Spotlight on Research

Real-time feedback in simulation: does it improve CPR performance?As the title alludes to, this study took place across 10 European emergency medical services with the aim of determining if real-time objective feedback, while training on manikins, improves CPR quality among professional pre-hospital EMS healthcare providers. The study also looked at whether competition between participating sites and, indeed, between the individual participants, had an effect on motivation to train, and improve performance (as has been suggested by other studies).Standard protocols (European Resuscitation Council 2010 adult and paediatric guidelines) and standardised bag valve masks (BVM) were used, and identical manikins were provided to simulate both adult and infant scenarios for out-of-hospital cardiac arrests (OHCA). The study was carried out over two stages, 6 months apart.Each of the 10 EMS sites recruited 20 pre-hospital healthcare professionals to participate in the study. Stage 1 provided objective assessment (for later analysis) of the participants' performance in standardised adult and infant cardiac arrest scenarios. Participants worked in two-person crews and no feedback was given during or after the scenarios.The participants were also asked to complete a demographic questionnaire including role identification, length of time since professional education, last CPR assessment and recent OHCA clinical experience. Before participating in Stage 2 (6 months after Stage 1), site training co-ordinators were encouraged to motivate their crews to practise with standardised equipment provided for the study, which enabled real-time feedback.Stage 2 was a repeat of Stage 1 and reassessed CPR performance. It also repeated the questionnaire, but with extra questions about how many times they had practised between the stages and what they thought about the value of objective feedback during training.An independent samples Student's t-test and Chi square Asympt. Sig (2-sided) test were used to analyse the questionnaire data. The mean objective CPR scores and the 95% confidence intervals calculated for both stages were analysed (more detail in main paper).In the adult scenarios there was an increase in the overall CPR score from 81 in Stage 1 to 95.1 in Stage 2: with an increase of 10.8 mm in the mean depth of compression, a reduction in the mean rate of compressions per minute from 116.4 to 111.8, and a reduction in mean overall leaning (-1.0 mm). In infant scenarios there was an increase in the overall CPR score from 55.1 in Stage 1 to 86.5 in Stage 2: with an increase of 7.4 mm in the mean depth of compression, a reduction in the mean rate of compressions per minute from 127.2 to 116.7, and a reduction in mean overall leaning (-1.8 mm). Interestingly, key EMS site information, while not part of the research, highlights the diversity of size of the sites and staff roles.Results showed no statistically significant difference between demographics in both stages at the sites. The study suggests that the real-time feedback while undertaking CPR manikin training appears to significantly improve adult and infant CPR performance (the improvement being greater in infant CPR), especially when frequently practised. The findings also indicate that competition between participants appears to motivate staff to perform the training.The researchers felt that there was a limitation in terms of the sample numbers, with only 20 individuals per site selected as a convenience sample, and they would have preferred a larger sample size.This paper will be of particular interest to those who engage with the education and training of CPR for EMS staff and students, and to all practitioners with regard to the usefulness of real-time feedback in practice sessions, where that equipment is available.

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