Table 1. The characteristics and outcomes of included studies.
| First author (year published) nation |
Study design | Study Group | Evaluation methods | Outcomes evaluated by the reviewers | Outcomes from the records of manikins or computers |
|---|---|---|---|---|---|
| Kellermann A et al (1989)USA [49] |
Non-RCT | (A) volunteers without prior CPR training with telephone instruction (n = 65) (B) previously trained volunteers with telephone instruction (n = 43) (C) previously trained volunteers without telephone instruction (n = 43) |
Evaluated by instructors and recording manikins | Group A vs Group B vs Group C Depth: A>C, B>C (p<0.001) Compression rate: A>C, B>C (p<0.02) Generally, A = B>C Mean time to first ventilations (min): A:B:C = 2:38 vs 2:29 vs 1:03 (p<0.001) Mean time to first compression (mins): A:B:C = 4.07 vs 3:53 vs 1:15 (p<0.001) Correct hand position: A>C, B>C (p<0.05) |
Group A vs Group B vs Group C Mean depth (mm): 18.1 vs 18.4 vs 12.4 (p = 0.002) Mean compression rate (n/min): 58 vs 62 vs 77 (p<0.001) Percentage of adequate compressions: 26.9 vs 34.4 vs 12.6 (p = 0.005) Mean ventilation volume (L): 0.70 vs 1.00 vs 0.98 (p = 0.14) Percentage of adequate ventilations: 36.0 vs 52.7 vs 58.3 (p = 0.02) |
| Woollard M et al (2003) UK [25] |
RCT | (A) compression-only telephone CPR group (n = 29) (B) standard telephone CPR group (n = 30) |
Observation of the video recording and measurements from a CPR training manikin with software | Group A vs Group B Ventilation: Airway opening: 64% vs 50% (p = 0.293) Check for airway obstruction: 84% vs 80% (p = 0.530) Breathing check: 76% vs 47% (p = 0.019) Median time to first compression (sec): 184 vs 245 (p<0.001) Median number of chest compressions delivered during test: 461 vs 186 (p<0.001) |
Group A vs Group B Proportion of subjects compressing at correct depth (40–50 mm): 17% vs 7% (p = 0.153) Proportion of subjects compressing at correct rate (90–110 per min): 21% vs 13% (p = 0.343) Deliver correct breath volume: not applicable vs 17% Correct hand position: 14% vs 38% (p = 0.042) No evidence of exhaustion in both groups |
| Williams JG et al (2006) USA [44] |
RCT | (A) subjects receiving traditional telephone CPR (n = 25) (B) subjects receiving compressions-only telephone CPR (n = 25) |
Stopwatch used to measure time to first compression and recording strips from manikin | Group A vs Group B Percentage of time paused in 1st 3 min of CPR: 36 vs 13 (p<0.001) Time to first compression (s): 117 vs 72 (p<0.001) |
Group A vs Group B Total number of correct compressions: 10 vs 13 (non-significant) Compression rate (/min): 60 vs 58 (non-significant) No evidence of exhaustion in both groups |
| Dias JA et al (2007) USA [34] |
RCT | (A) subjects given standard compression only-CPR (CC-CPR) protocol (n = 59) (B) subjects given simplified CC-CPR protocol (n = 58) |
Skillreportermanikin | Group A vs Group B Time to start of compressions (sec): 78.6 vs 60.9 (p<0.001) |
Group A vs Group B Percentage of chest compressions to the correct depth: 3% vs 31% (p<0.01) Mean depth of compressions (mm): 29.7 vs 35.6 (p<0.01) Compression rate(/min): 94 vs 104 (p = 0.13) Proportion with full chest recoil: 1 (0.99–1) vs 1 (0.98–1) (p = 0.09) Total hands-off chest time (sec): 95 vs 69 (p<0.001) Percentage of correct hand position: 84% vs 35% (p<0.01) |
| Brown TB et al (2008) USA [22] |
RCT | (A) subjects without receiving “put the phone down” instructions (n = 108) (B) subjects receiving “put the phone down” instructions (n = 107) |
Stopwatch and data from the manikin | Group A vs Group BMean compression depth (mm): 33.6 vs 32.8 (p = 0.60) Percentage of compressions done to correct depth: 7% vs 12% (p = 0.67) Mean compression rate (/min): 97.7 vs 98.8 (p = 0.82) Percentage of compressions done with full chest recoil: 1 (0.99–1) vs 1(1–1) (p = 0.05) Total hands-off chest time (sec): 71.0 vs 73.0 (p = 0.48) Time to start of compressions (sec): 65.0 vs 65.0 (p = 0.96) Percentage of compressions with correct hand position: 0.87 vs 0.90 (p = 0.86) |
