title: Effect of the Cardio First Angel™ device on CPR indices: a randomized controlled clinical trial.
abstract: BACKGROUND
  A number of cardiopulmonary resuscitation (CPR) adjunct devices have been developed to improve the consistency and quality of manual chest compressions. We investigated whether a CPR feedback device would improve CPR quality and consistency, as well as patient survival.
  
  
  METHODS
  We conducted a randomized controlled study of patients undergoing CPR for cardiac arrest in the mixed medical-surgical intensive care units of four academic teaching hospitals. Patients were randomized to receive either standard manual CPR or CPR using the Cardio First Angel™ CPR feedback device. Recorded variables included guideline adherence, CPR quality, return of spontaneous circulation (ROSC) rates, and CPR-associated morbidity.
  
  
  RESULTS
  A total of 229 subjects were randomized; 149 were excluded; and 80 were included. Patient demographics were similar. Adherence to published CPR guidelines and CPR quality was significantly improved in the intervention group (p < 0.0001), as were ROSC rates (72 % vs. 35 %; p = 0.001). A significant decrease was observed in rib fractures (57 % vs. 85 %; p = 0.02), but not sternum fractures (5 % vs. 17 %; p = 0.15).
  
  
  CONCLUSIONS
  Use of the Cardio First Angel™ CPR feedback device improved adherence to published CPR guidelines and CPR quality, and it was associated with increased rates of ROSC. A decrease in rib but not sternum fractures was observed with device use. Further independent prospective validation is warranted to determine if these results are reproducible in other acute care settings.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT02394977 . Registered on 5 Mar 2015.
authors.affiliation: Trauma Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Vahedian-Azimi
authors.affiliation: Loghman Clinical Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Hajiesmaeili
authors.affiliation: Department of Critical Care Medicine, Mehrad Hospital, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Amirsavadkouhi
authors.affiliation: Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Jamaati
authors.affiliation: Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Izadi
authors.affiliation: Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed J
authors.initials: SJ
authors.lastname: Madani
authors.affiliation: Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed M R
authors.initials: SM
authors.lastname: Hashemian
authors.affiliation: Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506-9149, USA. Taqwa1@gmail.com.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Miller
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D004867:Equipment Design / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis
keywords: CPR outcomes; Cardiac arrest; Cardio First Angel; Cardiopulmonary resuscitation