Under pressure: What individual characteristics lead to performance of high-quality chest compressions during CPR practice sessions?

Steven Marks; Lynn Shaffer; David Zehnder; David Aeh; Dawn M Prall

doi:10.1016/j.resplu.2023.100380

Under pressure: What individual characteristics lead to performance of high-quality chest compressions during CPR practice sessions?

Resusc Plus. 2023 Mar 28:14:100380. doi: 10.1016/j.resplu.2023.100380. eCollection 2023 Jun.

Authors

Steven Marks¹, Lynn Shaffer², David Zehnder³, David Aeh³, Dawn M Prall⁴

Affiliations

¹ Niagara University, 5795 Lewiston Road, NY 14109, USA.
² Mount Carmel Research Institute, Mount Carmel Health System, 5300 North Meadows Drive, Grove City, OH 43123, USA.
³ Mount Carmel Graduate Medical Education, Internal Medicine Program, Mount Carmel Health System, 5300 North Meadows Drive, Grove City, OH 43123, USA.
⁴ U.S. Department of Veterans Affairs, Chalmers P. Wylie Veterans Outpatient Clinic, 420 North James Road, Columbus, OH 43219, USA.

Abstract

Aim: Despite well-established protocols for cardiopulmonary resuscitation training, performance during real-life cardiac arrests can be suboptimal. Understanding personal characteristics which could influence performance of high-quality chest compressions could provide insight into the practice-performance gap. This study examined chest compression performance, while employing feedback and introducing code team sounds as an anxiety-inducing factor in registered nurses using a cardiopulmonary resuscitation training manikin.

Methods: Participants included 120 registered nurses with basic life support certification randomized to one of the following groups: no feedback and no code team sounds, feedback without code team sounds, or feedback with code team sounds. Chest compression sessions occurred at baseline, 30-days and 60-days. Demographic variables and anxiety level were also collected. The primary outcome was chest compression performance, defined as average percent of time with correct rate and percent with correct depth as captured by the defibrillator. Statistical analysis included linear mixed effects analysis.

Results: The effect of feedback on chest compression performance depended on the value of other parameters. The benefit of feedback on the primary outcome depended on: age, with feedback less beneficial among older participants (p = 0.0413); and time, with feedback more beneficial with repetition (p = 0.011). These interactions also affected the outcome percent of time with correct compression depth. Increased anxiety was associated with decreased percent correct compression depth (p < 0.001).

Conclusion: Feedback emerged as important in determining chest compression performance. Chest compression quality was limited by the performer's age and anxiety level. Future research should focus on identifying factors related to individual characteristics which may influence chest compression performance.

Keywords: CPR; CPR education; Cardiopulmonary resuscitation training; chest compression quality; cpr performance; high quality cpr; manikin training.