|
| Mirza M et al (2008) USA [37] |
RCT | (A) subjects with the instruction “push down firmly 2 inches” (n = 168) (B) subjects with the instruction “push as hard as you can” (n = 164) |
Stopwatch and data from the manikin | Group A vs Group B Mean compression depth (mm): 29.7 vs 36.4 (p<0.001) Proportion of compressions done without error: 0% vs 5% (p = 0.003) Proportion of compressions done to correct depth: 1% vs 32% (p<0.001) Mean Compression rate (/min): 97.5 vs 99.7 (p = 0.56) Proportion of compressions done with full chest recoil: 100% vs 100% (p = 0.14) |
|
| Nikandish R et al (2008) Iran [36] |
RCT with crossover study | (A) dominant hand group (n = 59) (B) non-dominant hand group (n = 59) |
Recording manikin | Group A vs Group B Total number of compressions with inadequate depth (mean): 197 vs 196 (p = 0.9) Total number of compressions with incorrect hand placement (mean): 45 vs 64 (p = 0.1) |
|
| Yang CW et al (2008) Taiwan [28] |
RCT | (A) voice group: only voice CPR instruction via a cell phone (n = 53) (B) video group: interactive voice and video instruction via a cell phone (n = 43) |
Video evaluated by 2 emergency physicians and data from the computer (manikin). | Group A vs Group B Opening the airway properly: 58.5% vs 95.3% (p<0.01) Visible chest rise: 28.3% vs 65.1% (p<0.01) Open airway while giving ventilation: 60.4% vs 88.4% (p<0.01) |
Group A vs Group B Mean volume of ventilation (ml): 322.0 vs 520.5 (p<0.01) Time to first rescue breath (sec): 102.0 vs 139.0 (p<0.01) |
| Bolle SR et al (2009) Norway [46] |
RCT | (A) audio group: non-loudspeaker audio-call instruction (n = 26) (B) video group: loudspeaker video-assisted instruction (n = 29) * The study paired 3 into one group. |
Video and data from Skillreporter manikin | Group A vs Group B Mean depth (mm): 38 vs 37 (p = 0.83) Done to correct depth (38–51 mm): 31% vs 35% (p = 0.53) Mean compression rate: (/min): 110 vs 114 (p = 0.75) Done with full chest recoil: 100% vs 100% (p = 0.83) Total hands-off-chest time (s): 331 vs 303 (p = 0.05) Mean ventilation volume (ml): 1356 vs 1163 (p = 0.74) Total number of ventilations: 24 vs 28 (p = 0.50) Percentage of correct volume (500–800 ml): 6% vs 11% (p = 0.30) Time to start of compressions (sec): 102 vs 104 (p = 0.29) Correct hand position: 50% vs 45% (p = 0.52) |
|
| Yang CW et al (2009) Taiwan [20] |
RCT | (A) voice group: only voice CPR instruction via a cell phone (n = 53) (B) video group: interactive voice and video instruction via a cell phone (n = 43) |
Video and data from Skillreporter manikin | Group A vs Group B Median compression depth (mm): 25.0 vs 36.0 (p<0.01) Median percentage of chest compressions with correct depth: 0% vs 20.0% (p<0.01) Mean Compression rate (/min): 63.0 vs 95.5 (p<0.01) Chest compressions with sufficient rate: 30.2% vs 46.5% (non-significant) Hands-off time (s): 0 vs 5.0 (p<0.01) Time to start of compressions (sec): 116.0 vs 145.0 (p<0.01) Median percentage of chest compressions with correct hand positioning: 95.6% vs 84.0% (non-significant) Median total instruction time (s): 121.0 vs 150.0 (p<0.01) |
|
| Merchant RM et al (2010) USA [23] |
RCT | (A) CPR trained, receiving a telephone aid (n = 42) (B) CPR trained, not receiving a telephone aid (n = 40) (C) no CPR training history, receiving a cell telephone aid (n = 38) (D) no CPR training history, not receiving a cell telephone aid (n = 40) |
Videotape evaluated by two authors and data from Skillreporter manikin | Group A + C vs Group B+D Total pauses (s): 74 vs 89 Time to start of compressions (sec): 48 vs 18 |
