Effectiveness of feedback with a smartwatch for high-quality chest compressions during adult cardiac arrest: A randomized controlled simulation study

Enhancing Cardiopulmonary Resuscitation Quality Using a Smartwatch: Neural Network Approach for Algorithm Development and Validation

BACKGROUND

Sudden cardiac arrest is a major cause of mortality, necessitating immediate and high-quality cardiopulmonary resuscitation (CPR) for improved survival rates. High-quality CPR is defined by chest compressions at a rate of 100-120 per minute and a depth of 50-60 mm. Monitoring and maintaining these parameters in real time during emergencies remain a challenge.

OBJECTIVE

This study introduces a neural network model designed to predict and assess CPR quality using accelerometer data from a smartwatch.

METHODS

The study involved 83 participants performing CPR on mannequins, with accelerometer data collected via smartwatches worn by the participants. These data were aligned with gold-standard data from the mannequins. The accelerometer-derived compression data were segmented into 5-second intervals for training the neural network models. A total of 1226 neural network models were developed, incorporating variations in hyperparameters and dataset configurations to optimize performance.

RESULTS

The optimal model demonstrated the capability to accurately predict the number of compressions and the average compression depth within a 5-second interval. The model achieved an accuracy of ±3.8 mm for compression depth and an average deviation of 0.8 compressions. The results indicated that the neural network model could accurately assess CPR quality metrics, surpassing other models discussed in the literature. The large and diverse dataset used in this study contributed to the robustness and reliability of the model.

CONCLUSIONS

This study validates the efficacy of a neural network model in accurately predicting CPR metrics using smartwatch accelerometer data. The model outperforms previous methods and shows promise for real-time feedback during CPR. Future work involves deploying the model directly on smartwatches for real-time application, potentially improving sudden cardiac arrest survival rates through immediate and accurate feedback on CPR quality.

The development and accuracy assessment of a wearable cardiopulmonary resuscitation real-time audio-visual feedback device

To enhance the quality of chest compressions and survival rates from cardiac arrest, several real-time audio-visual feedback devices have been developed. However, many of these feedback devices have certain issues regarding their usage or effectiveness. In this paper, we report on a wearable cardiopulmonary resuscitation real-time audio - visual feedback device, which is crafted with liquid silicone material for the casing to minimize skin injury. The device can display compression data (depth and frequency) in real-time and provides feedback through three forms of prompts. It has been evaluated for the accuracy of depth and frequency measurements against a reference device. The experimental results indicate that this wearable feedback device can provide more accurate depth and frequency data, holding the potential to become a tool for safely and effectively guiding high-quality cardiopulmonary resuscitation.

A Systematic Review: What Are the Impacts of Receiving Extrinsic Feedback on Health Professions Students in Higher Education?

Effective feedback is crucial for educating health professions students. This systematic review investigates the impact of extrinsic feedback on health professions students, encompassing medical, dental, and nursing fields. Through meticulous gathering and analysis of 37 studies, this review highlights verbal and visual feedback as predominant forms, often delivered immediately by instructors and supplemented by peer or simulated input. Notably, technology is increasingly utilised to enhance the provision of feedback. The impacts of feedback span various domains, including surgical skills and patient communication, revealing notable improvements in procedural skills such as suturing and knot-tying, as well as general patient communication proficiency. Meta-analyses underscore significant enhancements in communication skills and provide nuanced insights into chest compression techniques. Overall, the findings provide initial evidence that extrinsic feedback enhances surgical procedural skills and general patient communication proficiency among health professions students. The evolving role of technology in feedback provision is promising. Future studies should assess extrinsic feedback across different health professions to better understand its impacts and alignment with specific educational needs and accreditation standards, thereby enhancing learning outcomes.

A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers

Background

Cardiopulmonary resuscitation (CPR) quality significantly impacts patient outcomes during cardiac arrests. With advancements in health care technology, smartwatch-based CPR feedback devices have emerged as potential tools to enhance CPR delivery.

Objective

This study evaluated a novel smartwatch-based CPR feedback device in enhancing chest compression quality among health care professionals and lay rescuers.

