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Article

Effect of Plus/Delta Structured Debriefing on the Duration of Guideline-Compliant Chest Compressions During Simulated Cardiopulmonary Resuscitation

by
José Manuel García-Álvarez
1,* and
Alfonso García-Sánchez
2
1
Health Sciences Program, Catholic University of Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
2
Faculty of Nursing, Catholic University of Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
*
Author to whom correspondence should be addressed.
Emerg. Care Med. 2026, 3(2), 12; https://doi.org/10.3390/ecm3020012
Submission received: 6 February 2026 / Revised: 18 March 2026 / Accepted: 20 March 2026 / Published: 24 March 2026
Versions Notes

Abstract

Background/Objectives: Optimization of the frequency and depth of chest compressions is considered essential for effective cardiopulmonary resuscitation in patients with cardiac arrest. Structured debriefing performed after actual or simulated cardiac arrest may help resuscitators maintain chest compression parameters within guideline-recommended ranges. The objective of the present study was to analyze whether Plus/Delta structured debriefing after clinical simulation of cardiac arrest on the duration of chest compressions performed within guideline-recommended frequency and depth ranges. Methods: A quasi-experimental study without a control group was carried out with nursing students. Compression frequency and depth parameters were analyzed in two manikin-based tests separated by the performance of a Plus/Delta structured debriefing. Results: After the intervention, the frequency and depth of chest compressions showed a slight decrease, accompanied by a statistically significant increase in the duration of cardiopulmonary resuscitation within the ranges recommended by the guidelines, although with limited clinical relevance. Conclusions: In this simulated setting, Plus/Delta structured debriefing was associated with a modest increase in the duration during which chest compressions were maintained within guideline-recommended frequency and depth ranges. Given the absence of a control group, these findings should be interpreted as exploratory but suggest a potential educational value of structured reflective debriefing in CPR training.

