Effect of in situ coaching on cardiopulmonary resuscitation quality: a multicenter randomized simulation study

• CPR coaching achieved superior quality of chest compressions compared with defibrillator monitor and control groups. • Improvements were maintained even under muscular fatigue, with significantly better compression rate and chest recoil. • Defibrillator monitor feedback did not demonstrate significant benefit compared with unassisted controls. Background : A previous manikin-based simulation study among healthcare professionals developed a cardiopulmonary resuscitation (CPR) coaching method that significantly improved CPR quality compared with real-time audiovisual feedback provided by a defibrillator monitor. This study aimed to determine whether these findings could be replicated in a larger, multicenter trial involving first responders. We conducted a multicenter, block-randomized trial among French firefighters. Participants were randomized into three groups (n = 36 each): CPR coaching, defibrillator monitor or control. Each participant performed three 2-minute external chest compression sequences on an adult cardiac arrest simulator, which measured CPR quality, compression rate, chest recoil, and depth. A total of 108 participants were enrolled across two centers; one participant withdrew. In the second external chest compression sequence, the CPR coaching group achieved significantly higher CPR quality than the defibrillator monitor group (median 99% interquartile range (IQR) 99–100 vs 99% 78–99; p = 0.0022). This difference persisted in the third sequence (p = 0.0017). Compared with the control group, CPR quality in the CPR coaching group was significantly improved in both sequences (p < 0.001), whereas the defibrillator monitor group did not show a significant difference versus control. The study confirmed the findings of our previous study with healthcare professionals, demonstrating the superiority of CPR coaching over defibrillator monitor feedback for improving CPR quality in a simulation-based setting with lay rescuers.