The effect of automatic external defibrillator with a real-time feedback on quality of bystander cardiopulmonary resuscitation: A before-and-after simulation study

Abstract

High-quality bystander cardiopulmonary resuscitation (CPR) and early defibrillation in the community are important for survival in out-of hospital-cardiac-arrest, but maintaining the quality of CPR in bystanders is difficult. We aimed to determine the effect of an automated external defibrillator (AED) with real-time feedback on the quality of bystander CPR in a community setting. A before-and-after simulation study was designed. Trainees of basic life support education were recruited for the simulation experiment. Each team consisted of two bystanders with different roles (initial witness and CPR supporter). 82 teams performed simulation scenarios with the real-time feedback function of AED disabled initially, and then repeated it with feedback function enabled. Quality measures of chest compression depth and no-flow fraction were compared between each of the two simulation scenarios. CPR quality data from 82 teams were analysed. The mean percentage of chest compressions with adequate depth was significantly higher in simulations with real-time feedback (78.1% vs. 89.3%, p < 0.01). Similarly, no-flow fractions were lower in simulation scenarios with real-time feedback (32.0% vs. 30.3% p = 0.05). In a subgroup with the lowest percentage of adequate depth performance in the initial simulation without real-time feedback, a mean increase of 47.7% (95% CI 31.3-64.0) in the fraction of chest compressions with adequate depth was seen with real-time feedback. Use of an AED with real-time feedback improves the quality of bystander CPR in a simulated community setting. The positive effect of real-time feedback is greatest among people with a low level of CPR skill.