title: Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study.
abstract: OBJECTIVE
  Chest compressions require physical effort leading to increased fatigue and rapid degradation in the quality of cardiopulmonary resuscitation overtime. Despite harmful effect of interrupting chest compressions, current guidelines recommend that rescuers switch every 2 minutes. The impact on the quality of chest compressions during extended cardiopulmonary resuscitation has yet to be assessed.
  
  
  METHODS
  We conducted randomized crossover study on manikin (ResusciAnne; Laerdal). After randomization, 60 professional emergency rescuers performed 2 × 10 minutes of continuous chest compressions with and without a feedback device (CPRmeter). Efficient compression rate (primary outcome) was defined as the frequency target reached along with depth and leaning at the same time (recorded continuously).
  
  
  RESULTS
  The 10-minute mean efficient compression rate was significantly better in the feedback group: 42% vs 21% (P< .001). There was no significant difference between the first (43%) and the tenth minute (36%; P= .068) with feedback. Conversely, a significant difference was evident from the second minute without feedback (35% initially vs 27%; P< .001). The efficient compression rate difference with and without feedback was significant every minute, from the second minute onwards. CPRmeter feedback significantly improved chest compression depth from the first minute, leaning from the second minute and rate from the third minute.
  
  
  CONCLUSIONS
  A real-time feedback device delivers longer effective, steadier chest compressions over time. An extrapolation of these results from simulation may allow rescuer switches to be carried out beyond the currently recommended 2 minutes when a feedback device is used.
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France. Electronic address: buleon-c@chu-caen.fr.
authors.forename: Clément
authors.initials: C
authors.lastname: Buléon
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Delaunay
authors.affiliation: CHU de Caen, Unité de Biostatistiques et de Recherche Clinique, Caen F-14000, France; Université Normandie, EA4650 and UFR de Médecine, Caen F-14000, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Halbout
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Arrot
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Université Normandie, EA4650 and UFR de Médecine, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gérard
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Université Normandie, EA4650 and UFR de Médecine, Caen F-14000, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D018592:Cross-Over Studies; D004634:Emergency Medical Technicians; D005246:Feedback; D005260:Female; D000068156:Formative Feedback; D006336:Heart Massage / Q000379:methods / Q000592:standards*; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D009726:Nurses; D005082:Physical Exertion; D010820:Physicians; D000066908:Simulation Training