Feedback devices are tools that provide feedback to the learner through auditory, visual, or physical cues. For example, there are devices that give feedback on the depth and rate of chest compressions. These devices are most useful when tailored to how a learner best receives feedback. For example, an auditory-only device (such as a metronome) may be suitable for a learner with a visual impairment, but less effective for one who is deaf or hard-of-hearing.
Guidelines
Good practice points
- Devices that provide immediate feedback may be used during CPR to improve the quality of performance.
- Feedback devices may be used to improve learners’ skills by providing individualised feedback in real time.
- Feedback devices should be selected according to the outcomes that best serve the needs of the learners (e.g., selecting a device that provides visual feedback may be better suited for learners with hearing difficulties).
- Devices should be appropriate to how learners are able to receive information.
Chain of survival behaviours
To date, feedback devices have focused on the first aid steps domain in the Chain of survival behaviours. Some devices help learners give effective compressions during and have been used in both training and clinical settings. These devices range in complexity from a simple metronome (a device that marks time at a selected rate with a simple “tick”) to those that monitor performance and provide audio-visual feedback. Some devices can measure hand positioning, chest compression depth and rate and the ratio of compressions to ventilations. The feedback from these devices can optimise the time spent practising these skills and help learners provide CPR effectively. There are many other topics that could benefit from feedback devices, such as splinting or bleeding control.
Other opportunities to incorporate feedback devices in the Chain of survival behaviours include automated devices that help learners experience how to access emergency medical services (EMS).
Education considerations
Context considerations
- Feedback devices may add to training costs, making them less applicable for just-in-time learning or in areas with limited resources. Free first aid apps might be available as a substitute.
- Feedback devices may provide effective learning opportunities when a facilitator is absent. However, they may be less effective in contexts where learners respect or expect facilitator-led programming.
Learner considerations
- Consider the learner audience and their intended learning context (e.g., devices that may work for first aid providers may not fit the needs of professional responders).
Facilitation tips
- Provide a brief orientation of the topic and then introduce learners to the technology before starting to use the feedback device.
- Train facilitators to set up the device and link as necessary to automated external defibrillator, introduce it to learners, monitor and support the feedback provided, as well as resolve any technical difficulties.
Scientific foundation
There is some evidence in favour of using automated feedback devices. Randomised trials resulted in a statistically significant increase in CPR skills with a device, compared to no device (Wultzer et al., 2018) or learning with a facilitator (Sutton et al., 2007).
A review for this topic did not identify evidence showing significant improvement of chest compressions or ventilation rate. However, it did reference evidence that feedback can be useful where compression rates are too fast (Kleinman et al., 2015). Conversely, another study suggested that the use of CPR feedback or prompt devices in clinical practice does improve the quality of CPR and may improve the outcome of cardiac arrest (Lukas et al., 2012).
There is limited evidence to suggest that automated feedback devices increase or maintain learning (Wik et al., 2002). Two studies compared the use of feedback devices against a control group with no device. The results showed no difference between the two groups’ skill retention one year after training (Griffin, 2014; Zhou, 2020).
Further evidence is required on the following: the effectiveness of feedback devices, different types of feedback (auditory, visual, or physical) and how feedback devices may be applied to first aid skills other than CPR (e.g., splinting or bleeding control).
References
Griffin, P., Cooper, C., Glick, J., & Terndrup, T. E. (2014). Immediate and 1-year chest compression quality. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 9(4), 264–269.
Kleinman, M. E., Brennan, E. E., Goldberger, Z. D., Swor, R. A., Terry, M., Bobrow, B. J., Gazmuri, R. J., Travers, A. H., & Rea, T. (2015). Part 5: Adult basic life support and cardiopulmonary resuscitation quality. Circulation, 132(18 suppl 2), S414–S435.
Lukas, R.-P., Gräsner, J. T., Seewald, S., Lefering, R., Weber, T. P., Van Aken, H., Fischer, M., & Bohn, A. (2012). Chest compression quality management and return of spontaneous circulation: A matched-pair registry study. Resuscitation, 83(10), 1212–1218.
Sutton, R. M., Donoghue, A., Myklebust, H., Srikantan, S., Byrne, A., Priest, M., Zoltani, Z., Helfaer, M. A., & Nadkarni, V. (2007). The voice advisory manikin (VAM): an innovative approach to pediatric lay provider basic life support skill education. Resuscitation, 75, 161–168.
Wik, L., Myklebust, H., Auestad, B. H., & Steen, P. A. (2002). Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement. Resuscitation, 52, 273–279.
Wutzler, A., von Ulmenstein, S., Bannehr, M., Völk, K., Förster, J., Storm, C., & Haverkamp, W. (2017). Improvement of lay rescuer chest compressions with a novel audiovisual feedback device. Medizinische Klinik – Intensivmedizin Und Notfallmedizin, 113(2), 124–130.
Yeung, J., Meeks, R., Edelson, D., Gao, F., Soar, J., & Perkins, G. D. (2009). The use of CPR feedback/prompt devices during training and CPR performance: A systematic review, Resuscitation, 80(7), 743–751.
Zhou, X.-L., Wang, J., Jin, X.-Q., Zhao, Y., Liu, R.-L., & Jiang, C. (2020). Quality retention of chest compression after repetitive practices with or without feedback devices: A randomized manikin study. The American Journal of Emergency Medicine, 38(1), 73–78.
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Published: 15 February 2021
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