Instrumented directive feedback devices

Sudden cardiac arrest occurs in up to 100 per 100,000 people. Early high-quality cardiopulmonary resuscitation (CPR) and early defibrillation are crucial links in the American Heart Association (AHA) Chain of Survival.

Survival rates range from 1-6%, with survival to discharge ranging from 5-10%.

Researchers have also determined that low-quality CPR is a contributing factor to poor survival outcomes.

An instrumented directive feedback device, more commonly referred to as a CPR feedback device, provides the student or healthcare provider with real-time feedback about the compression rate, depth, hand placement and chest recoil.

These devices also can provide information on chest compression fractions, i.e. the amount of time the provider performed chest compressions. As of January 31, 2019, the AHA began requiring CPR feedback devices for adult CPR training. CPR feedback devices are not currently required for infant or child CPR. When the AHA decided on the requirement, CPR feedback devices were not commonly offered with infant and child CPR mannequins. Once these devices become more commonly available, the AHA will extend its requirement to include these areas of training.

Science and research

The 2015 AHA Guidelines Update for CPR and ECC provided the research showing the benefit of CPR feedback devices after determining that, “inadequate performance of CPR is common yet challenging for providers and instructors to detect, thereby making it difficult to appropriately focus feedback and improve future performance. Technology could theoretically help address this problem by assessing CPR performance and providing feedback.”

Three randomized trials demonstrated that using an auditory feedback device, a metronome, resulted in appropriate compression rates. One of the three studies also showed improved retention during training and another concluded that these methods result in a negative impact on the depth of compressions.

CPR feedback devices

CPR feedback devices are available in a range of price points — economy, mid-range and high end.

Economy $24-$250

  • Pros:
    • Inexpensive
    • Low cost to replace
  • Cons:
    • Low quality components
    • Low tech

Students commonly wear economy devices on their wrist. The least expensive version only provides information regarding compression rates — a light-emitting diode (LED) flashes red or green when the user achieves an appropriate compression rate of 100 to 120 compressions/minute. A slightly more expensive version will also provide an audible alarm if the student does not achieve a compression depth of 2 to 2.3 inches. These devices are also limited in battery life to three to four hours and take up to 1.5 hours to fully charge.

This price range includes upgrade kits that allow for CPR mannequins that were manufactured after February of 1999 to meet current AHA expectations. As you climb closer to the top end of this category, the new CPR mannequins provide real-time information on compression rate, depth and release as well as ventilation volume and the number of compression/ventilations/cycles. The student is also provided with an overall score and suggestions for improvement.

Mid-range $400-$750

  • Pros:
    • Quality components
    • Easy to maintain
    • All-inclusive
  • Cons:
    • More costly to replace/repair
    • More expensive

The products in this price range are commonly package deals that allow you to buy multiple CPR mannequins. Additionally, you have the option of buying four adults, four child or four infant mannequins.

You can also purchase kits that are a mix of of all three. These kits are ideal for those looking to get started teaching or replace old mannequins. Some of the packages also include the needed automated external defibrillator (AED) trainer. Warranties start to become available adding to the expense of this group, however. After the warranty expires equipment replacement becomes an issue as AED trainers may not be eligible for repair and will require full replacement.

High-end $1275-$3400

  • Pros:
    • Best quality
    • Most options
    • Best performance
  • Cons:
    • Highest cost
    • More maintenance
    • Faculty training

These models also come equipped with realistic anatomy and landmarks, allowing students to manipulate the mannequin as they would a real patient and feel for automated pulses. These devices include tablet apps that provide real-time summative feedback to the instructor. The downside to the high-end group is not only the expense, but also a significant amount of maintenance. These products commonly require not only a warranty, but also a service plan that requires regular visits from a trained technician and potentially out-of-house service for repair. Faculty training is also an issue as the staff must also learn to operate and maintain the equipment. This level of simulation is also more cumbersome to set-up and get ready for student use.

Personal CPR feedback devices

For individuals looking to purchase a CPR feedback device for personal or professional use, numerous free applications exist for your smart phone that provide real-time information and audio and visual cues about the rate and quality of compressions. These apps also allow the user to log the event detailing the actions taken at the location of the resuscitation.

For additional information regarding cardiac arrest management join us in either the 48-hour paramedic refresher lectures or the 24-hour EMT refresher lectures.