Introduction: Cardiac arrest survival is dependent upon chest compression quality. Target parameters for compression depth and rate became more specific from the 2010 Guidelines [≥2 inches, 80-120/min] to the 2015 Guidelines [2.0-2.5 inches, 100-120/min]. Real-time audiovisual feedback (RTAVF) may improve compression guideline adherence, but the impact of RTAVF with application of more specific targets is unknown.
Hypothesis: Dependence on RTAVF to achieve compression guideline adherence will increase with application of the more specific 2015 Guidelines.
Methods: Data were collected as part of a benchmarking program conducted at multiple U.S. hospitals. Compression rate and depth were recorded using RTAVF defibrillators (R Series, ZOLL Medical). The program included subjects enrolled before (n=756) and after (n=995) introduction of the 2015 Guidelines, with target compression parameters modified accordingly. At baseline subjects performed 2 min of continuous compressions on standard CPR manikins with RTAVF feedback disabled. After a brief RTAVF orientation, subjects repeated 2 min of continuous compressions on the same manikins with feedback enabled. The 2010 Guidelines cohort and 2015 Guidelines cohort were compared with regard to the percentage of compressions meeting appropriate rate/depth targets with and without use of RTAVF.
Results: An increase in compression guideline adherence was observed with use of RTAVF for both the 2010 Guidelines cohort [60.3% to 96.0%, OR 15.9 (10.8-23.6), p<0.01] and the 2015 Guidelines cohort [16.7% to 95.0%, OR 94.4 (67.9-131.2), p<0.01]. The proportion of subjects requiring RTAVF to achieve adherence increased from the 2010 Guidelines cohort to the 2015 Guidelines cohort [36.1% vs. 79.3%, OR 6.8 (5.5-8.4), p<0.01]. There were no statistically significant differences between the 2010 Guidelines cohort and the 2015 Guidelines cohort with regard to the proportion of subjects that could not be corrected [3.6% vs. 4.0%, OR 1.1 (0.7-1.9), p=0.63] or became nonadherent [0.4% vs. 1.0%, OR 2.6 (0.7-9.3), p=0.16] with RTAVF.
Conclusions: The use of RTAVF increases adherence to chest compression guidelines, particularly with application of the narrower 2015 Guidelines targets for compression depth and rate.