Methods

A single-center, open-label, randomized crossover study was conducted with 30 subjects categorized into 3 groups based on rescuer category. The Relay Response BLS smartwatch application was compared to a defibrillator-based feedback device (Zoll OneStep CPR Pads). Following an introduction to the technology, subjects performed chest compressions in 3 modules: baseline unaided, aided by the smartwatch-based feedback device, and aided by the defibrillator-based feedback device. Outcome measures included effectiveness, learnability, and usability.

Results

Across all groups, the smartwatch-based device significantly improved mean compression depth effectiveness (68.4% vs 29.7%; P < .05) and mean rate effectiveness (87.5% vs 30.1%; P < .05), compared to unaided compressions. Compression variability was significantly reduced with the smartwatch-based device (coefficient of variation: 14.9% vs 26.6%), indicating more consistent performance. Fifteen of 20 professional rescuers reached effective compressions using the smartwatch-based device in an average 2.6 seconds. A usability questionnaire revealed strong preference for the smartwatch-based device over the defibrillator-based device.

Conclusion

The smartwatch-based device enhances the quality of CPR delivery by keeping compressions within recommended ranges and reducing performance variability. Its user-friendliness and rapid learnability suggest potential for widespread adoption in both professional and lay rescuer scenarios, contributing positively to CPR training and real-life emergency responses.

Do laypersons need App-linked real-time feedback devices for effective resuscitation? - Results of a prospective, randomised simulation trial

Background

App-linked real-time feedback-devices for cardiopulmonary resuscitation (CPR) aim to improve laypersons' resuscitation quality. Resuscitation guidelines recommend these technologies in training settings. This is the first study comparing resuscitation quality of all App-linked feedback-devices currently on market.

Methods

A prospective randomised simulation study was performed. After standardised instructions, participants performed 2-minutes compression-only CPR on a manikin without feedback (baseline). Afterwards, participants performed 4 × 2 min CPR with four different feedback devices in randomised order (CorPatch® Trainer, CPRBAND AIO Training, SimCPR®ProTrainer, Relay Response™) (intervention). CPR metrics (chest compression depth (CD), chest compression rate (CR), percentage of correct CD/CR (%), correct hand position, correct chest recoil, and technical preparation-time) were assessed. Devices data were compared to the baseline group using Wilcoxon testing with IBM SPSS (primary outcome). Differences between devices were analysed with ANOVA testing (secondary outcome). Normally distributed data were described as mean ± standard deviation (SD) and non-normally distributed data as Median [Interquartile range (IQR). CPR self-confidence was measured by means of questionnaire before and after feedback devices' use. Comparison was performed by students t-test.

Results

Forty participants were involved. SimCPR®ProTrainer was the only device, which resulted in guideline-compliant chest compressions (Mean ± SD:5.37 ± 0.76) with improved chest compression depth (p < 0.001), and percentage of correct chest compression depth (p < 0.001) compared to unassisted CPR (baseline). CorPatch® Trainer as the only device with audio-visual recoil instructions resulted in improved chest recoil (Mean ± SD:72.25 ± 24.89) compared to baseline (Mean ± SD:49.00 ± 42.20; p < 0.01), while the other three devices resulted in significantly lower chest recoil rates (CPRBAND AIO Training: 37.03 ± 39.90; p < 0.01, SimCPR®ProTrainer: Mean ± SD:39.88 ± 36.50; p = 0.03, Relay Response™: Mean ± SD:36.88 ± 37.73; p = 0.02). CPR quality when using the different feedback devices differ in chest compression depth (p = 0.02), chest compression rate (p < 0.001), percentage of correct chest compression depth/rate (p = 0.03/p = 0.04), and technical preparation-time (p < 0.001). Feedback-devices' use increased participant's CPR self-confidence (p < 0.001).

Conclusion

Although, CPR feedback devices show improved CPR performance in layperson in some metrics, none of the tested CPR feedback devices supported layperson in overall adequate CPR performance. More and better technical functionality is necessary, to fully utilise the potential of CPR feedback devices and to prevent a worsening of CPR performance when layperson use this technology.

