Development of a quality metric to measure bystander cardiopulmonary resuscitation in out of hospital cardiac arrest: A modified Delphi study.
International Journal of Nursing Studies Advances · 2026-10-17 · Method & validation
Abstract
BACKGROUND: Out-of-hospital cardiac arrest remains a significant global public health challenge, with survival heavily dependent on early and high-quality bystander cardiopulmonary resuscitation. Current data collection frameworks lack standardised tools to assess the quality of bystander cardiopulmonary resuscitation. OBJECTIVE: This study aimed to develop a preliminary consensus-based quality metric for use in both research and clinical practice. SETTING: This study was conducted in the United Kingdom with international representation within the Delphi panel. PARTICIPANTS: A total of 104 participants registered, with 62, 48, and 18 completing rounds one to three, respectively in the Delphi panel. The panel consisted of Doctors, advanced practitioners, Paramedics, Nurses and academics. METHODS: A modified Delphi method was employed to identify and define quality indicators. Criteria were developed from a literature review, stakeholder input, and panel consensus. A diverse expert panel, including clinicians, researchers, educators, and informed laypersons, participated in three iterative rounds (two online surveys and a final virtual consensus meeting). Consensus was defined as ≥75% agreement on a 1-5 Likert scale. RESULTS: Eleven criteria achieved consensus for inclusion, encompassing core mechanical parameters (e.g., chest compression rate, depth, recoil) and contextual factors (e.g., dispatcher instruction, time from recognition to emergency call, and automated external defibrillator use). All criteria were agreed to be scored dichotomously. Two composite indicators were created to streamline overlapping elements. CONCLUSION: The provisional metric reflects both established guidelines and evolving evidence on factors influencing bystander cardiopulmonary resuscitation effectiveness. The inclusion of time and system-based criteria acknowledges the broader context in which cardiopulmonary resuscitation is delivered. Once validated in future studies this metric has potential for practical relevance for feedback tools, service evaluation, and research standardisation. This study was not registered.
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Tags
Automated external defibrillator · Bystanders · Research methods & trial conduct · Time intervals
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