Search Results (573)

Background: Cardiac arrest is a life-threatening event that requires early recognition and timely intervention. In-hospital cardiac arrest (IHCA) may be preceded by clinical deterioration, making competent monitoring, escalation, and resuscitation response essential. Cardiopulmonary resuscitation (CPR) is a key life-saving intervention, but CPR knowledge and skills may decline when healthcare professionals have limited opportunities for practice or exposure to real CPR events. Aim: This study aimed to evaluate CPR competency retention and compare knowledge and skills outcomes between nurses working in critical care and general care units. Methods and Results: A prospective comparative observational cohort study was conducted among 265 registered nurses. All participants were assessed immediately after BLS training, and each participant was reassessed once at an assigned post-training interval of 1, 3, or 6 months. Therefore, the findings represent subgroup comparisons across reassessment intervals rather than individual longitudinal trajectories across all time points. Knowledge was analyzed as a percentage score, while practical skills were analyzed categorically as Pass or Needs Remediation. Lower knowledge scores were observed at the assigned post-training reassessment intervals than at the immediate post-training assessment in both clinical groups, with clearer differences across reassessment intervals in the general care group. Skills competency also showed a higher proportion of nurses needing remediation at later intervals, particularly in the general care group. Conclusions: The findings suggest that CPR competency retention may vary across clinical settings and post-training reassessment intervals. The results support targeted refresher strategies, while acknowledging that causal explanations and individual longitudinal trajectories cannot be inferred from this design. Full article

Background: Prehospital return of spontaneous circulation (ROSC) is a widely used intermediate endpoint in out-of-hospital cardiac arrest (OHCA), but its downstream clinical meaning may differ according to when ROSC is achieved. Methods: We conducted a retrospective registry-based cohort study of adult non-traumatic OHCA patients treated with Smart Advanced Life Support (SALS) from 2015 to 2023 who achieved prehospital ROSC. The primary exposure was the low-flow interval, defined as the interval from CPR initiation to first prehospital ROSC, categorized a priori as <10, 10–14, 15–19, 20–24, 25–29, and ≥30 min. Multivariable logistic regression models estimated associations with good neurological recovery, prehospital rearrest, survival to hospital admission, and survival to discharge, adjusting for age, sex, witnessed arrest, bystander CPR, initial shockable rhythm, transport time interval, and region. Results: Among 19,156 adult SALS-treated OHCA patients, 4195 achieved prehospital ROSC; 3760 had valid low-flow interval values from 0 to 60 min and were included in the primary analysis. Good neurological recovery decreased from 582/1004 (58.0%) in the <10 min group to 17/249 (6.8%) in the ≥30 min group, while prehospital rearrest increased from 194/488 (39.8%) to 136/174 (78.2%). Compared with <10 min, the adjusted odds ratios for good neurological recovery were 0.368, 0.164, 0.135, 0.099, and 0.081 across progressively later ROSC categories. The adjusted odds ratio for rearrest in the ≥30 min group was 5.024. Conclusions: In this selected SALS-treated ROSC-positive OHCA cohort, later low-flow interval was associated with substantially lower odds of favorable neurological recovery and survival and higher odds of prehospital rearrest. These findings suggest that prehospital ROSC timing may serve as a prognostic marker but should not be interpreted as a standalone criterion for treatment termination or transport decisions. Full article

