Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing.

摘要

OBJECTIVE: Delivery of high-quality cardiopulmonary resuscitation increases survival from cardiac arrest, yet studies have shown that cardiopulmonary resuscitation quality is often poor during actual in-hospital resuscitation. Furthermore, recent work has shown that audiovisual feedback alone during cardiopulmonary resuscitation modestly improves performance. We hypothesized that a multimodal training method comprising audiovisual feedback and immediate debriefing would improve cardiopulmonary resuscitation performance among care providers. DESIGN: Prospective randomized interventional study. SETTING: Simulated cardiac arrests at an academic medical center. SUBJECTS: A total of 80 nurses were randomized to two groups. INTERVENTION: Each group underwent three trials of simulated cardiac arrest. The "feedback" group received real-time audiovisual feedback during the second and third trials, whereas the debriefing-only Both groups received short individual debriefing after the second trial. MEASUREMENTS: Cardiopulmonary resuscitation quality was recorded using a cardiopulmonary resuscitation-sensing defibrillator that measures chest compression rate/depth and can deliver audiovisual feedback messages from both groups during the three trials. An adequate compression rate was defined as 90-110 compressions/min and an adequate depth as 38-51 mm. MAIN RESULTS: In the debriefing-only group, the percentage of participants providing compressions of adequate depth increased after debriefing, from 38% to 68% (p = 0.015). In the feedback group, depth compliance improved from 19% to 58% (p = 0.002). Compression rate did not improve significantly with either intervention alone. The combination of feedback and debriefing improved compression rate compliance from 45% to 84% (p = 0.001) and resulted in a doubling of participants providing compressions of both adequate rate and depth, 29% vs. 64% (p = 0.005). CONCLUSIONS: Significant cardiopulmonary resuscitation quality deficits exist among healthcare providers. Debriefing or feedback alone improved cardiopulmonary resuscitation quality, but the combination led to marked performance improvements. Cardiopulmonary resuscitation feedback and debriefing may serve as a powerful tool to improve rescuer training and care for cardiac arrest patients.