1. Introduction

The quality of chest compressions is a key component of effective cardiac arrest resuscitation. Frequency and depth are two major parameters used to assess chest compression performance [1].
According to current international guidelines, it is recommended that chest compressions in adults be delivered at a frequency of 100 to 120 compressions per minute and a depth of 50 to 60 mm [2,3]. These parameters are associated with sufficient blood flow to the vital organs, which can help reduce the risk of complications and improve survival outcomes in patients experiencing cardiac arrest [4,5].
As the frequency of chest compressions during cardiopulmonary resuscitation (CPR) in patients experiencing cardiac arrest decreases, a decline has been observed in the percentage of patients who return to spontaneous circulation [6,7]. Conversely, excessively high chest compression frequency may reduce coronary blood flow and decrease the percentage of compressions reaching optimal depth [8,9]. Several studies suggest that the optimal frequency of chest compressions is between 100 and 120 compressions per minute [7,8,10]. Frequency maintained above or below this range is associated with poorer resuscitation outcomes in cases of cardiac arrest [6,7,8,10,11].
A minimum chest compression depth of 50 mm in adults has been associated with improved success rates for defibrillation and recovery of spontaneous circulation in patients with cardiac arrest [12,13,14,15]. Chest compression depths of less than 38 mm have been associated with decreased survival rates [16]. The optimal depth of chest compressions seems to depend on different factors such as the size of the patient, the frequency of chest compressions or environmental characteristics, including the presence of a good support surface [17,18,19,20]. Resuscitators are encouraged to aim for optimal compression depth, potentially using real-time feedback devices or recording their performance for later analysis [21,22].
Several studies have observed that chest compressions are not usually performed adequately during the resuscitation of a patient in cardiac arrest [6,12,15,23,24]. Although the frequency of chest compressions is usually maintained in optimal ranges for a long time, the depth of chest compressions is usually insufficient from the beginning and progressively decreases over time due to resuscitator fatigue [23,25]. Therefore, it is recommended to conduct regular training courses aiming to achieve a frequency and depth close to the minimum optimal limits to delay fatigue [26], or to change resuscitators at least every 2 min at most [24,26,27,28,29].
While optimal frequency and depth are essential for effective CPR, maintaining these parameters over time is often limited by rescuer fatigue. Therefore, educational interventions may help play a greater role in prolonging the duration of compressions within recommended ranges rather than modifying mean compression values [21,25,27,30].
Although frequency and depth are distinct aspects of chest compressions, the two are closely interrelated in practice [31,32,33]. Maintaining an adequate and consistent frequency and depth of chest compressions is often quite difficult because as the rescuer becomes fatigued, the frequency and depth of compressions tend to decrease, decreasing the effectiveness of cardiac resuscitation [31,32,33]. Therefore, guidelines recommend changing rescuers approximately every two minutes or sooner if the rescuer is fatigued so as not to decrease the quality of chest compressions [2,3]. However, when only one rescuer is available, it is very important that chest compressions are performed with a minimum effective frequency and depth to maintain their quality for as long as possible, while awaiting the arrival of other rescuers or spontaneous recovery of the heartbeat [23,27,28,29,30].
Chest compressions in real-life situations have been observed to be too shallow or too fast [34]. This poor quality in chest compressions significantly reduces patient survival [8,11,15]. Therefore, periodic training using all available educational tools is necessary to ensure optimal frequency and depth of chest compressions in patients in cardiac arrest [34,35].
Clinical simulation is a key tool in the continuous improvement of CPR techniques, including the quality of chest compressions [36]. Clinical simulation-based learning is composed of different phases. The prebriefing phase prior to the simulation allows establishing the guidelines to be followed during the simulation and creates a climate of trust. The briefing phase follows, during which the simulation is carried out. Finally, the debriefing phase, in which individuals reflect on what happened and the mistakes made, is included in order to achieve true learning from the simulated experience [37,38].
In the debriefing phase, a reflection on the simulated clinical scenario is performed to identify areas for improvement. The debriefing phase is considered a key important stage to achieve effective and meaningful learning based on experience through clinical simulation. The debriefing should be a self-evaluation process where the students themselves, assisted by a facilitator, should point out their strengths and weaknesses regarding their behavior during the simulation. In this way, what was done correctly is reinforced and the causes behind inadequate or erroneous actions are investigated [39,40,41].
Post-simulation debriefing can be structured or unstructured. Unstructured debriefing lacks well-defined phases and is conducted through free-flowing dialogue following the simulated experience. Structured debriefing follows a script with defined phases that allow for a systematic approach to important aspects, facilitating analysis [42]. Structured debriefing typically consists of three phases: description, analysis, and application. In the description phase, participants describe what they did and what they felt during the performance of a simulated clinical scenario. The analysis phase focuses on determining what the participants’ strengths and weaknesses were during the performance of the simulated clinical scenario. Finally, the application phase helps participants translate what they learned in the simulated clinical scenario to real clinical situations [43,44]. Structured debriefing enhances learning by promoting the acquisition of competencies, problem-solving skills, and clinical reasoning [45,46].
In the analysis phase of a structured debriefing, a Plus/Delta feedback model can be used to identify aspects that should be maintained (Plus) and those that should be improved (Delta). The Plus/Delta structured debriefing is the most widely used because it is best suited when time is limited and allows the use of visual aids to address the Plus/Delta aspects [47,48,49].
Some studies have observed that debriefing after cardiorespiratory arrest simulation is able to improve the quality of chest compressions. Debriefing after CPR provides reflective feedback that integrates technical and non-technical aspects of chest compressions and, unlike other methods, promotes a more comprehensive and effective analysis [50,51].
The objective of the present study was to analyze the influence of Plus/Delta structured debriefing after a clinical simulation of cardiac arrest on the duration of chest compressions performed within guideline-recommended frequency and depth ranges.

