Use of CPR feedback devices to treat out-of-hospital cardiac arrest in Germany: Associated with improved ROSC-rates, but infrequent usage, in a registry-based analysis of 107,548 cases.

Introduction: Out-of-hospital cardiac arrest is a leading cause of mortality in Europe. Quality cardiopulmonary resuscitation, particularly of chest compressions, is crucial. Real-time audiovisual feedback (RTAVF) devices aim to enhance chest compression quality. Recent studies on these tools have reported improved outcomes for in-hospital but not for out-of-hospital cardiac arrest. This registry-based, retrospective study investigated the use of feedback-devices by emergency medical services personnel to treat out-of-hospital cardiac arrest in Germany and assessed its effect on return of spontaneous circulation (ROSC).

Methods: We analyzed 107,548 records from the German Resuscitation Registry between 2015 and 2022 and compared patient outcomes of patients treated with feedback devices or not. ROSC rates both at any time and at hospital admission were compared to expected rates based on the "Rosc After Cardiac Arrest" (RACA) score. Furthermore, a generalized linear mixed methods model was calculated to receive an adjusted effect for those devices.

Results: Feedback-devices were used in 17.5% of cases overall, rising from 7.1% (2015) to 23.2% (2022). Patients resuscitated with feedback devices had a 2.6% higher rate of hospital admission with spontaneous circulation (35.9% vs. 33.3%). In both groups, the ROSC rates were higher than predicted by the RACA score. After multivariable adjustment we found a minor effect for RTAVF use on any ROSC (odds ratio 1.09, 95% confidence interval 1.04-1.14), but no effect on the ROSC rate on admission (odds ratio 0.98, 95% confidence interval 0.93-1.03).

Conclusion: We could show a minor association between the use of feedback devices and any ROSC, but not for ROSC on hospital admission, in out-of-hospital cardiac arrest patients in a generalized linear mixed model. Further research should address implementation strategies, sustainability and evaluate its effectiveness for other applications.