The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis

AIMS

Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training.

METHOD AND RESULT

Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices.

CONCLUSION

The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands.

REGISTRATION

PROSPERO: CRD42020205754.

Using real-time device-based visual feedback in CPR recertification programs: A prospective randomised controlled study

BACKGROUND

Receiving regular training to maintain CPR skills is critical for in-service health-care professionals, especially because motor skills diminish over time.

OBJECTIVES

To compare the effects of real-time device-based visual feedback and conventional instructor-based feedback on the chest compression skills and self-efficacy of nurses receiving a CPR recertification program.

DESIGN

A prospective randomised controlled study with repeated measurements was conducted according to the CONSORT 2010 guidelines.

METHODS

A total of 109 nurses were recruited, and 98 nurses were eligible for random allocation. The control group (CG, n = 49) was advised by instructors for skill correction, and the experimental group (EG, n = 49) adjusted their skills according to on-screen real-time feedback data. The study outcomes were CPR performance metrics and self-efficacy that were assessed immediately after the training session (T1) and retested after 12 weeks (T2).

RESULTS

In the EG, the percentage of the appropriate rate, depth, and chest recoil at T1 significantly improved by 24.47 % (P < .001), 19.63 % (P < .001), and 11.52 % (P = .001), respectively. The EG exhibited significantly higher chest compression total scores at T1, and the difference remained significant at T2 (P < 0.001). Moreover, the self-efficacy in the EG significantly improved at T1 (2.76; P < .001) and T2 (2.58; P < .001).

CONCLUSION

Compared with instructor-based feedback, real-time device-based visual feedback improved chest compression quality and CPR self-efficacy.

The Use of Feedback in Improving the Knowledge, Attitudes and Skills of Medical Students: a Systematic Review and Meta-analysis of Randomized Controlled Trials

This study aims to investigate the effectiveness of the use of different feedback modalities in improving the knowledge, attitudes, and skills of medical students compared to students receiving no feedback or unstructured feedback. A systematic review and meta-analysis of randomized controlled trials was conducted based on a search of the Cochrane, ERIC, PubMed, Scopus, and Web of Science databases. A total of 26 studies were included for the systematic review and 13 for the meta-analysis. The meta-analysis revealed that the use of feedback was associated with better results compared to control groups (SMD = 0.80 [0.56-1.04], p < 0.001), and also when only high-quality studies were included (SMD = 0.86 [0.56-1.16], p < 0.001). Our findings revealed high heterogeneity in the use of feedback in medical education. However, the results of most of the studies and of the meta-analysis were positive, showing that feedback had a positive influence on the education-learning process of the students. PROSPERO registration: CRD42018112688.

Impact of a Smart-Ring-Based Feedback System on the Quality of Chest Compressions in Adult Cardiac Arrest: A Randomized Preliminary Study

This study aimed to assess the effectiveness of a novel chest compression (CC) smart-ring-based feedback system in a manikin simulation. In this randomized, crossover, controlled study, we evaluated the effect of smart-ring CC feedback on cardiopulmonary resuscitation (CPR). The learnability and usability of the tool were evaluated with the System Usability Scale (SUS). Participants were divided into two groups and each performed CCs with and without feedback 2 weeks apart, using different orders. The primary outcome was compression depth; the proportion of accurate-depth (5–6 cm) CCs, CC rate, and the proportion of complete CCs (≤1 cm of residual leaning) were assessed additionally. The feedback group and the non-feedback group showed significant differences in compression depth (52.1 (46.3–54.8) vs. 47.1 (40.5–49.9) mm, p = 0.021). The proportion of accurate-depth CCs was significantly higher in the interventional than in the control condition (88.7 (30.0–99.1) vs. 22.6 (0.0–58.5%), p = 0.033). The mean SUS score was 83.9 ± 8.7 points. The acceptability ranges were ‘acceptable’, and the adjective rating was ‘excellent’. CCs with smart-ring feedback could help achieve the ideal range of depth during CPR. The smart-ring may be a valuable source of CPR feedback.