Background and objectives: Optimal oxygen administration during delivery room resuscitation remains a major challenge in very preterm infants. While both hypoxemia and excessive oxygen exposure have been associated with adverse outcomes, the prognostic value of early oxygenation parameters remains unclear. This study aimed to evaluate the association between preductal SpO₂ at 5 min of life and early respiratory and neurological outcomes in preterm infants born at or below 32 weeks of gestation. Materialsandmethods: This retrospective single-centre study included 31 preterm infants born at ≤32 weeks of gestation, identified from 34 consecutive eligible births. Demographic, delivery room, respiratory, laboratory, and neuroimaging data were collected from medical records. The primary outcome was intraventricular hemorrhage (IVH), graded by the Papile classification, during the first week of life. Secondary outcomes included respiratory support requirements, surfactant administration, and capillary blood gas parameters at two hours of life. Associations were evaluated using Spearman rank correlation; because SpO₂@5 and delivery room FiO₂ were strongly related to gestational age, partial correlations controlling for gestational age were additionally performed, together with a group comparison for IVH. Exact two-sided p values are reported. Results: The median gestational age was 28 weeks + 4 days (range: 22 weeks + 1 day to 31 weeks + 5 days), and the median birth weight was 1120 g. IVH of any grade occurred in 20 infants (64.5%), including severe (grade III–IV) IVH in 10 (32.3%). Median delivery room FiO₂ was 35% (IQR 30–50%), and median SpO₂ at 5 min of life was 83% (IQR 75–90%). Lower SpO₂ at 5 min of life was associated with an increased number of surfactant doses (rs = −0.46, p = 0.010), lower capillary pH at two hours of life (rs = 0.39, p = 0.032), and a higher grade of IVH (rs = −0.39, p = 0.030); median SpO₂@5 was 80% in infants with IVH versus 90% in those without (p = 0.057). Higher delivery room FiO₂ was associated with increased use of DuoPAP (rs = 0.36, p = 0.045), mechanical ventilation (rs = 0.41, p = 0.021), and surfactant administration (rs = 0.56, p < 0.001), as well as lower pH (rs = −0.55, p = 0.002) and higher lactate levels (rs = 0.37, p = 0.044) at two hours of life. Because SpO₂@5 and FiO₂ were both strongly correlated with gestational age (rs = 0.54 and −0.76, respectively), all associations were re-examined controlling for gestational age. The associations of SpO₂@5 with IVH grade (partial rs = −0.22, p = 0.247), surfactant doses (partial rs = −0.08, p = 0.678) and 2 h pH (partial rs = 0.19, p = 0.335) were attenuated and no longer significant, as were those of FiO₂ with mechanical ventilation (partial rs = −0.04, p = 0.817) and surfactant doses (partial rs = −0.01, p = 0.945); only the association between FiO₂ and 2 h pH persisted (partial rs = −0.37, p = 0.048). Conclusions: In preterm infants born at or below 32 weeks of gestation, lower SpO₂ at 5 min and higher delivery room oxygen requirements were associated with less favorable respiratory and metabolic outcomes, as well as with IVH. However, apart from the association between FiO₂ and 2 h pH, none of these associations remained statistically significant after adjustment for gestational age, and these findings, from a small and heterogeneous single-centre cohort, should be considered hypothesis-generating. Early oxygenation parameters are best viewed as simple bedside markers of cardiopulmonary adaptation and overall illness severity in very preterm infants, rather than as independent predictors of clinical outcomes. Further prospective studies are needed to confirm these associations and define clinically relevant threshold values. Full article

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency characterized by sudden cardiorespiratory collapse, disseminated intravascular coagulation (DIC), and a high case-fatality rate. Because no confirmatory test exists, the diagnosis remains clinical and one of exclusion. We report a case of presumed AFE in a 39-year-old primigravida with uterine myomas, obesity, and chronic hypertension who underwent an elective primary cesarean delivery under spinal anesthesia. During manipulation of the placenta, the patient developed abrupt cardiovascular collapse requiring cardiopulmonary resuscitation, with return of spontaneous circulation followed by profound coagulopathy and refractory uterine atony. Management included goal-directed transfusion within a massive transfusion protocol, uterotonic therapy, a failed B-Lynch suture, supracervical hysterectomy, and a subsequent right oophorectomy for an ovarian-vein hemorrhage identified on imaging. Laboratory studies demonstrated an overt consumptive coagulopathy consistent with the International Society on Thrombosis and Haemostasis (ISTH) criteria, while a normal serum tryptase argued against an anaphylactic mechanism. The neonate was delivered in good condition (Apgar scores 9, 10, and 10 at 1, 5, and 10 min; umbilical-artery pH 7.38) and required no neonatal intensive care. The mother achieved full hemodynamic and neurological recovery. This case illustrates that survival from presumed AFE is achievable through early recognition, high-quality resuscitation, prompt correction of coagulopathy, and decisive surgical hemostasis, and it highlights the diagnostic reasoning required to distinguish AFE from its principal differential diagnoses. Full article

