Impact of verbal pressure on CPR and AED performance: a randomized simulation study

Objective: The aim of this randomized-controlled simulation study was to evaluate the impact of external verbal pressure on the effectiveness and safety of automatic external defibrillator (AED) use and hands-on cardiopulmonary resuscitation (CPR) performed by students. Methods: Sixty-two first-year nursing students were recruited. Participants were split into pairs (n=31), randomly assigned to the study (n=16 pairs) and control groups (n=15 pairs). Subsequently, each pair took part in a brief simulation scenario concerning out-of-hospital cardiac arrest. One student was responsible for performing chest compressions, whilst the second was responsible for using an AED. The researcher verbally pressed the participants responsible for AED use in the study group. Students performing chest compressions were not the addressee of any comments. Participants in the control group acted without the researcher's pressure. Results: Only 2 participants in the control group used AED incorrectly, compared with 8 participants in the study group who incorrectly performed defibrillation. The rate of hands-on CPR was significantly faster in the study group compared to the control group (124±29.7 versus 104±20.8; P=0.028). Conclusion: Verbal pressure in simulation settings significantly diminishes the quality of performance during AED use. The pressure affected not only the participants to whom it was directly addressed but also their teammates, who performed worse compared to those without additional stressors.