Short-Term Learning Effects of a Cardiopulmonary Resuscitation Program with Focus on the Relationship between Learning Effect and Trainees' Perceived Competence

High-quality education and training are essential for effectively improving the quality of cardiopulmonary resuscitation (CPR); however, the relationship between the acquisition of motor skills and learners’ psychological characteristic has not been investigated fully. Therefore, we investigated the relationship between intrinsic motivation for training, self-efficacy for CPR, and CPR skill acquisition through training. Twenty health sciences undergraduate students participated in a 3-hour basic life support course. Their chest compression skills were assessed before and after the course. The main outcome of this study was the chest compression score, with changes in the score from pretest to posttest regarded as the short-term learning effects from training. The chest compression score was significantly higher after the course (median 53.5%, interquartile range [IQR] 39.8–83.0) than before the course (median 14.0%, IQR 0–43.3, p < 0.001). Furthermore, we found a significant correlation between perceived competence after the training and changes in the chest compression score from pretest to posttest (r = 0.483, p = 0.031), but other psychological indices did not correlate with changes in the chest compression score. A significant correlation was noted between trainees’ perceived competency and the short-term learning effects of CPR training. We suggest instructors focus on psychological components of training, including trainees’ perceived competence.

Correlation between real-time heart rate and fatigue in chest compression providers during cardiopulmonary resuscitation: A simulation-based interventional study

BACKGROUND

The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable.

OBJECTIVES

This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers.

STUDY DESIGN

A simulation-based prospective interventional study including 110 participants.

METHODS

Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated.

RESULTS

With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02-1.04; P < .001).

CONCLUSION

Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.

Effect of smartphone applications on cardiopulmonary resuscitation quality metrics in a mannequin study: A randomized trial

OBJECTIVE:

The aim of this randomized, cross-over trial is to reveal the effect of smartphone cardio-pulmonary resuscitation (CPR) feedback applications (App) on a group of lay rescuers' chest compression-only CPR quality metrics. Quality metrics is measured initially and after 3 months.

METHODS:

A floor-based Resusci Anne mannequin (Laerdal Medical, Stavanger, Norway) was used. Three scenarios (CPR with device App-on [scenario-a], CPR with device App-off [scenario-b], and hands-only CPR [scenario-c]) were randomly allocated to all participants. All the participants performed 2 min of hands only-CPR for each scenario. Data of mean chest compression rate, mean chest compression depth, and recoil were recorded and compared for each scenario.

RESULTS:

One hundred and thirty-seven first-year students from the Vocational School of Health Services in Turkey participated in this study to mimic lay rescuers. Difference in the initial mean rate of chest compressions was statistically significant when CPR was performed with device App-on (scenario-a) compared to scenarios b and c (P < 0.001, P < 0.001). Furthermore, difference in the mean chest compression rate at the 3^rd month was statistically significant among the scenarios when CPR was performed with device App-on (scenario-a) (P = 0.002, P = 0.001). The difference in initial and 3^rd month mean compression depth and the percentage of recoil was not statistically significant among the scenarios.

CONCLUSION:

This study shows that the mean chest compression rate and percentage of compressions with adequate rate improved with smartphone App-on, and these results were persistent up to 3 months.

Effectiveness of Smartwatch Guidance for High-Quality Infant Cardiopulmonary Resuscitation: A Simulation Study

Background and objectives: As in adults, the survival rates and neurological outcomes after infant Cardiopulmonary resuscitation (CPR) are closely related to the quality of resuscitation. This study aimed to demonstrate that using a smartwatch as a haptic feedback device increases the quality of infant CPR performed by medical professionals. Materials and methods: We designed a prospective, randomized, case-crossover simulation study. The participants (n = 36) were randomly allocated to two groups: control first group and smartwatch first group. Each CPR session consisted of 2 min of chest compressions (CCs) using the two-finger technique (TFT), 2 min of rest, and 2 min of CCs using the two-thumb encircling hands technique (TTHT). Results: The primary outcome was the variation in the “proportion of optimal chest compression duration” and “compression rate” between the smartwatch-assisted and non-smartwatch-assisted groups. The secondary outcome was the variation in the “compression depth” between two groups. The proportion of optimal CC duration was significantly higher in the smartwatch-assisted group than in the non-smartwatch-assisted group. The absolute difference from 220 was much smaller in the smartwatch-assisted group (218.02) than in the non-smartwatch-assisted group (226.59) (p-Value = 0.018). Conclusion: This study demonstrated the haptic feedback system using a smartwatch improves the quality of infant CPR by maintaining proper speed and depth regardless of the compression method used.