2. Materials and Methods

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and with the approval of the Ethics Committee of the Catholic University of Murcia (UCAM). Participating students were informed about the study’s characteristics, that participation was entirely voluntary, and that refusing to participate would not affect their academic grade. Written informed consent was obtained, and the confidentiality of participants was guaranteed.
A quantitative methodology was used for this study with a quasi-experimental pre–post design study without a control group, following the TREND (Transparent Reporting of Evaluations with Non-Randomized Designs) checklist for non-randomized intervention studies [52]. Although the study followed a quantitative quasi-experimental design, brief descriptive qualitative information derived from the Plus/Delta analysis phase was collected to contextualize the intervention and make its educational mechanisms explicit. These data were not subjected to formal qualitative analysis.
The study was conducted in the clinical simulation rooms of the UCAM in the period from October 2023 to July 2024.
The study subjects were fourth-year nursing students at the UCAM who performed CPR in their clinical simulation practicum and who wished to participate voluntarily in this study. These students were chosen for this study because they had experience performing CPR with chest compressions. This prior experience reduced variability among students and allowed the observed results to be attributed to the intervention.
To select the sample, non-probabilistic convenience sampling was carried out according to the groups assigned to the researchers by the Internship Unit of the UCAM.
Each student performed two chest compression tests separated by a 20 min debriefing. In order to maintain methodological consistency and avoid bias, the two tests and the debriefing were conducted by the same instructor. Using the same instructor allowed for consistency in instruction and minimized potential biases related to interaction, participant motivation, or teaching style. This instructor has advanced training and certifications in clinical simulation, as well as several years of experience in teaching and conducting CPR sessions for medical and nursing students.
Chest compressions were performed on a life support simulator manikin SimMan 3G (Laerdal, Stavanger, Norway) placed on the floor and equipped with a device that recorded the frequency and depth of chest compressions. Each participant individually performed chest compressions for a minimum of two minutes or until four consecutive chest compressions were no longer of sufficient quality in terms of frequency or depth. Chest compressions were defined as sufficient quality if they had a frequency of between 100 and 120 compressions per minute and a depth of between 50 and 60 mm.
After the initial chest compression test (pre), a structured Plus/Delta debriefing was conducted. This type of debriefing consists of three stages: reaction, analysis, and application. In the reaction stage, participants express their impressions and emotions to release tension and create a safe learning environment (approximate duration: 4 min). In the analysis stage, students conduct a reflective analysis of the initial test, verbalizing and writing on a board the strengths or aspects to maintain (Plus) and the weaknesses or points for improvement (Delta) (approximate duration: 12 min). In the application stage, practical conclusions were drawn that the students had to take into account in the final test (post) that was carried out afterwards (duration: approximately 4 min).
During the analysis phase of the Plus/Delta debriefing, participants explicitly identified strengths (Plus) and areas for improvement (Delta), which were verbally discussed and written on a board. These reflections focused primarily on compression rhythm control, avoidance of excessive speed, body posture, arm position, and perceived fatigue management strategies.
The variables in this study included gender, age, time with adequate chest compression frequency according to current resuscitation guidelines (seconds), time with adequate chest compression depth according to current resuscitation guidelines (mm), overall mean compression frequency, mean compression frequency per minute, overall mean compression depth, and mean compression depth per minute.
Data were collected directly from the SimMan 3G simulator and automatically exported to a Microsoft Excel file for subsequent analysis. The recorded variables were time with adequate compression frequency (seconds), time with adequate compression depth (mm), mean compression frequency per minute, and mean compression depth per minute. Although the SimMan 3G simulator is capable of providing information on chest recoil or residual compression, these variables were not recorded and therefore were not included in the analysis. Consequently, the assessment of compression release was outside the scope of the present study.
The IBM SPSS Statistics for Windows (Version 26.0, Armonk, NY, USA: IBM Corp.) statistical program was used to analyze the data obtained, calculating the frequencies and percentages for the qualitative variables, as well as the mean and standard deviation for the quantitative variables. The normality of the quantitative variables was analyzed. To evaluate the associations between the different variables analyzed, the Pearson bivariate correlation test, independent-samples and paired-samples Student’s t-test and McNemar’s test were used, considering differences with a value of p < 0.05 significant. In addition to statistical significance testing, effect sizes were calculated using Cohen’s d to estimate the magnitude of the observed differences between pre- and post-intervention measurements.
Correlation analyses were performed to explore the relationships between compression frequency, compression depth, and the duration of guideline-compliant compressions, in order to contextualize the effects of fatigue and performance trade-offs observed before and after the debriefing.

3. Results

The study sample consisted of 73 participants, 47 women (64.4%) and 26 men (35.6%). The age of the participants in this study presents a minimum value of 20 years and a maximum of 32 years, with a mean of 22.6 and a standard deviation of 2.605.
The results indicate small but significant changes in all evaluated chest compression performance parameters. The effect size was large for the time during which frequency and depth remained within the recommended ranges, and moderate for the remaining parameters (overall mean frequency, overall mean depth). However, since the parameters were analyzed separately, these results do not necessarily reflect the simultaneous maintenance of all of them within the recommended ranges (Table 1). Despite the large effect sizes, the absolute differences were small, reflecting modest gains in performance within an already high baseline level.
The Kolmogorov–Smirnov test indicated that all quantitative variables in this study followed a normal distribution curve.
The McNemar test was used to analyze the association between the percentages of participants who performed chest compressions within the guideline-recommended frequency or depth ranges in both tests at each minute. This test was appropriate because the analyzed variable was dichotomous (adequate frequency or depth according to resuscitation guidelines vs. non-adequate frequency or depth). No statistically significant differences were observed between tests during the first two minutes, whereas significant differences were found from the third minute onward. The Plus/Delta structured debriefing intervention appears to delay the onset of fatigue and to maintain chest compression frequency and depth within guideline-recommended ranges for a longer duration (Table 2).
Pearson’s test was used to analyze the correlations between the different quantitative variables of this study. It was observed that the age of the participants in this study did not present any statistically significant correlation with the rest of the quantitative variables of the study. Statistically significant negative correlations were observed between compression frequency, compression depth, and the duration of guideline-compliant chest compressions. These correlation analyses were performed to provide contextual insight into the interaction between compression parameters and the duration of guideline-compliant performance (Table 3).
The independent-samples Student’s t-test was used to analyze the association between gender and the variables analyzed related to the frequency and depth of chest compressions in both tests. As can be seen, a statistically significant association was found between gender and all the variables analyzed in both tests, except for the overall mean frequency in the initial test. Table 4 depicts the descriptive analysis of the variables analyzed regarding the frequency and depth of chest compressions by gender. As can be seen, in both tests, the values are higher in males.
The Plus/Delta debriefing revealed recurrent themes among participants. Frequently identified Plus items included maintaining an initial compression rhythm within recommended limits and adequate hand positioning. Common Delta items involved excessive compression speed over time, progressive reduction in depth due to fatigue, and inadequate body posture. During the application phase, participants proposed concrete strategies such as consciously targeting the lower limit of the recommended frequency range, improving body mechanics, and pacing compressions to delay fatigue.

