title: The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation.
abstract: The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel.
  
  
  
  Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause.
  
  
  
  In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p<0.001). The mean chest compression rate was within the recommended range of 100-120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p<0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27).
  
  
  
  Post-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses.
authors.affiliation: Ambulance Amsterdam, Amsterdam, The Netherlands. Electronic address: ebleijenberg@ambulanceamsterdam.nl.
authors.forename: Eduard
authors.initials: E
authors.lastname: Bleijenberg
authors.affiliation: Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
authors.affiliation: Ambulance Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hendrik
authors.initials: H
authors.lastname: de Vries
authors.affiliation: Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: Stefanie G
authors.initials: SG
authors.lastname: Beesems
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000592:standards; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration / Q000592:standards; D005246:Feedback; D005260:Female; D005392:First Aid / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration; D061665:Time-to-Treatment / Q000592:standards*
keywords: Advanced Life Support; Cardiac arrest; Cardiopulmonary resuscitation; Feedback