Effects of vibration-guided cardiopulmonary resuscitation with a smartwatch versus metronome guidance cardiopulmonary resuscitation during adult cardiac arrest: a randomized controlled simulation study

BACKGROUND

Smartwatches could be used as a cardiopulmonary resuscitation (CPR) guidance system through its vibration function. This study was conducted to determine whether vibration guidance by a smartwatch application influences CPR performance compared to metronome guided CPR in a simulated noisy setting.

METHODS

This study was randomised controlled trial. A total of 130 university students were enrolled. The experiment was conducted using a cardiac arrest model with hands-only CPR. Participants were randomly divided into two groups 1:1 ratio and performed 2-min metronome guidance or vibration guidance compression at the rate of 110/min. Basic life support quality data were compared in simulated noisy environments.

RESULTS

There were significant differences between the audio and vibration guidance groups in the mean compression rate (MCR). However, there were no significant differences in correct or mean compression depth, correct hand position, and correctly released compression. The vibration guidance group resulted in 109 MCR (Interquartile range [IQR] 108-110), whereas the metronome guidance group resulted in 115 MCR (IQR 112-117) (p < 0.001).

CONCLUSION

In a simulated noisy environment, vibration guided CPR showed to be particularly advantageous in maintaining a desired MCR during hands-only CPR compared to metronome guided CPR.

Effects of real-time feedback on cardiopulmonary resuscitation quality on outcomes in adult patients with cardiac arrest: A systematic review and meta-analysis

AIM

To investigate the relationship between the implementation of real-time audiovisual cardiopulmonary resuscitation (CPR) feedback devices with cardiac arrest patient outcomes, such as return of spontaneous circulation (ROSC), short-term survival, and neurological outcome.

METHODS

We systematically searched PubMed, Embase, and the Cochrane CENTRAL from inception date until April 30, 2020, for eligible randomized and nonrandomized studies. Pooled odds ratio (OR) for each binary outcome was calculated using R system. The primary patient outcome was ROSC. The secondary outcomes were short-term survival and favorable neurological outcomes (cerebral performance category scores: 1 or 2).

RESULTS

We identified 11 studies (8 nonrandomized and 3 randomized studies) including 4851 patients. Seven studies documented patients with out-of-hospital cardiac arrest and four studies documented patients with in-hospital cardiac arrest. The pooled results did not confirm the effectiveness of CPR feedback device, possibly because of the high heterogeneity in ROSC (OR: 1.42, 95% CI: 1.03-1.94, I²: 80%, tau²: 0.1875, heterogeneity test p <  0.01) and survival-to-discharge (OR: 1.27, 95% CI: 0.74-2.18, I²: 86%, tau²: 0.4048, heterogeneity test p <  0.01). The subgroup analysis results revealed that heterogeneity was due to the types of devices used. Patient outcomes were more favorable in studies investigating portable devices than in studies investigating automated external defibrillator (AED)-associated devices.

CONCLUSIONS

Whether real-time CPR feedback devices can improve patient outcomes (ROSC and short-term survival) depend on the type of device used. Portable devices led to better outcomes than did AED-associated devices. Future studies comparing different types of devices are required to reach robust conclusion.

PROTOCOL REGISTRATION

Prospero registration ID CRD42020155388.

Effect of Watch-Type Haptic Metronome on the Quality of Cardiopulmonary Resuscitation: A Simulation Study

Objectives

The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers.

Methods

A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100–120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups.

