Volume 84, Issue 8, Pages 1125-1130 (August 2013) Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%—A randomised controlled trial  Philip Martin, Peter Theobald, Alison Kemp, Sabine Maguire, Ian Maconochie, Michael Jones  Resuscitation  Volume 84, Issue 8, Pages 1125-1130 (August 2013) DOI: 10.1016/j.resuscitation.2013.03.029 Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Example chest deflection curves defining (a) chest compression depths, (b) chest release forces, (c) chest compression rates and (d) compression duty cycles. Each chest compression cycle is represented by a dashed line, with the circular markers defining the point/range reported for each internationally recommended target. The shaded region represents the area under the chest deflection curve and the dashed-dotted box represents the product of the chest compression depth and the chest compression cycle time. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 CONSORT flow diagram describing the progression of participants through our study. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 Overall quality index scores for the two-thumb (TT) and two-finger (TF) chest compression techniques as performed by both the feedback and control groups at the experimental stage. Data are presented as mean values with 95% confidence intervals. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 Simulated chest compression quality measures, illustrated against evidence based quality targets, for both two-thumb (TT) and two-finger (TF) chest compressions, as performed by the feedback and control groups at the experimental stage. Chest compression quality targets are illustrated by dashed lines. Compression depth targets were 36.7–46mm, release force targets were <2.5kg and <0.5kg, compression rate targets were 100–120min−1 and duty cycle targets were 30–50%. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Online Table 1 Definitions of infant chest compression quality measures and quality target ranges. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Online Figure The feedback system: Chest deflection is detailed such that the resuscitator remains within the target range (i.e. green zone), whilst not compressing too deeply and thus risking intra-thoracic injury (red zone). A minimum depth is required during the release phase (blue zone). The desired compression rate is also described by both the green flashing light, and a ‘metronomic’ beep. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Online Table 2 Study demographics. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Online Table 3 Data describing the chest compression quality measures and quality indices achieved during the ‘baseline’ phase of this study (i.e. with both groups receiving no feedback) by both cohorts of certified instructors during simulated infant CPR. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Online Table 4 Data describing the chest compression quality measures and quality indices achieved during the ‘experimental’ phase of this study (i.e. with the feedback group receiving feedback) by both cohorts of certified instructors during simulated infant CPR. Resuscitation 2013 84, 1125-1130DOI: (10.1016/j.resuscitation.2013.03.029) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions