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How Far Has CPR Feedback Come?

Meeting Advances in Resuscitation Science

As of January 31, 2019, the American Heart Association (AHA) requires the use of an instrumented directive feedback device in all courses that teach adult cardiopulmonary resuscitation (CPR) skills. The American Red Cross implemented the same initiative in their training courses in January 2018.

CPR feedback has come a long way since the development of the world’s first CPR manikin. Prior to 1960, many methods that would be considered unusual by today’s standards were used to treat victims of sudden cardiac arrest. Intuitively, people knew that there was something that could be done to revive victims – and then science proved them right. Here’s a look at the history of CPR feedback through the lens of the most recognizable and “most kissed” woman in the world – Resusci Anne.

Photo: Resusci Anne featured on The Today Show in 1973.

1960s

In 1960, Dr. James Jude, Dr. William Kouwenhoven and G. Guy Knickerbocker publish a paper in the Journal of the American Medical Association on “closed-chest cardiac massage,” which evolved into cardiopulmonary resuscitation (CPR). 1 A few years later, in 1963, the American Heart Association (AHA) formally endorsed CPR. 2

Developed by Asmund S. Laerdal, together with Dr. Safar and Dr. Bjorn Lind, Resusci Anne became the world’s first CPR training manikin. Resusci Anne provided real-time feedback for quality CPR training. Dials indicated correct ventilation and compressions.

Photo: Article published in 1968 about Resusci Anne.

1970s

In 1972, the world’s first mass CPR training program began in Seattle, certifying more than 100,000 people in the first two years.3 Seattle’s continued emphasis on bystander involvement and training has made it one of the safest places to have a cardiac arrest.4

The Recording Resusci Anne helped to train laypeople with printed performance feedback. The paper strip provided a visual representation of ventilation and compression quality.

Photo: Rosalynn Carter performing compressions on the Recording Resusci Anne at the White House.

1980s

A program to provide telephone instructions for CPR began in King County, Washington.  Emergency dispatchers gave directions to callers while the fire department and emergency medical technicians (EMTs) were en route to the scene.  Dispatcher-assisted CPR is now common throughout the United States, and dispatchers must hold a valid CPR certification.5

Laerdal recognized that quality CPR has a very different outcome than just any CPR. SkillMeter Resusci Anne was designed to meet the growing need for quantitative real-time CPR measurement and feedback. She used advanced electronics to display CPR technique and sequence of steps.

Photo: Many dispatchers began training to perform quality CPR using SkillMeter Resusci Anne. 

1990s

Public Access Defibrillation programs began placing automated external defibrillators (AEDs) in public places and providing training to the public.6 Rapid defibrillation is essential to increasing survival from SCA, and today AEDs can be found in nearly all public facilities.

Resusci Anne SkillGuide with basic CPR feedback was released. Laerdal developed a CPR-D version, which allowed for extensive, simulated automatic external defibrillation (AED) training. The SkillGuide device and SkillReporter printer were offered as complimentary feedback options. 

Photo: Margaret Rhea Seddon, NASA Astronaut, performed zero-gravity CPR training in anticipation of a mission in 1993.

2000s

The American Heart Association and European Resuscitation Council (ERC) guidelines emphasized the importance of quality CPR. Accuracy and precision began to carry more weight in CPR training classes.

Laerdal PC SkillReporting System was developed to offer an additional feedback option to supplement the SkillGuide device and SkillReporter printer.  By the end of the 2000’s, Resusci Anne was a highly-modular manikin offering numerous configurations, accessories, and feedback options.

Photo: SkillReporter Printer is used to review feedback at the same time as compressions are performed.

2010’s

The 2010 AHA Guidelines reinforced the importance of high-quality CPR, but also brought significant change. The recommended compression rate and depth were modified, which required individuals and teams to sharpen their CPR skills. At the same time, Seattle’s Resuscitation Academy was gaining prominence and training leaders from around the world on best practices to increase survival from cardiac arrest.

In 2013, Resusci Anne QCPR was released to improve feedback capabilities and manikin modularity. Resusci Anne QCPR worked with the SimPad platform, which increased the sophistication of CPR debriefing and data analysis. And, in 2015, the addition of ShockLink enabled Resusci Anne QCPR users to safely integrate their own clinical defibrillators into high-performance CPR training.

Photo: Emergency medical services (EMS) participate in a scenario during which they must defibrillate Resusci Anne.

Today

Now that the American Red Cross and the AHA have issued mandates that require the use of a direct feedback device in all adult CPR courses, quality CPR training is attainable for everyone- lay people and healthcare providers alike.

In 2018, Resusci Anne QCPR was redesigned to improve the simplicity of use. The latest enhancements include Bluetooth Low Energy (BLE) for an easier and faster connection, a rechargeable battery up to 34 hours of mobile operating time, and more feedback device options than ever before. The new Resusci Anne QCPR is compatible with the QCPR Instructor and QCPR Learner apps as well as CPR for Teams, a new training option within SimPad PLUS with SkillReporter. 

Photo: EMS professionals training in a realistic environment with their clinical defibrillator.

A Look Forward

Resuscitation training has continued to evolve in the direction of more robust feedback and analytics, effectively removing all “guessing” from the training equation. Now, we are seeing this feedback integrated into downloadable software and apps. The AHA has also announced that the adult CPR training requirement will extend to infant and pediatric training in the future.

As feedback technology evolves, so too does CPR training. It is estimated that Laerdal’s resuscitation manikins have been used to train more than 500 million people worldwide. An estimated 2.5 million lives have been saved. We can only hope that these trends will continue, so that every learner will gain the self-efficacy to perform life-saving CPR.

Photo: Review of a high-performance CPR team training session on SimPad PLUS with SkillReporter

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References

  1. American Heart Association (2015). History of cpr timeline. Retrieved from https://news.heart.org/history-of-cpr timeline-text-only/
  2. Ibid
  3. Ibid
  4. Sudden Cardiac Arrest Foundation (2014). King county, WA, has world’s highest survival rate for cardiac arrest. Retrieved from http://www.sca-aware.org/sca-news/king-county-wa-has-worlds-highest-survival-rate-for-cardiac-arrest 
  5. American Heart Association (2018). History of cpr. Retrieved from https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRECC/HistoryofCPR/UCM_475751_History-of-CPR.jsp 
  6. American Heart Association (2015). See Reference #1.