Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation.
OBJECTIVE
To determine the effect of visual feedback on rate of chest compressions, secondarily relating the forces used.


METHODS
Randomised crossover trial.


METHODS
Tertiary teaching hospital.


METHODS
Fifty trained hospital staff.


METHODS
A thin sensor-mat placed over the manikin's chest measured rate and force. Rescuers applied compressions to the same paediatric manikin for two sessions. During one session they received visual feedback comparing their real-time rate with published guidelines.


METHODS
Primary: compression rate. Secondary: compression and residual forces.


RESULTS
Rate of chest compressions (compressions per minute (compressions per minute; cpm)) varied widely (mean (SD) 111 (13), range 89-168), with a fourfold difference in variation during session 1 between those receiving and not receiving feedback (108 (5) vs 120 (20)). The interaction of session by feedback order was highly significant, indicating that this difference in mean rate between sessions was 14 cpm less (95% CI -22 to -5, p=0.002) in those given feedback first compared with those given it second. Compression force (N) varied widely (mean (SD) 306 (94); range 142-769). Those receiving feedback second (as opposed to first) used significantly lower force (adjusted mean difference -80 (95% CI -128 to -32), p=0.002). Mean residual force (18 N, SD 12, range 0-49) was unaffected by the intervention.


CONCLUSIONS
While visual feedback restricted excessive compression rates to within the prescribed range, applied force remained widely variable. The forces required may differ with growth, but such variation treating one manikin is alarming. Feedback technologies additionally measuring force (effort) could help to standardise and define effective treatments throughout childhood.
UCL Great Ormond Street Institute of Child Health, London, UK.|Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Rachael Kathleen
RK
Gregson
UCL Great Ormond Street Institute of Child Health, London, UK.
Tim James
TJ
Cole
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Sophie
S
Skellett
UCL Great Ormond Street Institute of Child Health, London, UK.
Emmanouil
E
Bagkeris
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Denise
D
Welsby
UCL Great Ormond Street Institute of Child Health, London, UK.|Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Mark John
MJ
Peters
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods / Q000592:standards; D002648:Child; D002983:Clinical Competence; D018592:Cross-Over Studies; D004496:Education, Continuing / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D005246:Feedback; D005260:Female; D006801:Humans; D007721:Knowledge of Results, Psychological; D008297:Male; D008348:Manikins; D005082:Physical Exertion; D011312:Pressure
CPR; Chest compression; Child; Feedback, sensory; Resuscitation