4. Discussion

This research has demonstrated that the Plus/Delta structured debriefing was associated with a statistically significant increase in the duration during which chest compression frequency and depth remained within guideline-recommended ranges. Delays in initiating effective chest compressions during cardiac arrest are associated with reduced survival probability: observational data indicate that each minute of delay in bystander CPR may reduce survival odds by approximately 2–3% [53], while contemporary international resuscitation guidelines synthesize evidence from multiple studies, emphasizing that survival decreases substantially with each minute without effective CPR, with secondary interpretations commonly expressed as a 7–10% reduction per minute [2,3]. Therefore, interventions such as structured Plus/Delta debriefing that help maintain adequate compression quality for longer durations could potentially contribute to improved resuscitation performance and, indirectly, patient outcomes. However, direct evidence linking the duration of quality CPR to increased survival remains limited, and this should be interpreted with caution.
Although statistically significant, the observed increases in the duration of guideline-compliant compressions were modest (21 s for frequency and 14 s for depth) and should be interpreted with caution from a clinical perspective. Mean compression frequency and depth remained nearly identical between tests and within recommended ranges, indicating a clear ceiling effect. This ceiling effect is likely related to the study population, as nursing students already possess baseline CPR knowledge and skills that limit the potential for measurable improvement in mean compression parameters.
Studies analyzing real-life cardiopulmonary resuscitation situations have observed a low level of guideline-compliant chest compressions, even when performed by healthcare professionals [6,12,15,23,24]. It is essential that chest compressions are performed within the frequency and depth limits considered optimal to support the maintenance of guideline-compliant CPR and potentially improve patient outcomes [2,3]. Very deep or rapid chest compressions can exhaust the rescuer, causing a progressive decrease in the quality of chest compressions and the effectiveness of resuscitation of the patient with cardiac arrest [23,25]. Therefore, it is necessary to use all those tools that allow training to improve the quality of chest compressions, such as the Plus/Delta structured debriefing used in this study.
The age and gender of resuscitators are important factors to consider because they can influence the ability to maintain adequate depth and frequency during CPR. In this study, a statistically significant negative correlation was observed between the frequency and depth of chest compressions. A statistically negative correlation of the frequency and depth of chest compressions with the duration of quality chest compressions was also observed. In addition, there was a tendency for rescuers to perform a rapid frequency that was accompanied by a decrease in the depth of chest compressions. These findings suggest that excessively high compression frequencies may be associated with reduced depth and shorter durations of guideline-compliant compressions. The Plus/Delta structured debriefing used in this research appears to support participants in maintaining chest compression frequency and depth within ranges considered optimal by previous studies [7,8,10,12,13,14,15] and by current guidelines [2,3]. The intervention did not change this negative physiological correlation between frequency and depth, although it allowed chest compressions to be maintained for longer within optimal values.
The observed negative correlations between frequency, depth, and duration highlight known physiological trade-offs during CPR and support the interpretation that the Plus/Delta structured debriefing did not alter these inherent relationships, but rather helped participants manage them more effectively over time.
In the initial test of this study, it was observed that the deterioration in the frequency and depth of chest compressions occurred after the second minute. These results are consistent with various studies that recommend rotating resuscitators at least every two minutes [23,27,28,29,30]. If there is only one resuscitator, it would be necessary to ensure that the frequency and depth of chest compressions are as close as possible to the optimal lower limit in order to reduce fatigue and increase the quality of cardiac resuscitation time. The results obtained in the second test after the Plus/Delta structured debriefing have proven useful in achieving this objective.
In addition to fatigue, the poor quality of chest compressions is influenced by the lack of adequate training [26]. Different studies have evaluated the effects of simulated scenarios, real-time audiovisual feedback, and debriefing after CPR on chest compression performance [54,55,56]. While some studies report improvements in optimizing compression frequency and depth, other [55], indicate that audiovisual feedback alone may not consistently enhance CPR quality and can be associated with deviations from recommended compression depth. These findings highlight the complexity of implementing feedback strategies effectively, underscoring the need for further research to identify the most effective approaches to improve CPR quality in clinical settings.
As has also been observed in other studies, the use of Plus/Delta structured debriefing after clinical simulation is able to improve the quality of chest compressions in CPR by optimizing frequency and depth and increasing the duration of effective chest compressions [50,51]. The Plus/Delta structured debriefing method used in this study has successfully adjusted the frequency and depth of chest compressions to the minimum optimal limits, increasing the time it takes for the rescuer to become fatigued and enhancing their effectiveness. The structured Plus/Delta debriefing intervention appears to allow guideline-compliant chest compressions to be maintained for several minutes longer.
Making the Plus/Delta debriefing content explicit allows a better understanding of how the intervention may have influenced performance. Rather than modifying mean compression values, the debriefing helped participants recognize fatigue-related behaviors and adopt strategies aimed at prolonging the duration of guideline-compliant compressions.
From a practical perspective, the most relevant finding is the increased proportion of participants able to maintain guideline-compliant compressions over successive minutes, as shown in Table 2. This effect is particularly relevant in situations where rescuer rotation is not feasible and a single rescuer must sustain effective CPR for as long as possible. Structured Plus/Delta debriefing appears to support fatigue management strategies rather than altering compression mechanics.
In this study, a statistically significant association was observed between the gender of the participants and the duration of quality chest compression frequency in both tests, the overall mean frequency of the final test, the duration of quality chest compression depth in both tests, and the overall depth in both tests. Consistent with other studies, it has been observed that the frequency and depth of chest compressions in both tests are higher in the male gender [25,26,56]. The gender of the resuscitator can influence the quality of compressions due to physiological differences, although training, physical condition, and the use of technological aids can minimize this effect.
The present study has some limitations that derive from the non-probabilistic selection of the sample, which could limit its external validity. In addition, it was a simulation study with a mannequin and did not involve chest compressions in real cardiac arrest situations with the differences that could be found especially in chest stiffness. As the final test was performed immediately after debriefing, it was not possible to assess whether the improvements observed were maintained in the long term.
Since all students were part of the same educational program in which simulated chest compressions followed by structured debriefing are mandatory, it was not possible to establish a control group. The absence of this control group limits the ability to attribute the results obtained to structured debriefing, although since it was the only intervention carried out between the two consecutive simulations, it is likely that it contributed to the observed changes. Future studies should employ controlled intervention designs, including parallel control groups without structured debriefing or with alternative debriefing strategies. Such designs would allow a more robust evaluation of the causal effect of Plus/Delta structured debriefing on CPR performance and help determine whether the observed prolongation of guideline-compliant compressions translates into clinically meaningful benefits.
While this study focused on the duration of chest compressions meeting guideline-recommended depth and rate with Plus/Delta structured debriefing, Cheng et al. (2023) assessed a broader set of parameters before and after data-informed debriefing, including chest compression fraction, peri-shock pause, and time to interventions [50]. Their study did not specifically evaluate the time compressions remained within guideline depth and rate, so direct comparisons are limited. Nonetheless, both studies show that structured debriefing improves guideline-compliant chest compressions in simulation settings, and future research should compare Plus/Delta and data-informed approaches to determine which most effectively sustains CPR performance.
Another limitation of the study was its failure to consider other factors that can also influence the quality of chest compressions during cardiopulmonary resuscitation, such as chest expansion or incomplete chest recoil. However, the frequency and depth of chest compressions are the factors that depend most directly on the rescuer and are therefore the ones that can be maintained within optimal limits with any patient or situation. In addition, the frequency and depth of chest compressions indirectly influence chest expansion and incomplete chest recoil, as excessively high compression frequencies or depths can reduce both factors. Future studies should also include these parameters to enable a more comprehensive assessment of the effect of Plus/Delta structured debriefing on overall improvements in chest compression quality.

