Add real-time feedback to CPR training for better results
New American Heart Association guidelines call for instant feedback on compression depth, rate and chest recoil in CPR training modules
Sponsored by Bound Tree Medical
By Tim Nowak for EMS1 BrandFocus
Continuous chest compressions … 30:2 … It all adds up to a lot of hard work!
The question is: Are your compressions effective?
Starting January 31, 2019, CPR feedback will be an integrated part of your American Heart Association basic life support courses, as well as all adult CPR training modules. Compression depth, rate and chest recoil will all be monitored during courses by not only the instructor, but by a CPR training feedback device as well.
Each year, more than 350,000 cardiac arrests occur outside the hospital, and over 200,000 occur in a hospital setting. Only 46 percent of people who suffer an out-of-hospital cardiac arrest receive bystander CPR before professional help arrives. 
As we expand the implementation of evidence-based practice into our clinical guidelines, we also need to provide some form of validation to show the continued progress and effectiveness of those changes. Having a trained and certified CPR instructor visually monitor a classroom of students simply may not be enough to accomplish this.
Using Feedback to Improve CPR Performance
Specific and targeted feedback is critical to students’ understanding and delivery of high-quality CPR when faced with a cardiac emergency. Incorporating feedback devices into adult CPR courses provides the quality and consistency of CPR training, which increases the chance of a successful outcome when CPR is performed.
The end goal is to help students master the critical CPR skills and reduce the time between training and demonstration of competence in a training environment.  Because inadequate performance of CPR is a common but challenging occurrence for providers and instructors to detect, technology can prove valuable to help address the problem by assessing CPR performance and providing feedback on the spot. 
With the January 2019 update, feedback devices will be a required component of the adult portion of CPR courses. In the future, however, this requirement may be incorporated into the child and infant portions of the program as more feedback devices become available. 
What Constitutes a CPR Feedback Device?
CPR training feedback devices monitor several elements of the process. For starters, a metronome provides a rate to follow during CPR practice, but it does not give directive feedback on the student’s actual performance.  For this reason, a metronome alone will not meet the new roll-out requirements for a CPR feedback device.
To comply with the new AHA requirements, feedback devices must, at a minimum, measure and provide real-time audio and/or visual feedback on compression rate and depth, allowing students to self-correct or validate their skill performance immediately during training.  Many such devices base this feedback on hand position, chest recoil and chest compression fraction (the percentage of time in which chest compressions are done by rescuers). 
CPR feedback devices are available in a variety of options to training centers, as well as through various vendors. Such devices can be integrated into the manikin or serve as an accessory. Many high-fidelity manikins also provide the required feedback to meet this requirement. 
In terms of quantity, the updated recommendations will keep the same manikin-to-student ratio and will recommend one feedback device per manikin. Since the practical skills portion of the class will focus more on physical competence and skills compliance, this has the potential to decrease class time because students may show skills proficiency at an earlier point in the course.  Being able to self-correct in real time can help to reinforce proper compression performance rather than require later remediation after an improper skill has already been performed.
The Goal: Improved Outcomes
The end result of this updated training requirement is not to increase the cost of CPR courses, nor is it to add any burden to training centers and instructors. Rather it is to improve the efficacy of CPR instruction and skills performance through a more objective approach.
Improved skills performance should lead to increased CPR performance overall, as well as improved patient survival results. This should empower instructors, providers and citizens to help in doubling survival rates from cardiac arrest by 2020. 
About the Author
Tim Nowak, AAS, BS, NRP, CCEMT-P, SEMSO, is the founder and CEO of Emergency Medical Solutions, LLC, an independent EMS training and consulting company that he developed in 2010. He's been involved in EMS and emergency services since 2002, and has worked as an EMT, paramedic and critical care paramedic in a variety of urban, suburban, rural and hospital settings. He’s also been involved as an EMS educator, consultant, item writer, clinical preceptor, board member, reference product developer, firefighter and HazMat technician throughout his career.