Effect of real-time and post-event feedback in out-of-hospital cardiac arrest attended by EMS - A systematic review and meta-analysis

Resusc Plus. 2021 Mar 12;6:100101. doi: 10.1016/j.resplu.2021.100101. eCollection 2021 Jun.


Objectives: A systematic review to determine if cardiopulmonary resuscitation (CPR) guided by either real-time or post-event feedback could improve CPR quality or patient outcome compared to unguided CPR in out-of-hospital cardiac arrest (OHCA).

Methods: Four databases were searched; PubMed, Embase, CINAHL, and Cochrane Library in August 2020 for post 2010 literature on OHCA in adults. Critical outcomes were chest compression depth, rate and fraction. Important outcomes were any return of spontaneous circulation, survival to hospital and survival to discharge.

Results: A total of 9464 studies were identified with 61 eligibility for full text screening. A total of eight studies was included in the meta-analysis. Five studies investigated real-time feedback and three investigated post-event feedback. Meta-analysis revealed that real-time feedback statistically improves compression depth and rate while post-event feedback improved depth and fraction. Feedback did not statistically improve patient outcome but an improvement in absolute numbers revealed a clinical effect of feedback. Heterogenity varied from "might not be important" to "considerable".

Conclusion: To significantly improve CPR quality real-time and post-event feedback should be combined. Neither real-time nor post event feedback could statistically be associated with patient outcome however, a clinical effect was detected. The conclusions reached were based on few studies of low to very low quality.

Prospero registration: CRD42019133881.

Keywords: CCD, chest compression depth; CCF, chest compression fraction; CCR, chest compression rate; CI, confidence interval; CINAHL, cumulative index to nursing and allied health literature; CPR quality; CPR, cardiopulmonary resuscitation; EMS, emergency medical service; ERC, European Resuscitation Council; GRADE, grades of recommendation, assessment, development, and evaluation; IHCA, in-hospital cardiac arrest; MD, mean difference; MESH, medical subject headings; OHCA, out-of-hospital cardiac arrest; Out-of-hospital cardiac arrest; PICO, population, intervention, comparison and outcome; PRISMA, preferred reporting items for systematic reviews and meta-analyses; PROSPERO, international prospective register of systematic reviews; Post-event feedback; RCT, randomised controlled trial; ROBINS-I, Cochrane’s risk of bias in non-randomized studies – of interventions; ROSC, return of spontaneous circulation; RR, risk ratio; Real-time feedback.

Publication types

  • Review