Randomised controlled trial of technology enhanced vs. face to face cardiac compression training

Associate Professor Alison Pighills1,2, Ms Rachel  Waye1, Ms Stephanie Taylor1, Ms Vicki Braithwaite1

1Mackay Hospital And Health Service, Mackay, Australia, 2James Cook University, Townsville, Australia

Background: Effective training in external cardiac compression (ECC) skills improves survival rates. Technology enhanced ECC training is more effective than traditional, face to face training. [1] Current annual ECC retraining cycles do not maintain competence,[1] with high frequency, low dose training required to prevent skill degradation.[2] Few studies have examined the trajectory of skills degradation.

Methods: This randomised controlled trial (RCT) examined the effectiveness of technology enhanced ECC training compared to face to face training, timeframes for skills decline and the impact of frequent skills practise. Participants included; hospital based doctors, nurses, health practitioners and operational staff whose roles might involve ECC.

The intervention group received technology enhanced skills training and objective feedback via the Resuscitation Quality Improvement (RQI) training system. The control group underwent traditional ECC training.

The RQI system provided objective measures of rate, depth of compression, release and hand position to give an overall score (%). A score of 75% or over indicated competence. The system recorded the number of times staff practised ECC skills.

Results: 502 participants were recruited to the trial. Baseline results showed that 21% of staff were competent at ECC which increased to 38% on re-assessment. Only 16% of the 75 Health Practitioners, were competent at baseline increasing to 47% on reassessment. Health practitioners showed the greatest increase in skill level following training. There were no statistically significant differences between groups in ECC skill level on reassessment (p=0.941). Only 73% of participants attended ECC training and those who received training achieved higher competency scores (p=0.001). The mean time to decline in skill score was 32 weeks. The participants who practised ECC between assessments had a statistically significantly higher mean score than those who didn’t (p=0.02).

Discussion: ECC training increased healthcare staff skill levels, but neither training modality was more effective than the other.


  1. Cheng, A., et al., Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial. JAMA Pediatrics, 2015. 169(2): p.137-144.
  2. Mundell, W.C., et al., Simulation technology for resuscitation training: a systematic review and meta-analysis. Resuscitation, 2013. 84(9): p.1174-1183.


Alison completed her PhD in 2008 at the University of York, UK, which involved a RCT (n=238), to evaluate the clinical effectiveness of environmental assessment and modification to prevent falls in older people. She was awarded the University of York K M Stott prize for the best PhD thesis. She is currently a co-investigator on a multi-centre RCT in the UK (n=1333) which replicates her PhD research on a larger scale. Her research interests include: falls prevention, rural and remote models of care, professional skill sharing and delegation; and, research capacity development.

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