Purpose: This study aimed to compare direct hospitalisation costs for patients with cancer during terminal hospitalisation between those receiving palliative care consultation and those receiving usual care. Methods: A retrospective medical record review was conducted to obtain clinical information and cost data for patients with cancer during terminal hospitalisation. Hospitalisation costs between the palliative care and usual care groups were compared using analytical statistics. Effect sizes for cost comparisons were presented as median differences. Results: A total of 154 and 112 patients were classified into the palliative care group and the usual care group, respectively. Patients in the palliative care group had a longer length of hospital stay than those in the usual care group (8 days vs. 3 days, p < 0.001). Compared with usual care, patients receiving palliative care had lower utilisation of the intensive care unit (ICU) (8.4% vs. 44.6%, p < 0.001), invasive mechanical ventilation (4.5% vs. 36.6%, p < 0.001), cardiopulmonary resuscitation (1.9% vs. 8.9%, p = 0.020), and vasopressors and inotropes (7.1% vs. 25.9%, p < 0.001). Total hospitalisation costs did not differ significantly between palliative care and usual care groups (27,910.8 vs. 24,216.4 Thai Baht (THB), p = 0.305). However, the palliative care group had significantly lower daily hospitalisation costs (3587.4 vs. 6918.2 THB/day, p < 0.001). Median daily costs were lower in the palliative care group for breast cancer (3326.8 vs. 8049.0 THB/day; median difference −4390.1, p = 0.016), colorectal cancer (3422.8 vs. 5595.0 THB/day; median difference −2500.7, p = 0.008), hepato-pancreatico-biliary cancer (3611.7 vs. 5097.0 THB/day; median difference −1740.0, p = 0.004), and lung cancer (3435.4 vs. 7998.7 THB/day; median difference −3896.5, p < 0.001). Conclusions: Palliative care consultation was associated with lower direct daily hospitalisation costs during end-of-life cancer care. Full article

Cardiac arrest followed by cardiopulmonary resuscitation (CA/CPR) induces systemic ischemia and frequently results in acute kidney injury (AKI). The ketone body β-hydroxybutyrate (BHB) maintains mitochondrial and peroxisomal homeostasis through activation of the C/EBPβ–Pck1 axis, whereas Pck1 preserves mitoribosome integrity and mtDNA-encoded oxidative phosphorylation (OXPHOS) translation. However, it remains unclear whether this pathway is disrupted during CA/CPR-induced AKI and whether empagliflozin can restore its activity. Male C57BL/6J mice and proximal tubule-specific Pck1 conditional knockout (CKO) mice were subjected to short-duration or standard CA/CPR protocols. Empagliflozin was administered orally for 7 days before CA/CPR induction. Circulating BHB levels, renal expression of C/EBPβ and Pck1, and markers of mitochondrial, peroxisomal, and mitoribosomal abundance and function were evaluated using established methods. CA/CPR markedly reduced circulating BHB levels and suppressed the C/EBPβ–Pck1 signaling axis. These changes were accompanied by depletion of peroxisomal markers, mitochondrial regulators, and mitoribosomal components as well as increased tubular apoptosis and albuminuria. Pck1 CKO mice exhibited severe organelle dysfunction and aggravated renal injury. In contrast, empagliflozin restored BHB levels, preserved C/EBPβ and Pck1 expression, and maintained mitochondrial, peroxisomal, and mitoribosomal integrity, thereby attenuating tubular injury and albuminuria. Notably, empagliflozin treatment increased BHB, C/EBPβ, and Pck1 levels in noninjured mice without inducing organelle expansion, suggesting that Pck1 activation alone is insufficient to promote mitoribosome biogenesis under basal conditions. Collectively, these findings demonstrate that empagliflozin protects against CA/CPR-induced AKI and identify Pck1 as a key metabolic regulator linking ketone signaling to organelle resilience. Full article

Background/Objectives: Snow can disrupt emergency medical services (EMSs); however, previous studies have mainly measured snowfall or prefecture-level exposure. These measures may not capture snow remaining on the ground or conditions within ambulance operating areas. We examined whether the daily snow depth assigned at the fire department level was associated with EMS time intervals and 1-month survival after out-of-hospital cardiac arrest (OHCA). Methods: This retrospective cohort study included 7395 adults with OHCA from the Akita Prefecture Utstein-style emergency transport registry between 2019 and 2023. Daily snow depth from the nearest Automated Meteorological Data Acquisition System (AMeDAS) station was assigned to each case by the fire department. Snow exposure was analyzed as >0 cm versus 0 cm, as five depth categories, and as a continuous variable using natural splines. Multivariable models were adjusted for age, sex, cardiac origin, initial rhythm, fire department area, witnessed status, bystander cardiopulmonary resuscitation, and year. Results: Call-to-scene time and total EMS time were longer with snow cover than without snow cover (median, 9 vs. 8 min and 34 vs. 31 min, respectively; both p < 0.001). Snow cover was associated with lower 1-month survival after adjustment (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.54–0.98), but this association was attenuated after additional adjustment for call-to-scene time (OR, 0.77; 95% CI, 0.57–1.03). Category-based and spline analyses showed no clear dose–response relationship. Conclusions: Daily snow depth is consistently associated with longer EMS response and transport times. However, its association with 1-month survival remains unclear. This survival association may reflect broader winter conditions rather than snow cover itself. Full article

