title: Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial.
abstract: OBJECTIVE
  The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines.
  
  
  OBJECTIVE
  To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA.
  
  
  METHODS
  Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams).
  
  
  METHODS
  Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA.
  
  
  METHODS
  The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA.
  
  
  RESULTS
  The quality of CPR was poor in the control group, with 12.7% (95% CI, 5.2%-20.1%) mean depth compliance and 27.1% (95% CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9% (95% CI, 11.1%-28.7%; P < .001) and rate compliance by 12.0% (95% CI, 0.8%-23.2%; P = .037). Visual feedback compared with no VisF improved depth compliance by 15.4% (95% CI, 6.6%-24.2%; P = .001) and rate compliance by 40.1% (95% CI, 28.8%-51.3%; P < .001). Neither intervention had a statistically significant effect on CC fraction, which was excellent (>89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines but was not significantly better than either intervention in isolation.
  
  
  CONCLUSIONS
  The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT02075450.
authors.affiliation: KidSIM-Assessing Simulation in Pediatrics: Improving Resuscitation Events (ASPIRE) Simulation Research Program, Section of Emergency Medicine, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Brown
authors.affiliation: Stollery Children's Hospital, University of Alberta, Calgary, Alberta, Canada.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Duff
authors.affiliation: KidSIM-Assessing Simulation in Pediatrics: Improving Resuscitation Events (ASPIRE) Simulation Research Program, Section of Emergency Medicine, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davidson
authors.affiliation: Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Frank
authors.initials: F
authors.lastname: Overly
authors.affiliation: Children's of Alabama, University of Alabama at Birmingham.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Tofil
authors.affiliation: Children's of Alabama, University of Alabama at Birmingham.
authors.forename: Dawn T
authors.initials: DT
authors.lastname: Peterson
authors.affiliation: Children's of Alabama, University of Alabama at Birmingham.
authors.forename: Marjorie L
authors.initials: ML
authors.lastname: White
authors.affiliation: Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Farhan
authors.initials: F
authors.lastname: Bhanji
authors.affiliation: Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Ilana
authors.initials: I
authors.lastname: Bank
authors.affiliation: Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Gottesman
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University School of Medicine, Chicago, Illinois.
authors.forename: Mark
authors.initials: M
authors.lastname: Adler
authors.affiliation: Children's Medical Center of Dallas, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Zhong
authors.affiliation: KidSIM-Assessing Simulation in Pediatrics: Improving Resuscitation Events (ASPIRE) Simulation Research Program, Section of Emergency Medicine, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Grant
authors.affiliation: Bristol Royal Hospital for Children, University Hospitals Bristol, Bristol, England.
authors.forename: David J
authors.initials: DJ
authors.lastname: Grant
authors.affiliation: Yale New Haven Health, Yale Medical School, New Haven, Connecticut.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Sudikoff
authors.affiliation: Baystate Children's Hospital, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Marohn
authors.affiliation: Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Alex
authors.initials: A
authors.lastname: Charnovich
authors.affiliation: Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: David O
authors.initials: DO
authors.lastname: Kessler
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: KidSIM-Assessing Simulation in Pediatrics: Improving Resuscitation Events (ASPIRE) Simulation Research Program, Section of Emergency Medicine, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Nicola
authors.initials: N
authors.lastname: Robertson
authors.affiliation: KidSIM-Assessing Simulation in Pediatrics: Improving Resuscitation Events (ASPIRE) Simulation Research Program, Section of Emergency Medicine, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Lin
authors.affiliation: British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Quynh
authors.initials: Q
authors.lastname: Doan
authors.affiliation: Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Duval-Arnould
authors.affiliation: Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000295:instrumentation*; D056228:Feedback, Sensory; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007318:Inservice Training; D008297:Male; D017410:Practice Guidelines as Topic; D011214:Practice, Psychological; D011446:Prospective Studies; D014743:Videotape Recording