A prior simulation-based investigation among medical professionals using manikins demonstrated that a cardiopulmonary resuscitation (CPR) coaching strategy yielded notable improvements in CPR quality compared with real-time audiovisual feedback from a defibrillator monitor. The objective of the current research was to determine whether these outcomes could be replicated in an expanded, multicenter study involving first responders. A multicenter, block-randomized trial was conducted among French firefighters. Rescuers were allocated into three distinct cohorts (n = 36 per group): a CPR coaching group, a defibrillator monitor group, or an unassisted control group. Every participant executed three separate 2-min sequences of external chest compressions using an adult cardiac arrest simulator, which recorded CPR quality, compression rate, chest recoil, and compression depth. A cohort of 108 participants was recruited across two distinct facilities; a single participant dropped out. During the second external chest compression sequence, the CPR coaching cohort demonstrated a significantly higher level of CPR quality than the defibrillator monitor cohort (median 99% [interquartile range (IQR) 99–100] vs 99% [78–99]; P = 0.0022). This statistical discrepancy remained evident during the third sequence (P = 0.0017). Compared with the unassisted control cohort, the quality of CPR in the CPR coaching group was markedly enhanced across both evaluation sequences (P < 0.001). In contrast, the defibrillator monitor cohort showed no statistically significant difference compared with the control group. This investigation validated the outcomes of our earlier project involving healthcare practitioners, confirming that CPR coaching is superior to defibrillator monitor feedback for improving CPR quality in a simulated environment with lay rescuers.
