title: The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  We assess whether an initiative to optimize out-of-hospital provider cardiopulmonary resuscitation (CPR) quality is associated with improved CPR quality and increased survival from out-of-hospital cardiac arrest.
  
  
  METHODS
  This was a before-after study of consecutive adult out-of-hospital cardiac arrest. Data were obtained from out-of-hospital forms and defibrillators. Phase 1 included 18 months with real-time audiovisual feedback disabled (October 2008 to March 2010). Phase 2 included 16 months (May 2010 to September 2011) after scenario-based training of 373 professional rescuers and real-time audiovisual feedback enabled. The effect of interventions on survival to hospital discharge was assessed with multivariable logistic regression. Multiple imputation of missing data was used to analyze the effect of interventions on CPR quality.
  
  
  RESULTS
  Analysis included 484 out-of-hospital cardiac arrest patients (phase 1 232; phase 2 252). Median age was 68 years (interquartile range 56-79); 66.5% were men. CPR quality measures improved significantly from phase 1 to phase 2: Mean chest compression rate decreased from 128 to 106 chest compressions per minute (difference -23 chest compressions; 95% confidence interval [CI] -26 to -19 chest compressions); mean chest compression depth increased from 1.78 to 2.15 inches (difference 0.38 inches; 95% CI 0.28 to 0.47 inches); median chest compression fraction increased from 66.2% to 83.7% (difference 17.6%; 95% CI 15.0% to 20.1%); median preshock pause decreased from 26.9 to 15.5 seconds (difference -11.4 seconds; 95% CI -15.7 to -7.2 seconds), and mean ventilation rate decreased from 11.7 to 9.5/minute (difference -2.2/minute; 95% CI -3.9 to -0.5/minute). All-rhythms survival increased from phase 1 to phase 2 (20/231, 8.7% versus 35/252, 13.9%; difference 5.2%; 95% CI -0.4% to 10.8%), with an adjusted odds ratio of 2.72 (95% CI 1.15 to 6.41), controlling for initial rhythm, witnessed arrest, age, minimally interrupted cardiac resuscitation protocol compliance, and provision of therapeutic hypothermia. Witnessed arrests/shockable rhythms survival was 26.3% (15/57) for phase 1 and 55.6% (20/36) for phase 2 (difference 29.2%; 95% CI 9.4% to 49.1%).
  
  
  CONCLUSIONS
  Implementation of resuscitation training combined with real-time audiovisual feedback was independently associated with improved CPR quality, an increase in survival, and favorable functional outcomes after out-of-hospital cardiac arrest.
authors: Department of Health Services, University of Arizona College of Medicine, Phoenix, AZ, USA. bobrowb@azdhs.gov
authors: Bentley J
authors: BJ
authors: Bobrow
authors: Tyler F
authors: TF
authors: Vadeboncoeur
authors: Uwe
authors: U
authors: Stolz
authors: Annemarie E
authors: AE
authors: Silver
authors: John M
authors: JM
authors: Tobin
authors: Scott A
authors: SA
authors: Crawford
authors: Terence K
authors: TK
authors: Mason
authors: Jerome
authors: J
authors: Schirmer
authors: Gary A
authors: GA
authors: Smith
authors: Daniel W
authors: DW
authors: Spaite
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000379:methods; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D018794:Problem-Based Learning / Q000379:methods*; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors