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

Abstract

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.