Real-time CPR feedback in out-of-hospital cardiac arrest: A systematic review of CPR quality and outcomes.

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality in industrialised countries, with survival highly dependent on high-quality cardiopulmonary resuscitation (CPR). Real-time feedback systems have been introduced to optimise CPR performance by improving compression depth, rate, chest compression fraction (CCF), and recoil.

AIM: To evaluate the effectiveness of real-time feedback systems on CPR quality indicators and clinical outcomes in adult OHCA patients treated by prehospital emergency medical services.

METHODS

A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261290413). Searches were performed in MEDLINE/PubMed, Embase, CINAHL, and Scopus, supplemented by ClinicalTrials.gov and grey literature. Eligible studies included primary research conducted in real prehospital settings with comparator groups. Risk of bias was assessed using RoB 2 and ROBINS-I, while certainty of evidence was evaluated with GRADE. Narrative synthesis with vote-counting was performed.

RESULTS

Six studies involving 16,683 OHCA patients from five countries (2011-2022) were included. Interventions comprised audiovisual feedback integrated into monitor-defibrillators, AED-based feedback for bystanders, structured CPR improvement bundles, and video-assisted dispatcher CPR. One cluster-RCT showed improvements in CPR quality indicators, including CCF (64% vs 66%), compression depth (38 vs 40 mm), and incomplete recoil (15% vs 10%). However, no significant improvements were observed in ROSC, survival to hospital discharge, or favourable neurological outcomes. Evidence certainty ranged from moderate for CPR quality outcomes to very low for clinical outcomes.

CONCLUSIONS

Real-time feedback systems may improve technical CPR quality in prehospital care, but current evidence does not demonstrate consistent clinical benefits.