:Middle Aged; D055815:Young Adult