Group A + C vs Group B+D Mean depth (mm): 41 vs 31 Sufficient depth (38-51mm): 49% vs 31% Mean compression rate (n/min): 100 vs 44 Sufficient rate (90-120/min): 91% vs 3% Correct hand position (%): 97% vs 75% |
| Neset A et al (2010) Norway [42] |
RCT | (A) chest compression-only CPR (CCC) with feedback (n = 16) (B) 30:2 with feedback (n = 16) (C) CCC without feedback (n = 16) (D) 30:2 without feedback (n = 16) |
Data from Skillreporter manikin and survey | A. CCC [(A)+(C)] vs 30:2 [(B)+(D)] Mean depth (mm): 41vs 42 (p = 0.14) Median number of compressions: 948 vs 574 (p<0.0005) Mean compression rate (/min): 96 vs 91 (p = 0.31) Total hands-off time (s): 2 vs 204 (p<0.0005) Mean ventilation rate (/min): N/A vs 4 Mean ventilation (ml): N/A vs 960 B. Feedback [(A)+(B)] VS No feedback [(C)+(D)] Mean depth (mm): 41 vs 42 (p = 0.27) Median number of compressions: 817 vs 705 (p = 0.010) Mean compression rate (/min): 101 vs 86 (p = 0.002) Total hands-off time (s): 195 vs 210 (p = 0.65) Mean ventilation rate (/min): 4 vs 2 (p = 0.026) Mean ventilation volume (ml): 902 vs 1395 (p = 0.009) |
|
| Nishiyama C et al (2010) Japan [32] |
RCT | (A) chest compression-only CPR group (n = 106) (B) conventional CPR (30:2) group (n = 107) |
Data from Skillreporter manikin | Group A vs Group B: Proportion of chest compressions with appropriate depth during 20-s CPR period Significant mean difference between 2 groups in 61–80 seconds (58.2% vs 74.3%, p = 0.003) Number of chest compressions: Group A>Group in any stage Mean no-flow time: 32.0 vs 81.0 (p<0.001) Mean time to first resuscitation (either chest compression or ventilation) (s): 32.0 vs 35.0 (p = 0.005) |
|
| Ghuysen A et al (2011) Belgium [29] |
RCT | (A) untrained non-guided group (n = 30) (B) untrained guided group (by phone)(n = 30) (C) trained non-guided group (n = 25) (D) trained guided group (by phone) (n = 25) |
Cardiff evaluation test and data from Skillreporter manikin | Group A vs Group B Airway management successful rate: 0% vs 57% (p<0.0001) Mean time to start of compressions (min): 0.27 vs 2.48 (P<0.0001) CPR performance score: 1.3 vs 4.8 (p<0.0001) |
Group A vs Group B Mean depth (mm): 32 vs 41.5 Compression rate (n/min): 41.8 vs 59.7 (p<0.0001) Correct hand position: 16.7% vs 40% *The outcomes we compared here are between group (A) and group (B), excluding group (C) and (D) due to their nursing background. |
| Lee JS et al (2011) Korea [50] |
RCT | (A) video group: received aid by watching a video on a cellular phone while performing compression-only CPR (n = 39) (B) audio group: had the aid of a voice dispatcher while performing compression-only CPR (n = 39) |
Video reviewed by two emergency physicians and data from Skillreporter manikin | Group A vs Group B Total hands-off time: 11 vs 24 (non-significant) Percentage of no “hands-off” event after starting CPR: 71.8% vs 46.2% (p<0.05) Time to start of compressions (sec): 184 vs 211 (p<0.01) Correct hand position: 71.8% vs 43.6% (p = 0.01) |
Group A vs Group B Mean depth (mm): 27.5 vs 31.3 (non-significant) Percentage of adequate compression depth: 20.5% vs 17.9% (non-significant) Mean compression rate (/min): 99.5 vs 77.4 (p<0.01) Percentage of adequate compression rate: 59% vs 28.2% (p<0.01) |
| Paal P et al (2012) Italy [43] |
RCT | (A) assisted BLS group: with the aid of a BLS software program on a mobile phone (n = 64) (B) non-assisted BLS group: without the aid (n = 77) |
Skillreporter manikin and a score chart. | Group A vs Group B Overall score (mean): 19.2 vs 12.9 (p<0.001) *Secondary endpoint: Check environment: 64% vs 27% (p<0.001) Protect from environmental risks: 70% vs 39% (p<0.001) Call for help: 56% vs 27% (p<0.001) Open the upper airway: 78% vs 16% (p<0.001) |
Group A vs Group B Depth: non-significant Correct chest compression rate: 44% vs 14% (p<0.001) Ventilation: non-significant Mean time to start of compressions (sec): 165.3 vs 87.1 (p<0.001) Correct hand position: non-significant |
