title: Cardiopulmonary resuscitation guidance improves medical students' adherence to guidelines in simulated cardiac arrest: a randomised cross-over study.
abstract: BACKGROUND
  The 2010 Resuscitation Guidelines require high-quality chest compression and rapid defibrillation for patients with ventricular fibrillation with rhythm analysis and defibrillation repeated every 2 min. A lack of adherence to the guidelines by medical students was observed during simulated resuscitation training.
  
  
  OBJECTIVE
  To assess whether real-time cardiopulmonary resuscitation guidance, including an audiovisual countdown timer, a metronome, a display of the chest compression quality and voice prompts, might improve adherence to the guidelines by medical students.
  
  
  METHODS
  Randomised cross-over simulation study.
  
  
  METHODS
  Studienhospital Münster, Faculty of Medicine University Münster, Germany
  
  
  METHODS
  One hundred and forty-one medical students (fifth year) in 47 teams.
  
  
  METHODS
  Simulated resuscitation with and without real-time cardiopulmonary resuscitation guidance.
  
  
  METHODS
  The preshock pause, postshock pause, fraction of time without chest compression and defibrillation intervals. Observed quality parameters were chest compression depth and chest compression rate.
  
  
  RESULTS
  With real-time cardiopulmonary resuscitation guidance, there were improved mean (SD) chest compression rates (105 ± 8 vs. 121 ± 12 bpm; P < 0.005), fewer inappropriate shock intervals [median (interquartile range) 0 (1 to 5) vs. 4 (1 to 7); P < 0.005], a smaller fraction of time without chest compression (18.9 ± 4.4 vs. 22.5 ± 7.0%; P < 0.005) and shorter postshock pauses (2.3 ± 0.9 vs. 3.4 ± 1.2 s; P < 0.005).
  
  
  CONCLUSIONS
  Real-time cardiopulmonary resuscitation guidance significantly increased adherence to the guidelines by medical students treating simulated out-of-hospital cardiac arrest. Using a simple tool such as a countdown timer makes it possible to reduce the number of inappropriate shock intervals and time without chest compression.
authors.affiliation: From the Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital (RPL, PE, SW, ST, HVA, KH, AB), the Faculty of Medicine, Studienhospital Münster (HF), the Institute of Biostatistics and Clinical Research, University of Münster (JG), the City of Münster Fire Department (AB), Münster, Germany *Roman-Patrik Lukas and Philipp Engel contributed equally to the writing of the article.
authors.forename: Roman-Patrik
authors.initials: RP
authors.lastname: Lukas
authors.forename: Philipp
authors.initials: P
authors.lastname: Engel
authors.forename: Sascha
authors.initials: S
authors.lastname: Wecker
authors.forename: Sebastian
authors.initials: S
authors.lastname: Thies
authors.forename: Hendrik
authors.initials: H
authors.lastname: Friederichs
authors.forename: Joachim
authors.initials: J
authors.lastname: Gerss
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Klaus
authors.initials: K
authors.lastname: Hahnenkamp
authors.forename: Andreas
authors.initials: A
authors.lastname: Bohn
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods / Q000592:standards; D018592:Cross-Over Studies; D004501:Education, Medical / Q000379:methods; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008348:Manikins; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013337:Students, Medical; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000628:therapy