Abstract
INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality in the UK, with survival rates remaining low despite advancements in resuscitation techniques. The European Resuscitation Council and Resuscitation Council UK guidelines recommend controlled ventilation during cardiopulmonary resuscitation (CPR), yet studies show that ambulance clinicians often fail to meet these standards. In particular, hyperventilation has been linked to worse outcomes. This protocol describes a study that will explore the impact of different applications of real-time ventilation feedback on the quality of ventilations during CPR in a simulated environment. METHODS: This exploratory simulation study will assess the effectiveness of real-time feedback on the quality of ventilations delivered by ambulance clinicians. Participants from North East NHS Foundation Trust will be randomly assigned to three arms, receiving a single episode of feedback, regular feedback or no feedback (used as a control group). Each arm will complete four simulated OHCA scenarios over six months, and their ventilation quality will be assessed at each session. The primary outcome will be the quality of ventilations, measured by rate and tidal volume, at the six-month mark. Secondary outcomes include trends in ventilation quality over time and participant characteristics. DISCUSSION: This study aims to explore whether regular feedback improves the quality of ventilations during CPR and whether feedback sessions influence skill retention over a six-month period. Findings could inform training strategies, highlighting the role of real-time feedback in maintaining high-quality CPR skills. With a lack of prior research on ventilation skill maintenance in the UK, this study is expected to provide valuable insights into optimising clinical performance.