Results

The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups—good: haptic feedback-assisted (0.57–0.06) vs. non-haptic feedback-assisted (0.54–0.03), p < 0.001; bad: haptic feedback-assisted (0.57–0.07) vs. non-haptic feedback-assisted (0.58–0.18), p = 0.005—and the adequate chest compression number showed significant differences— good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001.

Conclusions

A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.

GOFlow: Smartwatch app to deliver laboratory results in emergency departments - A feasibility study

PURPOSE

Information Technology (IT) plays a critical role in supporting emergency physicians' (EPs) routines. Pagers, personal computers, and smartphones offer fast access to patient data, such as laboratory results. However, due to the inherent features of specimen processing and laboratory instruments, the turnaround time from test ordering to availability of results can be long. Lack of follow-up of abnormal results can lead to missed information that could impact patient care and safety. Despite the increasing use of ubiquitous technologies, a third of physicians remains devoid of reliable methods for ensuring that results have been received. In this feasibility study, we report the potential of using a smartwatch to deliver laboratory results to EPs at the point-of-care and to support efficiency in emergency care. Unlike mobile devices that are increasingly used by EPs, smartwatches are always accessible, even during hands-on procedures.

METHOD

Two EPs and four experts in human-computer interaction designed the smartwatch application following the Design Science Research Methodology (DSRM). The application was then evaluated in a pediatric emergency department through semi-simulated scenarios by eleven EPs. The primary outcome was to measure both the app perceived usability and satisfaction scores by the aim of the System Usability Scale (SUS), and the perceived usefulness and intention of its use by the aim of the Unified Theory of Acceptance and Use of Technology (UTAUT) scale. Secondary outcomes were to assess the application's efficiency by measuring the delay between the reception of the notification and 1) the access to its details and 2) the visit to the patient. Finally, open questions about the positive and negative aspects of the prototype as well as potential improvements were asked and evaluated qualitatively.

RESULTS

The prototype obtained a score of 81.4 out of 100 (good) on the SUS and a score of 5.96 out of 7 on the UTAUT scale. EPs using the smartwatch visited patients within 30 seconds receiving the laboratory results.

CONCLUSIONS

This study demonstrates the capacity of smartwatches to speed up the point-of-care delivery of laboratory results in the ED.

Comparison of two-thumb encircling and two-finger technique during infant cardiopulmonary resuscitation with single rescuer in simulation studies: A systematic review and meta-analysis

BACKGROUND

The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer.

METHODS

We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).

RESULTS

Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted.

CONCLUSION

This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.

Effect of smart devices on the quality of CPR training: A systematic review

AIM OF THE REVIEW

Use of smart devices to provide real-time cardiopulmonary resuscitation (CPR) feedback in the context of out-of-hospital cardiac arrest (OHCA) has considerable potential for improving survival. However, the findings of previous studies evaluating the effectiveness of these devices have been conflicting. Therefore, we conducted a systematic review of the literature to assess the utility of smart devices for improving the quality of CPR during CPR training.

DATA SOURCES

Thirteen electronic databases were searched. The articles were reviewed according to the eligibility criteria. CPR quality was evaluated based on the rates and depths of chest compression, and the proportion of adequate depth of chest compressions.

RESULTS

Ultimately, 11 studies (5 randomised controlled trials, 1 randomised trial, and 5 randomised cross-over trials) were selected for this systematic review. Eight of these studies used smartphones and three used smartwatches. This review did not find an apparent benefit from smart device use during CPR in terms of maintaining the recommended compression rates and depths of chest compressions. However, all three smartwatch studies reported that the proportion of chest compressions of adequate depth was significantly improved with smartwatch use (smartwatch group vs. non-smartwatch group in the three studies: 65.01% vs. 45.15%, p = 0.01; 64.6% vs. 43.1%, p = 0.049; 98.7% vs. 79.3%, p = 0.002).

CONCLUSION

This review does not find durable evidence for usefulness of smart devices in CPR training. However, the smartwatches may improve the accuracy of chest compression depth. Future studies with larger sample sizes might be necessary before reaching a firm conclusion.

