The Impact of Real-Time CPR Feedback Devices on Chest Compression Quality and Neurologic Outcomes in Pediatric Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Background The impact of real-time CPR feedback devices on outcomes in pediatric out-of-hospital cardiac arrest (OHCA) remains inadequately synthesized. This systematic review and meta-analysis aimed to evaluate the effect of these devices on chest compression quality and neurologic outcomes in this population. Methods We searched seven electronic databases and clinical trial registries from January 2015 to December 2024 for randomized controlled trials and observational studies comparing real-time CPR feedback devices to standard CPR in pediatric OHCA. Study selection, data extraction, and risk-of-bias assessment (using RoB 2 and ROBINS-I tools) were conducted independently by two reviewers. Meta-analyses were performed using random-effects models, and the certainty of evidence was assessed with the GRADE framework. Results From 957 identified records, 11 studies involving 3,448 patients were included in the meta-analysis. Pooled analysis demonstrated that feedback devices significantly improved the rate of good neurological outcome (Cerebral Performance Category 1–2) (Risk Ratio [RR] 1.32, 95% CI 1.12–1.56; I²=45%; moderate certainty). Significant benefits were also observed for return of spontaneous circulation (RR 1.24, 95% CI 1.08–1.43), survival to hospital discharge (RR 1.18, 95% CI 1.01–1.38), and chest compression depth (Mean Difference 3.2 mm, 95% CI 1.8–4.6). Subgroup analyses revealed greater effectiveness for children aged 1–12 years compared to infants, and for audiovisual devices compared to sensor-based systems. Conclusion Real-time CPR feedback devices significantly improve neurological outcomes, survival, and CPR quality in pediatric OHCA. These findings support the implementation of this technology, particularly audiovisual feedback systems, in pediatric resuscitation protocols.