Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR cares study) a randomized clinical trial

Adam Cheng, Linda L. Brown, Jonathan P. Duff, Jennifer Davidson, Frank Overly, Nancy M. Tofil, Dawn T. Peterson, Marjorie L. White, Farhan Bhanji, Ilana Bank, Ronald Gottesman, Mark Adler, John Zhong, Vincent Grant, David J. Grant, Stephanie N. Sudikoff, Kimberly Marohn, Alex Charnovich, Elizabeth A. Hunt, David O. KesslerHubert Wong, Nicola Robertson, Yiqun Lin, Quynh Doan, Jordan M. Duval-Arnould, Vinay M. Nadkarni, Aaron Donoghue, Robert M. Sutton, Dana Niles, Shannon D. Scott, Jenny Chatfield, Nnenna Chime

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

IMPORTANCE: The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. OBJECTIVE: To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. DESIGN, SETTING, AND PARTICIPANTS: Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). INTERVENTIONS: Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. MAIN OUTCOMES AND MEASURES: The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. RESULTS: The quality of CPRwas poor in the control group, with 12.7%(95%CI, 5.2%-20.1%) mean depth compliance and 27.1%(95%CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9%(95%CI, 11.1%-28.7%; P 89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines butwas not significantly better than either intervention in isolation. CONCLUSIONS AND RELEVANCE: The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalJAMA Pediatrics
Volume169
Issue number2
DOIs
StatePublished - Feb 1 2015

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Cardiopulmonary Resuscitation
Heart Arrest
Randomized Controlled Trials
Equipment and Supplies
Sensory Feedback
Thorax
Compliance
Guidelines
Delivery of Health Care
Pediatrics
Resuscitation
Hemodynamics
Outcome Assessment (Health Care)
Technology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR cares study) a randomized clinical trial. / Cheng, Adam; Brown, Linda L.; Duff, Jonathan P.; Davidson, Jennifer; Overly, Frank; Tofil, Nancy M.; Peterson, Dawn T.; White, Marjorie L.; Bhanji, Farhan; Bank, Ilana; Gottesman, Ronald; Adler, Mark; Zhong, John; Grant, Vincent; Grant, David J.; Sudikoff, Stephanie N.; Marohn, Kimberly; Charnovich, Alex; Hunt, Elizabeth A.; Kessler, David O.; Wong, Hubert; Robertson, Nicola; Lin, Yiqun; Doan, Quynh; Duval-Arnould, Jordan M.; Nadkarni, Vinay M.; Donoghue, Aaron; Sutton, Robert M.; Niles, Dana; Scott, Shannon D.; Chatfield, Jenny; Chime, Nnenna.

In: JAMA Pediatrics, Vol. 169, No. 2, 01.02.2015, p. 137-144.

Research output: Contribution to journalArticle

Cheng, A, Brown, LL, Duff, JP, Davidson, J, Overly, F, Tofil, NM, Peterson, DT, White, ML, Bhanji, F, Bank, I, Gottesman, R, Adler, M, Zhong, J, Grant, V, Grant, DJ, Sudikoff, SN, Marohn, K, Charnovich, A, Hunt, EA, Kessler, DO, Wong, H, Robertson, N, Lin, Y, Doan, Q, Duval-Arnould, JM, Nadkarni, VM, Donoghue, A, Sutton, RM, Niles, D, Scott, SD, Chatfield, J & Chime, N 2015, 'Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR cares study) a randomized clinical trial', JAMA Pediatrics, vol. 169, no. 2, pp. 137-144. https://doi.org/10.1001/jamapediatrics.2014.2616
Cheng, Adam ; Brown, Linda L. ; Duff, Jonathan P. ; Davidson, Jennifer ; Overly, Frank ; Tofil, Nancy M. ; Peterson, Dawn T. ; White, Marjorie L. ; Bhanji, Farhan ; Bank, Ilana ; Gottesman, Ronald ; Adler, Mark ; Zhong, John ; Grant, Vincent ; Grant, David J. ; Sudikoff, Stephanie N. ; Marohn, Kimberly ; Charnovich, Alex ; Hunt, Elizabeth A. ; Kessler, David O. ; Wong, Hubert ; Robertson, Nicola ; Lin, Yiqun ; Doan, Quynh ; Duval-Arnould, Jordan M. ; Nadkarni, Vinay M. ; Donoghue, Aaron ; Sutton, Robert M. ; Niles, Dana ; Scott, Shannon D. ; Chatfield, Jenny ; Chime, Nnenna. / Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR cares study) a randomized clinical trial. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 2. pp. 137-144.
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T1 - Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR cares study) a randomized clinical trial

AU - Cheng, Adam

AU - Brown, Linda L.

AU - Duff, Jonathan P.

AU - Davidson, Jennifer

AU - Overly, Frank

AU - Tofil, Nancy M.

AU - Peterson, Dawn T.

AU - White, Marjorie L.

AU - Bhanji, Farhan

AU - Bank, Ilana

AU - Gottesman, Ronald

AU - Adler, Mark

AU - Zhong, John

AU - Grant, Vincent

AU - Grant, David J.

AU - Sudikoff, Stephanie N.

AU - Marohn, Kimberly

AU - Charnovich, Alex

AU - Hunt, Elizabeth A.

AU - Kessler, David O.

AU - Wong, Hubert

AU - Robertson, Nicola

AU - Lin, Yiqun

AU - Doan, Quynh

AU - Duval-Arnould, Jordan M.

AU - Nadkarni, Vinay M.

AU - Donoghue, Aaron

AU - Sutton, Robert M.

AU - Niles, Dana

AU - Scott, Shannon D.

AU - Chatfield, Jenny

AU - Chime, Nnenna

PY - 2015/2/1

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N2 - IMPORTANCE: The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. OBJECTIVE: To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. DESIGN, SETTING, AND PARTICIPANTS: Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). INTERVENTIONS: Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. MAIN OUTCOMES AND MEASURES: The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. RESULTS: The quality of CPRwas poor in the control group, with 12.7%(95%CI, 5.2%-20.1%) mean depth compliance and 27.1%(95%CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9%(95%CI, 11.1%-28.7%; P 89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines butwas not significantly better than either intervention in isolation. CONCLUSIONS AND RELEVANCE: The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes.

AB - IMPORTANCE: The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. OBJECTIVE: To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. DESIGN, SETTING, AND PARTICIPANTS: Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). INTERVENTIONS: Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. MAIN OUTCOMES AND MEASURES: The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. RESULTS: The quality of CPRwas poor in the control group, with 12.7%(95%CI, 5.2%-20.1%) mean depth compliance and 27.1%(95%CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9%(95%CI, 11.1%-28.7%; P 89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines butwas not significantly better than either intervention in isolation. CONCLUSIONS AND RELEVANCE: The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes.

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