To the Editor,
We thank Dr. Oh for his interest in our work.
1.
Our primary objective was to evaluate whether chest compression depth was significantly associated with outcome based on accelerometer-recordings obtained with monitor-defibrillators. We agree that real-time feedback is intended to improve adherence to evidence-based recommendations for cardiopulmonary resuscitation (CPR) process, and that such improved adherence is intended to improve outcomes. We also agree our prior trial of such real-time audiovisual feedback to emergency medical services (EMS) providers did not demonstrate improved outcome.2.
However, the prior trial evaluated a different manufacturer’s devices as well as adherence to different evidence-based recommendations. We are unclear which of these two factors contributed more to an effect discordant with our current analysis. A before-after study of feedback provided using the same manufacturer’s devices as were used in our current analysis showed that feedback was associated with greater outcome.3.
We have insufficient information in our present sample to be able to precisely report whether real-time feedback was associated with greater outcome.We understand that differences in patient body size or resilience of the material underlying the patient could increase the variation in depth of compression measured. Such increased noise would tend to decrease our ability to detect a signification relationship between compression depth and outcome. Despite these vagaries, our analysis demonstrated that increased chest compression depth measured by accelerometer is associated with better survival. It also confirmed that current evidence-based recommendations to compress within 50–60 mm are likely associated with greater survival than compressing to another depth.
Conflict of Interest
Nichol- Salary Support from Leonard A Cobb∼ Medic One Foundation Endowed Chair in Prehospital Emergeny Care, University of Washington; Consultant and PI, STEMI COOL trial of intravascular cooling in patients with ST-elevation myocardial infarction (STEMI), funded by ZOLL Circulation Inc. San Jose, CA; Consultant, Acute Care Program, General Electric Health Care Inc., Chicago, IL and Roche Inc., Chicago, IL; Kestra Medical Technologies, Kirkland, WA; Pagonia Medical Inc., Menlo Park, CA; Vapotherm Inc., Exeter, NH. Medical Developments International, Chicago, IL. Principal Investigator, Abiomed Inc., Danvers, MA Principal Investigator, General Electric Health Care Inc., Chicago, IL.
References
- Compression depth measured by accelerometer vs. outcome in patients with out-of-hospital cardiac arrest.Resuscitation. 2021; 167: 95-104
- Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial.BMJ. 2011; 342: d512
- The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.Ann Emerg Med. 2013; 62 (47-56 e1)
Article info
Publication history
Published online: October 04, 2021
Accepted:
September 24,
2021
Received:
September 21,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
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- Clinical applicability of the accelerometer-based chest compression measurement in cardiac arrestResuscitationVol. 169
- PreviewI have read the article by Nichol et al. titled “Compression depth measured by accelerometer vs. outcome in patients with out-of-hospital cardiac arrest” with great interest.1 However, I think that there are two important issues in this study. The first issue is whether there was any effect of feedback on the chest compression depth, and the second is regarding the possibility of overestimation when using an accelerometer device for measuring the chest compression depth. I would like to discuss these issues with the authors of the manuscript and readers of the journal.
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