| Rössler B et al (2013) Austria [51] |
RCT | (A) non-flowchart group: performed CPR without flowchart support (n = 41) (B) flowchart group: performed CPR with flowchart support (n = 43) |
Evaluated by an independent investigator using a Skillreporter manikin | Group A vs Group B Completeness of BLS algorithm correctly (%): 0% vs 62% (p<0.0001) Feeling confidence 5 vs 7 (p = 0.0009) Fear of harming patients or making a mistake: non-significant |
Group A vs Group B Mean depth (mm): 41 vs 43 (p = 0.49) Total number of compression (mean): 189 vs 200 (p = 0.55) Mean compression rate (/min): 76 vs 78 (p = 0.75) Mean compressions per cycle: 17 vs 28 (P<0.0001) Mean overall hands-off time (s): 169 vs 147 (p = 0.024) Corrected hands-off time (s): 146 vs 87 (p<0.0001) Mean time to start of compressions (sec): 23 vs 60 (p<0.0001) |
| Birkenes TS et al (2013) Norway [41] |
RCT | (A) reference instruction group: based on ERC recommendations (n = 19) (B) intervention instruction group: using arm and nipple line (n = 18) |
Measured using the laser beam at the upper and lower borders of the compressing hands and photographed | Correct hand position: Less caudal hand placement and the difference in mean hand position offset was 47 mm in intervention group (p = 0.001) None in the intervention group placed their hands in the abdominal region vs. 27.8% in the control group (p = 0.045) |
|
| Buléon C et al (2013) France [45] |
Randomized crossover controlled trial | (A) guided group: feedback by the CPRmeter device (n = 154) (B) blinded group: without feedback by the CPRmeter device (n = 154) |
Data recorded by the CPR meter on a memory microSD card. | Group A vs Group B Mean depth (mm): 44:36 (p<0.001) Percentage of adequate depth: 85% vs 43% (p<0.001) Mean compression rate(/min): 107: 107 (non-significant) Percentage of adequate rate of chest compressions (CCs): 81% vs 56% (p<0.0001) Percentage of adequate release after CC: 100%:99% (non-significant) Rate of efficient compression (%): 71% vs 26% (p<0.0001) (Primary) |
|
| Eisenberg Chavez D et al (2013) USA [52] |
RCT | (A) no dispatch instruction to remove clothing (n = 47) (B) dispatch instruction to remove clothing (n = 52) |
Measured by study coordinator and data from Skillreporter manikin. | Group A vs Group B Mean time to first chest compressions (sec): 79 vs 109 (p<0.001) |
Group A vs Group B Mean depth (mm): 40 vs 41 (p>0.05) Mean compression rate (/min): 99 vs 97 (p>0.05) Complete chest recoil: 91% vs 95% (p>0.05) |
| Park SO et al (2013) Korea [21] |
RCT | (A) metronome group: metronome sounds played to the rescuer through the speaker (n = 35) (B) control group: without metronome sounds, substituted with repeat verbal encouragement (n = 35) |
Data from Skillreporter manikin | Group A vs Group B Mean compression depth (mm): 45.9 vs 46.8 (p = 0.692) Median percentage of compression depth <38 mm: 69.2% vs 15.7% (p = 0.035) Median percentage of compression depth >51 mm: 13.5 vs 27.2 (p = 0.308) Mean compression rate (/min): 111.9 vs 96.7 (p = 0.018) Providers of correct compression rate: 32% vs 5% (p<0.0001) Mean numbers of chest compressions (/min): 109.4 vs 95.9 (P = 0.048) Mean total numbers of chest compressions: 439.4 vs 385.1 (p = 0.040) Median percentage of incomplete chest release: 0.0 vs 0.0 (p = 0.478) Mean time to start of compressions (sec): 35 vs 37 (p = 0.658) Median percentage of abnormal hand positions: 2.7 vs 22.7 (p = 0.361) |
|
| Birkenes TS et al (2014) Norway [27] |
RCT | (A) standard T-CPR group: the rescuer perform CPR most of the time without dispatcher involvement (n = 49) (B) continuous T-CPR group: New protocol with some added instructions with speakerphone activation, removing obstacles and continuous instruction during CPR (n = 46) |