Background/Objectives: Children with congenital long QT syndrome (cLQTS) are at extremely high risk of torsades de pointes (TdP) and sudden cardiac death (SCD). Although the implantable cardioverter-defibrillator (ICD) is a cornerstone in SCD prevention, traditional transvenous ICDs are associated with venous access occupation, lead wear or fracture due to somatic growth, and difficulties with long-term lead revision or extraction. The extravascular ICD, which places the lead in the substernal extravascular space, has the potential to circumvent these lead-related complications. We report the experience of successful extravascular ICD implantation in a young child with drug-refractory cLQTS type 2 (cLQTS2). Methods: The clinical data of a 9-year-old boy with cLQTS2 were retrospectively analyzed. The patient carried a heterozygous KCNH2 variant (c.1810G>A, p.Gly604Ser) and had been on long-term oral propranolol and mexiletine. He presented with a cardiac arrest out of hospital during nocturnal sleep, was transferred to our hospital after successful cardiopulmonary resuscitation, and had TdP captured on ambulatory monitoring. Following multidisciplinary discussion, preoperative chest computed tomography (CT) assessment of the substernal anatomy, and informed consent, extravascular ICD implantation was performed on hospital day 11. The procedure involved the creation of a substernal tunnel via a subxiphoid incision, placement of the defibrillation lead in the anterior mediastinum with lead slack reserved for growth, and positioning of the pulse generator in a left axillary subcutaneous pocket. Intraoperative defibrillation testing succeeded with a single 30 J shock. Results: The postoperative recovery was uneventful without procedure-related complications. At the 2-month follow-up, device parameters were satisfactory and no inappropriate shocks had occurred. The corrected QT interval (QTc) decreased from 563 ms on admission to 522 ms. Ambulatory monitoring detected asymptomatic episodes of non-sustained ventricular tachycardia, but no ventricular fibrillation or syncope was observed. Venous access was fully preserved. Conclusions: In children with drug-refractory cLQTS2, the extravascular ICD provides defibrillation and antitachycardia pacing (ATP) while avoiding transvenous lead complications and preserving venous access. This case shows that with precise preoperative planning and lead redundancy, the device appears feasible and can be implanted without short-term complications in young children. Larger studies with longer follow-up are needed to evaluate long-term device performance. Full article

Background: The COVID-19 pandemic exerted competing pressures on bystander cardiopulmonary resuscitation (CPR)—infection control aversion to rescue breathing versus a shift in arrests toward the home—yet reported effects have been inconsistent and evidence by arrest location and CPR method is scarce. Methods: Using the Korean Cardiac Arrest Research Consortium multicentre registry (January 2016–June 2025; 21,182 adults with home or public out-of-hospital cardiac arrest), we performed an interrupted time-series analysis across pre-COVID-19, pandemic (February 2020–May 2023) and endemic periods. Results: Both settings shared rising pre-COVID-19 trends; at the February 2020 interruption, the bystander CPR rate trajectory changed asymmetrically (home −0.278 versus public −0.151 percentage points/month), with block-bootstrap counterfactual shortfalls by series end of −17.6 (home) and −12.5 (public) percentage points. After adjustment, the location interaction was marginal overall (p = 0.065) but significant in witnessed arrests (p = 0.046). Conventional CPR fell abruptly and uniformly (level-change odds ratio 0.22), while compression-only CPR rose above 97% with no recovery through the endemic period. Period-by-location interaction was non-significant for return of spontaneous circulation, survival and good neurological outcome. Conclusions: COVID-19 produced a robust, uniform shift in bystander CPR methods toward compression-only CPR and a more limited and suggestive location-asymmetric change in the bystander CPR rate (marginal overall, significant only in witnessed arrests), without differential effects on short-term outcomes. Full article

