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Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) ( P =0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively ( P <0.001). Median chest compression rate per minute was 111 and 109 ( P <0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% ( P <0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% ( P <0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) ( P <0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252.

Objectives: To investigate whether real-time ventilation feedback would improve provider adherence to ventilation guidelines., Design: Non-blinded randomised controlled simulation trial., Setting: One Emergency Medical Service trust in Copenhagen., Participants: 32 ambulance crews consisting of 64 on-duty basic or advanced life support paramedics from Copenhagen Emergency Medical Service., Intervention: Participant exposure to real-time ventilation feedback during simulated out-of-hospital cardiac arrest., Main Outcome Measures: The primary outcome was ventilation quality, defined as ventilation guideline-adherence to ventilation rate (8-10 bpm) and tidal volume (500-600 ml) delivered simultaneously., Results: The intervention group performed ventilations in adherence with ventilation guideline recommendations for 75.3% (Interquartile range (IQR) 66.2%-82.9%) of delivered ventilations, compared to 22.1% (IQR 0%-44.0%) provided by the control group. When controlling for participant covariates, adherence to ventilation guidelines was 44.7% higher in participants receiving ventilation feedback. Analysed separately, the intervention group performed a ventilation guideline-compliant rate in 97.4% (IQR 97.1%-100%) of delivered ventilations, versus 66.7% (IQR 40.9%-77.9%) for the control group. For tidal volume compliance, the intervention group reached 77.5% (IQR 64.9%-83.8%) of ventilations within target compared to 53.4% (IQR 8.4%-66.7%) delivered by the control group., Conclusions: Real-time ventilation feedback increased guideline compliance for both ventilation rate and tidal volume (combined and as individual parameters) in a simulated OHCA setting. Real-time feedback has the potential to improve manual ventilation quality and may allow providers to avoid harmful hyperventilation., (© 2021 The Authors.)