Data from computer recorded manikin. Audio and video recordings reviewed by one person for time intervals. | Group A vs Group B Median time to first chest compression (sec): 84 vs 144 (p<0.001) |
Group A vs Group B Mean absolute depth (mm): 48 vs 47 (p = 0.83) Depth≧40 mm (percentage of total compression)(median): 89 vs 80 (p = 0.83) Median total compressions: 870 vs 1000 (p = 0.014) Percentage of correct compression rate (90-120/min): 60% vs 87% (p<0.001) Mean compression rate (n/min): 108 vs 106 (p = 0.41) Median Hands-off time (s): 64 vs 12 (p<0.001) Correct hand position (%)(median): 99.7% vs 100% (p = 0.001) |
| Painter I et al (2014) USA [40] |
RCT | (1) simplified scripts group (n = 39) (2) conventional scripts group (n = 36) |
All data other than time to first compression were obtained by Skillreporter manikin. | Group A vs Group B Mean time to first compressions (sec): 99 vs 123 (p<0.01) |
Group A vs Group B Mean compression depth (mm): 32 vs 25 (p<0.05) Percentage of compressions≧38 mm: 33% vs 20% (p = 0.14) Mean compression rate(/min): 102 vs 93 (p = 0.34) Mean percentage of sufficient rate: 24% vs 19% (p = 0.45) Mean compression fraction: 78 vs 77 (p = 0.78) Percentage of complete chest recoil: 89 vs 92 (p = 0.62) Mean number of hands-off periods: 5.3 vs 5.4 (p = 0.95) Mean total hands off time (s): 39 vs 41 (p = 0.78) Mean percentage of correct hand position: 63% vs 86% (p<0.01) |
| Rodriguez SA et al (2014) USA [35] |
RCT | (1) Push hard group: Given “push as hard as you can” instructions (n = 64) (2) Two inches group: Given “push down approximately 2 inches” instructions (n = 64) |
Data measured by a CPR recording defibrillator | Group A vs Group B Mean compression Depth (mm): 43 vs 36 (p<0.01) Percentage of adequate depth (≧ 47 mm): 39% vs 20% (p = 0.02) Mean compression rate (/min): 93 vs 82 (p = 0.06) Percentage of adequate rate (≧ 100/min): 36% vs 30% (p = 0.45) Percentage of subjects achieving full chest recoil: 53% vs 75% (p = 0.01) |
|
| van Tulder R et al (2014) Austria [26] |
RCT | (A) standard instruction group:”push down firmly 5cm” (n = 8) (B) repeated standard instruction group: repeating the instruction every 20 s (n = 8) (C) intensified wording group: “It is very important to push down the chest firmly 5 cm every time” (n = 8) (D) repeated intensified wording group (n = 8) |
Data from simulator manikin | Group A vs Group B Mean compression depth (mm): 43 vs 32 vs 20 vs 22 Mean compression rate (/min): 93 vs 89 vs 93 vs 101 Leaning depth: 8 vs 7 vs 5 vs 8 Mean cumulative hands off (s): 60 vs 134 vs 157 vs 146 Time to start of compressions (sec): 52 vs 50 vs 47 vs 60 |
|
| Kim YH et al (2015) Korea [47] |
RCT | (A) same side group: two rescuers on the same side (n = 32) (B) opposite side group: two rescuers on the opposite side (n = 32) |
Data from Skillreporter manikin | Group A vs Group B Mean depth (mm): 38 vs 37 (p = 0.616) Total number of compressions (median): 815 vs 811 (p = 0.381) Percentage of adequate compression (median): 2.5% vs 1.0% (p = 0.171) Percentage of incomplete chest recoil (median): 16 vs 4 (p = 0.564) Cumulative hand-off time (s)(mean): 6.6 vs 4.5 (p = 0.005) Percentage of incorrect hand position (median): 11% vs 19% (p = 0.361) |
|
| Rasmussen SE et al (2017) Denmark [33] |
RCT | (A) novel protocol group: designed based on previous research and pilot studies (n = 61) (B) standard protocol (n = 64) |
Data was sampled from the manikin. Video recordings were assessed independently by two ERC certified BLS/AED instructors. | Group A vs Group B Overall score (points)(mean): 18.6 vs 17.5 (p<0.001) |
Group A vs Group B Mean compression depth (mm): 58 vs 52 (p = 0.02) Mean compression rate (/min): 114 vs 110 (p = 0.04) Compressions without total recoil (%)(median): 14 vs 8 (p = 0.06) Hands-off time per min (s)(median): 6 vs 1 (p<0.001) Time to start of compressions (sec)(median): 65 vs 72 (p<0.001) Correct hand position (%): 61% vs 23% (p = 0.01) |
