Exploring enablers and barriers to the use of chest compression feedback devices in advanced life support: a qualitative study

BACKGROUND: In sudden cardiac arrest, high-quality chest compressions are crucial for survival with favorable neurological outcomes. Chest compression feedback devices improve chest compression quality and the likelihood of achieving return of spontaneous circulation. However, implementation remains challenging. Understanding enablers and barriers is essential to inform implementation strategies and device design. METHODS: We conducted a qualitative exploratory study using semi-structured interviews with 15 healthcare professionals from pre- and in-hospital advanced life support settings in Norway and Denmark. Data were analyzed using reflexive thematic analysis to identify patterns of meaning related to enablers and barriers to device use. RESULTS: Data analysis led to the construction of four themes: (1) The CPR sensor-a key physical interaction point, where usability was shaped by ergonomics, as well as challenges related to sensor positioning and detachment. The sensor created a physical buffer that reduced the discomfort of feeling rib and sternum fractures and skin damage during compressions, helping providers maintain focus and perform compressions consistently. (2) Feedback-Device-to-rescuer communication, where visual feedback was preferred and considered informative, while audio feedback was often seen as disruptive and difficult to perceive during compressions. (3) Organizing cardiac arrest treatment, where team structure, leadership roles and protocol integration influenced device use. Clear assignment of responsibility and predefined equipment layout supported consistent use. (4) Perceived usefulness-an important enabling factor, where feedback was especially valued in supervisory roles, supporting clinical oversight and decision-making, leading to device integration into team workflows. In the pre-hospital setting, the device supported effective guidance for bystanders. The device's inability to provide physiological feedback raised questions about its future relevance. CONCLUSIONS: Successful implementation of chest compression feedback devices in advanced life support depends on user-centered design, role-sensitive feedback, and integration into clinical protocols. Key enablers included sensor ergonomics, visual feedback, and structured team roles, while barriers such as sensor detachment and disruptive audio feedback hindered sustained use. Future development should focus on multimodal feedback tailored to team functions and support physiology-guided resuscitation.