Background: Cardiovascular disease has been the leading cause of mortality worldwide for the past century, but advancements in health intervention have led to a decline of over 20%.

However, the Out of Hospital Cardiac Arrest (OHCA) mortality rate remains unacceptably high, exceeding 90% over the past few decades. The primary reasons are the lack of cardiopulmonary resuscitation (CPR) knowledge and delayed medical response [1]. In 2018, the American Heart Association (AHA) introduced audio-directed CPR by 911 operators. However, the effectiveness of this approach in guiding laypeople to perform CPR is far from optimal [2].

Methods: Laypeople were randomly divided into audio and video groups, with each group receiving instructions through their respective medium on how to perform CPR on manikins. Simulated OHCA scenarios were created, involving on-site testing with subjects having no prior CPR experience, and a remote call site providing CPR instructions either through audio or video. Both on-site and online activities were recorded and analyzed. The accuracy of hand positions, the time of CPR initiation, the speed and effectiveness (depth) of chest compressions were tracked and compared between the audio and video guided groups based on AHA requirements.

Results: Across 61 trials, CPR initiation occurred in 22 ± 11 seconds in the audio group and 22 ± 6 seconds in the video group. Hand location accuracy was 77% in audio participants and 97% in video participants (p<0.05). The average speed of CPR was 0.55 ± 0.23 seconds with audio guidance and 0.45 ± 0.27 seconds with video guidance. The effectiveness of compressions was 33% ± 39% in the audio group and significantly improved to 79% ± 26% in the video group (p<0.0001).

Conclusion: The implementation of a new video-guided CPR system can significantly enhance CPR effectiveness when compared to the audio-assisted approach.

CPR, Chest compressions, Manikins, Audio-guided, Video-guided, Out-of-hospital cardiac arrest