| Sakai T et al (2015) Japan [19] |
RCT | (A) CPR support application group: with the aid of the CPR support application on a smartphone (n = 43) (B) control group: without the aid of the CPR support application on a smartphone (n = 41) |
Data from Skillreporting manikin | Group A vs Group B Mean compression depth (mm)(mean): 35.0 vs 36.7 (p = 0.492) Number of chest compressions with appropriate depth (mean): 65.7 vs 41.0 (p = 0.095) Time without chest compression (s)(mean): 4.4 vs 63.8 (p<0.001) Mean time to start of compressions or ventilations (s): 37.1 vs 29.3 (p = 0.048) Number of chest compressions with correct hand position (mean): 109 vs 42.6 (p<0.001) Rate of calling 119: 67.4% vs 46.3% (p = 0.041) Rate of requesting AED: 60.5%: 22.0% (p<0.001) Chest compressions performed: 100% vs 75.6% (p<0.001) Number of total chest compressions (mean): 211.6 vs 77.0 (P<0.001) |
|
| Krikscionaitiene A et al (2016) Lithuania [30] |
RCT | (A) control group: Standard hands-only CPR with two-hands chest compression (n = 32) (B) intervention group: hands-only CPR with Andrew’s manoeuver (four-hands chest compression) (n = 34) |
Data from Skillreporter manikin | Group A vs Group B Mean compression depth (mm): 47.8 vs 54.2 (p = 0.002) Number of chest compressions with adequate depth (5-6cm) (mean): 188 vs 334 (p = 0.012) Percentage of chest compression with adequate depth: 46.9% vs 74.8% (p = 0.003) Number of total chest compressions (mean): 394 vs 444 (p = 0.831) Mean chest compression rate (/min)(mean): 97.3 vs 91.0 (p = 0.352) Percentage of leaning (mean):1.1% vs 0.8% (p = 0.639) Mean chest compression fraction: 85.6% vs 86% (p = 0.882) Mean hand-off time (sec): 69.1 vs 67.2 (p = 0.882) Mean percentage of chest compression duty cycle: 40.8% vs 44 (p = 0.083) |
|
| Spelten O et al (2016) Germany [31] |
RCT | (A) U-CPR group: uninstructed CPR (n = 20) (B) DACO-CPR group: dispatcher-assisted compression-only CPR (n = 19) (C) DAF-CPR group: full dispatcher-assisted CPR including rescue ventilation (n = 19) |
Manikin and software. Hand positioning and head-tilt for ventilation reviewed by two independent investigators via video recordings. | Group A vs Group B vs Group C Mean compression depth (mm): 40.6 vs 41.0 vs 38.8 (p>0.05) Mean compression rate (1/min): 35.6 vs 65.5 vs 44.5 (p = 0.001) Percentage of compressions without correct release(mean): 13.2% vs 16.9% vs 6.5% (p>0.05) Overall no-flow-time(sec)(mean): 273.4 vs 99.8 vs 240.1 (p<0.001) Total number of ventilation attempts (mean): 37.44 vs 2.0 vs 23.26 (group A: C: p = 0.006) Time to start of compressions (sec)(mean): 25.1 vs 55.2 vs 101.2 (group B:C:p<0.001) Percentage of compressions with wrong hand position (mean): 15.6% vs10.5% vs 16.0% (p>0.05) Numbers of total compressions (mean): 293.53 vs 512.11 vs 356.53 (p = 0.001) |
|
| Stipulante S et al (2016) Belgium [39] |
RCT | (A) t-CPR group: only receiving audio telephone instructions (n = 60) (B) v-CPR group: receiving videoconferencing and perform CPR (n = 60) |
Audio-video recordings evaluated by investigators and Skillreporter manikin. | Open the airway successfully: 68% vs 98.3% (p<0.0001) Breathing check: 82% vs 98.3% (p = 0.003) Time for responsiveness check (s)(median): 34.5 vs 39 (p = 0.0043) Time for airway opening (s)(median): 72 vs 66.5 (p = 0.18) Time for breathing check (s): 85 vs 93.5 (p = 0.08) |
Group A vs Group B Mean compression depth (mm): 47.1 vs 48.38 (p = 0.64) Percentage of compression with appropriate depth: 40.3% vs 43.3% (p = 0.85) Mean Compression rate (/min): 85.6 vs 110.4 (p<0.0001) Total number of chest compressions (median): 301 vs 421 (p<0.0001) Percentage of compressions with appropriate rate: 37.9% vs 80% (p<0.0001) Hands-off time (s)(median): 7 vs 0 (p<0.0001) Time to start of compressions (sec)(median): 122.5 vs 146 (p<0.0001) Percentage of compressions with correct hand positioning: 68% vs 91.7% (p = 0.0017) |
