Simulation-based feedback systems in cardiopulmonary resuscitation training: a scoping review

Sudden cardiac arrest is among the leading causes of death worldwide and continues to be a public health issue. The quality of cardiopulmonary resuscitation (CPR) which relates to the depth, rate, and full recoil of chest compressions, is critical to return of spontaneous circulation (ROSC) and survival. Simulation-based environments provide a safe, controlled, and no-risk setting for practice of CPR, thus making it a prime setting to utilize the evaluation of feedback devices. This study sought to examine the influence of feedback systems on CPR quality in those simulations. A search was conducted in three major databases: PubMed, Web of Science, and Scopus. Search terms were tailored to the characteristics of each database and included a combination of keywords related to CPR and feedback devices. Inclusion criteria comprised English-language studies with experimental, quasi-experimental, or randomized controlled trial (RCT) designs that examined the effect of feedback devices on CPR quality in simulated scenarios and reported at least one CPR quality parameter. The findings of this review of 31 studies published from 2006 to 2022 demonstrate that real-time feedback systems (including visual, auditory, combined, mobile, smartwatches, gamification, augmented/virtual reality, and video-based systems) produced an overall improvement in CPR quality with respect to compression depth and rate, full chest recoil, and correct hand positioning. Devices like TrueCPR, Mini-VREM, and smartwatch-based technology improved technical performance the most, while some accelerometer-based or AED integrated devices improved certain components, but produced decreased compression depth. Gamification worked well for younger learners, while combining video-based feedback with verbal feedback produced the best learning and retention of skills. On the contrary, some feedback tools increased the workload or contributed to distractibility, but some had a positive impact depending on the conditions of use. All in all, the evidence supported the use of real-time feedback in CPR quality in simulated environments. Real-time feedback is a valuable education, training, and clinical strategy for enhancing CPR skills. However, there needs to be a consideration between the ideal technology selected for the demographic population, educational or clinical setting, and the learning objective(s) intended. More research with a better methodology is warranted to examine the sustained impact of the technology, as well as the impact on the clinical outcomes of the patients involved.