Background:  High cardiopulmonary resuscitation (CPR) quality is associated with better patient survival from cardiac arrest. However, CPR providers may not have an accurate perception of the depth and rate of their chest compressions (CC). Realtime feedback during resuscitation improves CPR quality compared to no feedback. Evidence comparing audio-visual feedback device (AVF) and team leader’s feedback (TLF) in improving CPR performance is limited and conflicting.  Methodology:  We performed a randomized crossover study to evaluate CC performance with AVF and TLF. Seventy participants performed CC for 1 minute on a CPR manikin connected to ZOLL R series defibrillator with CPR-sensing capability in a randomised crossover sequence. We interviewed participants to explore their perception and preference with both feedback methods. Results:  Mean CC rate was higher with AVF than with TLF (121.8 min -1  ± 17.7 vs. 117.4 min -1  ± 13.5,  p  = 0.005). There was no significant difference in proportions of participants performing CC within the recommended rate of 100-120 beats per minute between AVF and TLF (48.6% and 51.4%,  p  = 0.824). Overall, CC depth was below the recommended target regardless of feedback method with mean CC depth of 4.4 cm ± 0.8 in AVF and 4.3 cm ± 0.9 in TLF respectively ( p  = 0.479). Most participants felt that TLF was easier to follow, more motivating and preferable compared to AVF. Those who preferred TLF performed CC at rates above the recommended range with AVF compared to TLF (124.1 min -1  ± 19.4 versus 118.2 min -1  ± 14.9,  p  = 0.004). Conclusion:  A well-trained team leader is as effective as an AVF device in leading high-quality CC.  CPR providers’ performance may be influenced by their preferred feedback method.

The authors have declared no competing interest.

NMRR-19-1174-48443

The author(s) received no specific funding for this work.

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Medical Research Ethics Committee of University Malaya Medical Centre and the National Medical Research of Malaysia gave ethical approval for this work.

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The data underlying the results presented in the study are available from the corresponding author via email at nuraliyah@ummc.edu.my