Addition of Audiovisual Feedback During Standard Compressions Is Associated with Improved Ability

A benefit of in-hospital cardiac arrest is the opportunity for rapid initiation of "high-quality" chest compressions as defined by current American Heart Association (AHA) adult guidelines as a depth 2-2.4 inches, full chest recoil, rate 100-120 per minute, and minimal interruptions with a chest compression fraction (CCF) ≥ 60%. The goal of this study was to assess the effect of audiovisual feedback on the ability to maintain high-quality chest compressions as per 2015 updated guidelines.

Ninety-eight participants were randomized into four groups. Participants were randomly assigned to perform chest compressions with or without use of audiovisual feedback (+/- AVF). Participants were further assigned to perform either standard compressions with a ventilation ratio of 30:2 to simulate cardiopulmonary resuscitation (CPR) without an advanced airway or continuous chest compressions to simulate CPR with an advanced airway. The primary outcome measured was ability to maintain high-quality chest compressions as defined by current 2015 AHA guidelines.

Overall comparisons between continuous and standard chest compressions (n=98) were without significant differences in chest compression dynamics (p's >0.05). Overall comparisons between +/- AVF (n = 98) were significant for differences in average rate of compressions per minute (p= 0.0241) and proportion of chest compressions within guideline rate recommendations (p = 0.0084). There was a significant difference in the proportion of high quality-chest compressions favoring AVF (p = 0.0399). Comparisons between chest compression strategy groups +/- AVF were significant for differences in compression dynamics favoring AVF (p's < 0.05).

Overall, AVF is associated with greater ability to maintain high-quality chest compressions per most-recent AHA guidelines. Specifically, AVF was associated with a greater proportion of compressions within ideal rate with standard chest compressions while demonstrating a greater proportion of compressions with simultaneous ideal rate and depth with a continuous compression strategy.