Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2023; 15(10): 531-541
Published online Oct 26, 2023. doi: 10.4330/wjc.v15.i10.531
Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis
Nitish Sood, Anish Sangari, Arnav Goyal, Christina Sun, Madison Horinek, Joseph Andy Hauger, Lane Perry
Nitish Sood, Anish Sangari, Arnav Goyal, Madison Horinek, Lane Perry, Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
Christina Sun, Dental College of Georgia, Augusta University, Augusta, GA 30912, United States
Joseph Andy Hauger, Department of Chemistry and Physics, Augusta University, Augusta, GA 30912, United States
Author contributions: Sood N, Sangari A, and Goyal A contributed equally to this work; Sood N and Sangari A designed the research study; Sood N, Sangari A, and Goyal A performed the research; Sood N performed the statistical analysis; Sood N, Sangari A, Goyal A, Sun C, Horinek M, Hauger JA, and Perry L analyzed the data and wrote the manuscript; Sood N, Sangari A, Goyal A, Sun C, Horinek M, Hauger JA, and Perry L reviewed the manuscript before submission; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nitish Sood, BSc, Medical College of Georgia, Augusta University, No. 1120 15th Street, Augusta, GA 30912, United States. nsood@augusta.edu
Received: June 7, 2023
Peer-review started: June 7, 2023
First decision: July 4, 2023
Revised: July 23, 2023
Accepted: August 3, 2023
Article in press: August 3, 2023
Published online: October 26, 2023
Processing time: 139 Days and 4.3 Hours
Abstract
BACKGROUND

Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.

AIM

To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA.

METHODS

We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration’s “risk of bias” tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05.

RESULTS

Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047].

CONCLUSION

RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.

Keywords: Real-time audiovisual feedback; Cardiopulmonary resuscitation; Cardiac arrest; Return of spontaneous circulation; Survival to hospital discharge; Cardiopulmonary resuscitation quality

Core Tip: Real-time audiovisual feedback (RTAVF) devices have been shown to significantly improve cardiopulmonary resuscitation (CPR) quality in manikin/simulation studies. Despite this improvement, previous reviews have not seen a translation into improvement in patient outcomes. This systematic review and meta-analysis is the largest one to-date conducted on this topic, including 13 studies and 17600 patients. We found that the use of RTAVF devices significantly improves CPR quality metrics of chest compression rate and depth. Contrary to prior literature, we found that usage significantly increases return of spontaneous circulation in cases of in-hospital cardiac arrest but does not improve survival to hospital discharge.