Background/Objectives: Intensive care unit (ICU) mortality reflects interactions between baseline vulnerability, acute physiological derangement, ICU-acquired infection, and the intensity of organ-support therapy. Methods: This single-center retrospective cohort study included 3323 adult first ICU hospitalizations at the University Clinical Hospital in Bialystok, Poland, between 1 January 2017 and 1 June 2023. Secondary ICU admissions/readmissions, patients aged <18 years, and one pregnancy admission were excluded. Patients were classified as ICU survivors (n = 1778) or ICU non-survivors (n = 1545). Variables were compared using t-tests, chi-square tests, or Fisher exact tests, and an adjusted logistic regression model was fitted as an exploratory prognostic model. Results: ICU mortality was 46.5%, and 28-day ICU mortality was 40.2%. Non-survivors were older than survivors (66.7 ± 15.1 vs. 60.9 ± 17.2 years; p < 0.001) and more frequently had arterial hypertension, diabetes mellitus, COVID-19, ischemic heart disease, atrial fibrillation, renal failure, and acute myocardial infarction or ischemic stroke. In the adjusted model, ICU mortality was associated with age per 10 years (OR 1.32, 95% CI 1.18–1.47), COVID-19 (OR 3.15, 95% CI 2.07–4.79), ventilator-associated pneumonia (OR 1.68, 95% CI 1.22–2.30), lactate per 1 mmol/L (OR 1.29, 95% CI 1.16–1.43), pH per 0.1-unit decrease (OR 1.79, 95% CI 1.41–2.29), mechanical ventilation (OR 14.74, 95% CI 3.40–63.87), cardiopulmonary resuscitation (OR 9.45, 95% CI 4.67–19.13), renal replacement therapy (OR 2.01, 95% CI 1.39–2.91), and treatment of acidosis or alkalosis (OR 1.95, 95% CI 1.29–2.94). Conclusions: ICU non-survival was associated with older age, COVID-19, cardiovascular and renal vulnerability, ICU-acquired infection, inflammatory and metabolic dysfunction, and early requirement for rescue organ-support interventions. These findings should be interpreted as adjusted associations, not causal effects. Full article

A 14-year-old intact female mongrel dog presented for periodontal disease underwent anesthesia for dental procedures. During surgery, the dog developed cardiopulmonary arrest (CPA) characterized by a sudden drop in end-tidal carbon dioxide and pulseless electrical activity. Cardiopulmonary resuscitation was initiated and return of spontaneous circulation was achieved after 20 min. Post-resuscitation imaging revealed moderate pneumoperitoneum, hepatic portal venous gas, and gas within the caudal vena cava without evidence of gastrointestinal rupture or peritonitis. Conservative management including intensive monitoring and supportive care resulted in progressive resolution of these gas accumulations and complete clinical recovery. This is the first veterinary report to describe pneumoperitoneum following CPR during dental surgery. The case broadens current understanding of nonsurgical etiologies of pneumoperitoneum in small animals and demonstrates that conservative management may be a viable option in selected post-resuscitation patients. Full article

Background: Performing and maintaining high-altitude cardiopulmonary resuscitation (CPR) could pose a significant physical challenge for rescuers. The objective of this study is to analyse the effects of reducing the oxygen fraction at altitudes of 3000 m and 5000 m above sea level (asl), with and without conditioning to hypoxia, on the quality of resuscitation performed in adults. Methods: An analytical before–after study in which 56 students with a Degree in Nursing between 18 and 30 years old perform 10 min of resuscitation on a mannequin at different altitudes (670, 3000 and 5000 m asl) will be carried out. Subsequently completing an intermittent hypoxia conditioning programme, the participants will perform the resuscitation manoeuvres at previously referenced altitudes. Sociodemographics, CPR quality, self-perception CPR, adequate anthropometric data, physical condition, blood tests, oxygenation in muscular tissue, biceps, brachii and erector spinae, subjective perception of effort, anxiety levels and quality of resuscitation will be measured in all participants at different altitudes. Discussion: Although CPR is a submaximal effort manoeuvre, it is subject to being performed by anyone without motor disabilities. Our study will also provide evidence as to whether this characteristic continues to hold true in a hostile environment such as medium and high altitudes. Our study aims to demonstrate that the improvement in physical performance and recovery capacity induced by intermittent hypoxia conditioning programmes increases the quality of CPR in prolonged cardiac arrests and in adverse conditions, such as at high altitudes. The proposed study will contribute as a novelty to the estimation of the influence of high altitudes and conditioning on performing basic CPR manoeuvres. If the hypothesis turns out to be true, recommendations about the practice of moderate-intensity physical exercise could be incorporated into the CPR guidelines as one of the important aspects in the training of rescuers to conduct CPR. Full article