| Torney H et al (2016) UK (Experiment 2) [38] |
RCT | (A) CPR rate feedback group (n = 68) (B) control group: without CPR rate feedback group (n = 72) |
Data from public access defibrillator | Group A vs Group B Mean compression depth (mm): 24.61 vs 20.08 (p = 0.001) Percentage of participants achieving good CPR compression speed within 45s: 95.6% vs 62.5% (p<0.0001) Mean percentage chest compression fraction: 91.6% vs 88.7% (non-significant) |
|
| Hurst V 4th et al (2007) USA [53] |
Crossover interventional study | (A) BVM group: bag-valve mask with self-inflating bag (n = 40) (B) Model 730 group: a pneumatically powered transport ventilator that is specifically developed for field use by personnel who have a wide range of training and expertise (n = 40) |
Data were collected on a laptop computer using devices and software from the research pneumotach system. | Group A vs Group B Mean number of compressions (4 min cycle): 281.85 vs 230.75 (p<0.05) Mean number of breaths (4 min cycle): 38.1 vs 32.0 (p<0.05) Mean delivered tidal volume per breath (ml): 803.03 vs 672.08 (p<0.05) Mean delivered airway flow rate per breath (ml/min-breath): 161.01 vs 21.31 (p<0.05) Mean delivered airway pressure per breath (cmH2O): 14.43 vs 7.54 (p<0.05) |
|
| Atkinson PR et al (1999) UK [17] |
RCT | (A) CPR with no additional instruction (n = 9) (B) CPR with receiving telephone instruction (n = 10) (C) CPR with advice over a video-link (n = 10) (D) CPR with advice by an instructor standing beside them (n = 9) |
The CPR standard was determined by 2 observers and by computerized analysis of manikin recordings. | Group A vs Group B vs Group C vs Group D Total number of correct ventilations (median): 0 vs 8.5 vs 2.5 vs 2 (compared with group A, the other groups were all significantly difference.) |
Group A vs Group B vs Group C vs Group D Total numbers of correct chest compressions (median): 0 vs 0.5 vs 7.5 vs 10 (Group A: Group B, p = 0.11; Group A: Group C, p = 0.021; Group A: Group D, p = 0.046) Time to onset of CPR (sec)(median): 7 vs 30 vs 35 vs 34 (Compared with group A, the other groups were all significantly different.) Total numbers of compressions with correct hand position but incorrect depth (median): 2 vs 16.5 vs 35 vs 43(Group A: Group B, p = 0.23; Group A: Group C, p = 0.023; Group A: Group D, p = 0.002) |
| Liu S et al (2016) Canada [18] |
Randomized crossover trial | (A) CCC (continuous chest compression) group (n = 63) (B) 30:2 group (n = 62) |
Recordings from manikin | Group A vs Group B Numbers of adequate chest compressions depth (≧5cm)(mean): 381.5 vs 324.9 (p = 0.0001) Numbers of adequate chest compressions decreased over time in CCC group (p<0.0001) but not 30:2 group (p = 0.75) Mean number of chest compressions (mean): 480 vs 376.3 (p<0.0001) Mean compression rate (/min): 99.7 vs 101.8 (p = 0.0002) |
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| Trenkamp RH et al (2015) USA [24] |
Observational study | (A) manual group: performing CPR with their hands (n = 49) (B) heel group: performing CPR with their heels (n = 49) |
Recordings from the manikin | Group A vs Group B Percentage of performing compliant compressions for 10 minutes: 16% vs 65% Percentage of subjects performing compressions without adequate depth: 24% vs 2% Length of time to perform compliant compressions (sec)(mean): 2.9 vs 7.9 (p<0.001) |
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| Birkenes TS et al (2012) Norway [48] |
Observational study | intervention: continuous telephone-instructed 30:2 CPR with duration of 10 minutes. Compare CPR performance within first minute with those within 10th minute. |
