Optimizing Integration of CPR Feedback Technology With CPR Coaching for Cardiac Arrest

Cardiopulmonary resuscitation (CPR) is provided for thousands of children with
cardiopulmonary arrests (CPA) each year in North America. The quality of CPR directly
impacts hemodynamics, survival, and neurologic outcome following cardiac arrest.
Well-trained healthcare providers consistently fail to perform CPR within established Heart
and Stroke Foundation of Canada (HSFC) resuscitation guidelines. The poor quality of
healthcare provider CPR adversely affects survival outcomes and quality of life in cardiac
arrest survivors.

CPR feedback devices that provide real-time visual corrective feedback during CPA have
become valuable tools to help to improve the overall quality of CPR. The cardiac arrest
literature shows that although CPR feedback devices help to improve the overall quality of
CPR, there is still substantial room for improvement. A recent multicenter study involving
ten pediatric institutions led by the principal investigator of this project evaluated the
impact of CPR feedback on CPR quality during simulated CPA5. This study demonstrated that
the use of CPR feedback improved depth compliance by 15.4% and rate compliance by 40.1%.
However, overall compliance with guidelines in the CPR feedback group was still under 40%
for depth and under 75% for rate.

Data collected by this research team suggests that a variety of factors may influence the
effectiveness of real-time CPR feedback. CPR providers interviewed after a simulated cardiac
arrest report that they often are distracted by other events while providing CPR, are unable
to clearly see the device, or have difficulty interpreting the visual display on the CPR
feedback device. Additionally, many providers' perception of CPR quality is inaccurate, with
providers consistently overestimating the quality of CPR provided during simulated CPA, even
when using CPR feedback. This suggests a need to improve provider perception of CPR and
provider awareness of the CPR feedback device.

To improve the quality of CPR the investigators propose the implementation of a standardized
resuscitation team structure with a CPR coach. To date, there have been no studies
describing the optimal team structure required for integration of CPR feedback
defibrillators during CPA. In this study,the investigators propose the concept of a CPR
coach, whose primary responsibility is to provide real-time coaching during cardiac arrest
to improve the quality of CPR. Preliminary pilot work done in the intensive care unit at
Johns Hopkins Children's Hospital suggests that use of a CPR coach improves the quality of
CPR in comparison prior teams that functioned without a CPR coach. This study will assess
the impact of a CPR Coach for improving CPR quality and CPR perception in a team of
healthcare providers during simulated CPA.

Inclusion Criteria:

- Team Members: (i) Pediatric healthcare providers: such as nurses, nurse
practitioners, respiratory therapists and residents (pediatric, emergency medicine,
anesthesia, family medicine); and (ii) Basic Life Support (BLS), Pediatric Advanced
Life Support (PALS) or Advanced Cardiac Life Support (ACLS) certification within the
past two years;

- Team Leaders: (i) Residents (Year 3 or 4) in pediatrics, family medicine, anesthesia,
or emergency medicine training programs or fellows in pediatric emergency medicine,
pediatric critical care or pediatric anesthesia subspecialty training programs; (ii)
Attending physicians from pediatric intensive care, pediatric emergency medicine,
general pediatrics; and (iii) PALS certification in the past two years or are PALS

Exclusion Criteria:

- Not BLS certified