Background: Current cardiopulmonary resuscitation (CPR) guidelines recommend a uniform chest compression depth (5–6 cm) for all adults, disregarding anatomical variability. The primary objective was to determine whether thoracic anthropometric parameters are associated with 28-day mortality after in-hospital cardiac arrest (IHCA); the secondary objective was whether these associations vary with CPR duration. Methods: In this retrospective single-center cohort, 431 adults with IHCA and available chest computed tomography (CT) were analyzed. Body mass index (BMI), internal anteroposterior diameter (IAPD), and external anteroposterior diameter (EAPD) were measured. Patients were stratified by CPR duration (≤5, 5–10, >10 min), and multivariable logistic regression with interaction terms tested time-dependent effects on 28-day mortality. Results: Overall 28-day survival was 40.8% (176/431). During the early phase (≤5 min), higher BMI, IAPD, and EAPD were each associated with increased mortality, and underweight patients had lower mortality than normal-weight and overweight patients. These anatomical associations attenuated and lost significance during prolonged resuscitation (>10 min), when CPR duration dominated outcomes. Conclusions: The prognostic value of body composition after IHCA is time-dependent, being greatest during the first five minutes, supporting individualized, body composition-guided chest compression—particularly using readily available BMI—during early resuscitation. Full article

The Lazarus phenomenon (LP), also called auto-resuscitation, may happen after the end of ineffective cardiopulmonary resuscitation (CPR), or after death is confirmed in a person who did not undergo CPR, and heart activity returns spontaneously. The aim of the study was to focus on older individuals (aged >60) experiencing the LP and to analyse distractors that cause this phenomenon. Methods. PubMed, Scopus, and Web of Science electronic databases were searched to find cases of LP from the year 1982 until 31 December 2025. Of the 81 total cases found, 48 patients were included in the study. For the analysis they were divided into two subgroups dependent on age: No 1 (60–79), No 2 (≥80). Results. Based on the descriptive analysis, the causes of cardiac arrest were divided almost equally between cardiac and non-cardiac causes (47.6% and 52.3% respectively). Cardiac arrest occurred equally in the IH and OH. In 16 out of 37 cases where such data were reported, a return to consciousness was confirmed, representing 43.2%. Conclusions. In older people, even those of very advanced age, the Lazarus phenomenon may occur. Based on the analysis carried out and given the lack of available data and the small sample size (48 individuals), it is not possible at this stage to definitively identify the causes of LP in the elderly population. As a potential cause of LP, age-related changes should be taken into account. Given that LP also occurs in the older population, consideration should be given to the need for extended monitoring of vital signs following the declaration of death. With a view to raising awareness of LP, it seems appropriate to include information on this phenomenon in the CPR guidelines. Full article

Background/Objectives: This prospective, randomised controlled trial aimed to evaluate whether using a real-time feedback device during basic life support (BLS) training for laypersons improves chest compression quality immediately after training and at the four-month follow-up. Methods: Participants were randomly assigned to a control group (standard BLS training) or an intervention group (BLS training with a real-time feedback device). All participants completed a standardised 2-h BLS course, followed by a 4-min practical assessment immediately after training and at the four-month follow-up. The primary outcomes were chest compression rate and depth, while the secondary outcomes were correct hand position, full chest recoil and flow fraction. These compression parameters were compared within and between groups at both time points. Results: Data from 101 participants were analysed. Both groups showed significantly decreased mean and adequate compression rates over time, but only the intervention group demonstrated significantly better performance at follow-up. The mean compression depth was approximately 5 cm in both groups; however, the proportion of adequate compression depth was low and did not differ significantly within or between groups. Correct hand position was consistently higher in the intervention group across both assessments. Full chest recoil improved in both groups, whereas flow fraction increased only in the control group. Conclusions: Incorporating real-time feedback devices into layperson BLS training leads to superior performance in selected chest compression parameters, particularly compression rate and hand position. Therefore, real-time feedback devices can be a valuable adjunct to standard BLS training to enhance skill retention over time. Full article