Video recordings reviewed by researchers and recordings from the manikin | 1st min VS 10th min Chin lift: 17/29 vs 18/29 (p = 1.0) Head lift: 14/29 vs 20/29 (p = 0.15) Nose pinch: 19/29 vs 22/29 (p = 0.25) Hand placement on nipple line: 17/29 vs 24/29 (p = 0.065) Participants communicating with dispatcher and performing CPR simultaneously): 29/30 vs 29/30 (non-significant) Correct rescuer position for chest compressions: 13/30 vs 21/30 (p = 0.008) |
1st min VS 10th min Mean compression depth (mm): 43 vs 42 (non-significant) Mean compression rate (/min): 84 vs 101 (p<0.001) Mean time between compression series (s): 20.5 vs 12.1 (p<0.001) Percentage of participants achieving successful ventilations: 13/30 vs 23/30 (p = 0.006) |
| White AE et al (2017) Singapore [54] | Randomized crossover controlled study | (A) chest compression with CPRcard feedback (n = 35) (B) chest compression without CPRcard feedback (n = 35) |
CPRcard or Resusci Anne’s SimPad SkillReporter | Group A vs Group B Mean compression depth (cm) (median): 5.0: 5.0 (p = 0.319) Mean compression rate (/min) (median): 117: 122 (p = 0.001) Adequate compression rate (median) 83%: 47% (p< 0.001) Adequate depth (median) 52%: 48% (p = 0.957) Met compression rate of 100–120/min & depth ≥ 5 cm(n,%) 9 (36%): 1 (4%) (p = 0.022) |
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| Wutzler A et al (2018) Germany [55] | Randomized crossover controlled study | (A) chest compression with audiovisual feedback (n = 48) (B) chest compression without audiovisual feedback (n = 48) |
Data from Physio-Control (TrueCPR Report Generator) | Group A vs Group B Mean compression depth (mm): 54: 55.6 (p = 0.789) Mean compression rate(/min): 98.4: 95.7 (p = 0.937) Percentage of optimal chest compression(%)(mean) 58.9:14.6 (p < 0.0001) Longest interval without optimal chest compression (sec) (mean) 27.5: 76.5 (p < 0.0001) Effective chest compression trials (%) 45.8: 0 (p < 0.0001) |
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| Liu Y et al (2018) China [56] | RCT | (A) hands-only CPR (AHA 2010 guidelines) without feedback (n = 42) (B) hands-only CPR (AHA 2015 guidelines) without feedback (n = 42) (C) hands-only CPR (AHA 2015 guidelines) with feedback (n = 40) |
Data from LinkCPR (SunLife, China) | Group A vs Group B vs Group C Mean compression depth (mm) 1 min: 49: 51: 56 (p <0.05) 2 min: 44: 49: 56 (p <0.05) Mean compression rate (/min)(mean) 1 min: 118: 112: 104 (p <0.05) 2 min: 115: 109: 104 (p <0.05) Percentage of correct chest compression depth (%)(mean) 1 min: 63.1: 37.6: 89.1 (p <0.05) 2 min: 64.2: 35.8: 88.4 (p <0.05) Percentage of correct chest compression rate (%)(mean) 1 min 83.5: 61.9: 86.5 (p <0.05) 2 min: 76.4: 58.9: 85.9 (p <0.05) Percentage of correct chest compression (%)(mean) 1 min: 54.9: 29.6: 87.8 (p <0.05) 2 min: 53.6: 25.6: 87.1 (p <0.05) |
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| Eaton G et al (2018) UK [57] | Randomized crossover study | (A) CPR with PocketCPR (n = 118) (B) CPR without PocketCPR (n = 118) |
Data from the manikin software (Laerdal Resuscitation manikin) | Group A vs Group B Percentage of mean correct compression depth (5-6mm): 44.28%: 40.57% (p = 0.001) Mean Compression rate (/min)(mean) 106.87: 105.37 (p = 0.858) Mean total compression (/2min)(): 205.19: 163.25 (p < 0.001) Time to start of compressions (sec): Nil Correct hand position: non-significant |
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| Scott G et al (2018) USA [58] | RCT | (A) CPR under dispatcher’s instruction with the use of the metronome tool (n = 85) (B) CPR under dispatcher’s instruction without the use of the metronome tool (n = 63) |
Data from simulator manikin | Group A vs Group B Correct compression depth (5-6mm), n (%) 4 (4.7%): 2 (3.2%) Correct compression rate: achieving target rate (100-120/min), n (%) 39 (45.9%): 14 (22.2%) (p = 0.003) |