U, Ruetzler K. The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial

BACKGROUND

International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students.

METHODS

A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups-the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month.

RESULTS

The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group.

CONCLUSIONS

Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.

Chest Compression Depth and Rate - Effect on Instructor Visual Assessment of Chest Compression Quality

BACKGROUND

The aim of the present study was to determine whether instructors could accurately assess chest compression quality visually, considering the association between chest compression depth and rate.

METHODS AND RESULTS

In this prospective, observational study, the quality of chest compressions performed by a simulated actor in a video was visually assessed by certified instructors. The film consisted of 14 case scenarios, each including a combination of depth (2 patterns: adequate, 5-6 cm; and inadequate, <5 cm) and rate (7 categories: compressions 90-150 times/min in increments of 10 times/min). The participants evaluated whether the compression depth was adequate, deep, or inadequate; and whether the compression rate was appropriate, fast, or slow. Of 198 instructors, 56% of participants misidentified adequate depth as deep at a chest compression rate of 120/min (the tendency toward this response increased as chest compression rate increased), and 64.1% of participants incorrectly determined 130/min to be appropriate. On generalized linear mixed-effects model analysis, perceived chest compression depth and rate were significant factors for a correct response (P<0.01, both). A significant interaction between chest compression depth and rate was observed (P<0.01).

CONCLUSIONS

In the visual assessment of chest compression quality, recognition of chest compression depth was closely associated with compression rate. Misidentification of adequate chest compression depth as deep increased as the compression rate increased.

A novel depth estimation algorithm of chest compression for feedback of high-quality cardiopulmonary resuscitation based on a smartwatch

INTRODUCTION

High-quality cardiopulmonary resuscitation (CPR) is a key factor affecting cardiac arrest survival. Accurate monitoring and real-time feedback are emphasized to improve CPR quality. The purpose of this study was to develop and validate a novel depth estimation algorithm based on a smartwatch equipped with a built-in accelerometer for feedback instructions during CPR.

METHODS

For data collection and model building, researchers wore an Android Wear smartwatch and performed chest compression-only CPR on a Resusci Anne QCPR training manikin. We developed an algorithm based on the assumptions that (1) maximal acceleration measured by the smartwatch accelerometer and the chest compression depth (CCD) are positively correlated and (2) the magnitude of acceleration at a specific time point and interval is correlated with its neighboring points. We defined a statistic value M as a function of time and the magnitude of maximal acceleration. We labeled and processed collected data and determined the relationship between M value, compression rate and CCD. We built a model accordingly, and developed a smartwatch app capable of detecting CCD. For validation, researchers wore a smartwatch with the preinstalled app and performed chest compression-only CPR on the manikin at target sessions. We compared the CCD results given by the smartwatch and the reference using the Wilcoxon Signed Rank Test (WSRT), and used Bland-Altman (BA) analysis to assess the agreement between the two methods.

RESULTS

We analyzed a total of 3978 compressions that covered the target rate of 80-140/min and CCD of 4-7 cm. WSRT showed that there was no significant difference between the two methods (P = 0.084). By BA analysis the mean of differences was 0.003 and the bias between the two methods was not significant (95% CI: -0.079 to 0.085).

CONCLUSION

Our study indicates that the algorithm developed for estimating CCD based on a smartwatch with a built-in accelerometer is promising. Further studies will be conducted to evaluate its application for CPR training and clinical practice.

Emerging and Future Technologies in Out-of-Hospital Cardiac Arrest Care

The care for victims of out-of-hospital cardiac arrest is evolving and will be influenced by future and emerging technologies that will play a role in the systems of care for these patients. Recent advances in extracorporeal life support and point-of-care ultrasound imaging, both in-hospital and out-of-hospital, may offer a therapeutic solution in some systems for patients with refractory or recurrent cardiac arrest. Drones capable of delivering automated external defibrillators to the scene of an out-of-hospital cardiac arrest, advances in digital and mobile technologies to notify and leverage bystander response, and wearable life detection technologies may improve survival.