5. Conclusions

Current resuscitation guidelines emphasize the importance of maintaining chest compressions within recommended frequency and depth ranges to ensure effective cardiopulmonary resuscitation. Our findings support these recommendations by demonstrating that Plus/Delta structured debriefing can prolong the duration of guideline-compliant chest compressions in a simulation setting.
In addition, our results suggest that maintaining compression frequency and depth closer to the lower limit of the recommended range may help delay rescuer fatigue and sustain performance over time, particularly in scenarios where rescuer rotation is not feasible. These findings provide practical insight into how guideline targets may be operationalized during prolonged resuscitation efforts.
Plus/Delta structured debriefing appears to be a useful educational tool for supporting chest compression frequency and depth within recommended ranges and increasing the duration of guideline-compliant cardiopulmonary resuscitation in simulated settings. Further studies are needed to determine the most appropriate ways to implement this approach in academic and professional settings and to assess whether it leads to clinically meaningful improvements in chest compression performance.
The practical value of Plus/Delta structured debriefing lies in its potential to help rescuers maintain guideline-compliant chest compressions for longer periods, particularly in single-rescuer scenarios, rather than in producing clinically meaningful changes in mean compression frequency or depth.

Author Contributions

J.M.G.-Á. and A.G.-S.: conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing—original draft preparation, writing—review and editing, visualization, supervision, and project administration. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was performed in accordance with the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of the Catholic University of Murcia (UCAM) (Reference number: CE012107/Date of approval: 29 January 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Chest compression performance parameters before and after the intervention.
Table 1. Chest compression performance parameters before and after the intervention.
Initial Test FinalTest
VariableMinimum
Value		Maximum
Value		MeanStandard DeviationMinimum
Value		Maximum
Value		MeanStandard Deviationp-Values *Effect Size **
Time within recommended frequency range 9739221867.9210740223972.760.0001.04
Overall mean frequency 991131103.491001181093.820.0000.64
Time within recommended depth range 9538621466.8210539722871.130.0051.08
Overall mean depth 4962553.445061543.200.0000.55
Note: Duration time (seconds), frequency (chest compressions per minute), depth (millimeters). * Paired-samples Student’s t-test. ** Cohen’s d.
Table 2. Frequency and percentage of participants performing chest compressions within guideline-recommended frequency and depth ranges over time.
Table 2. Frequency and percentage of participants performing chest compressions within guideline-recommended frequency and depth ranges over time.
FrequencyDepth
Initial Test
Number/%		Final Test
Number/%		p-Values *Initial Test
Number/%		Final Test
Number/%		p-Values *
First minute72/9973/1001.00072/9973/1001.000
Second minute67/9271/970.12566/9070/960.500
Third minute44/6056/770.00046/6355/750.012
Fourth minute20/2729/400.00417/2324/330.016
Fifth minute12/1620/270.0088/1115/210.016
Sixth minute2/311/150.0162/39/120.016
Note: Number/% = number of participants/percentages. * McNemar’s test.
Table 3. Correlations between frequency and depth of chest compressions.
Table 3. Correlations between frequency and depth of chest compressions.
Initial Test FinalTest
Time Within Recommended Frequency RangeOverall Mean FrequencyTime Within Recommended Depth RangeOverall Mean DepthTime Within Recommended Frequency RangeOverall Mean FrequencyTime Within Recommended Depth RangeOverall Mean Depth
Initial test: Time within recommended frequency range-−0.580 *1.000 *0.928 *0.961 *−0.603 *0.983 *0.933 *
Initial test: Overall mean frequency−0.580 *-−0.581 *−0.485 *−0.557 *0.896 *−0.600 *−0.554 *
Initial test: Time within recommended depth range1.000 *−0.581 *-0.929 *0.962 *−0.605 *0.984 *0.934 *
Initial test: Overall mean depth0.928 *−0.485 *0.929 *-0.933 *−0.588 *0.936 *0.953 *
Final test: Time within recommended frequency range0.961 *−0.557 *0.962 *0.933 *-−0.654 *0.978 *0.888 *
Final test: Overall mean frequency−0.603 *0.896 *−0.605 *−0.588 *−0.654 *-−0.640 *−0.584 *
Final test: Time within recommended depth range0.983 *−0.600 *0.984 *0.936 *0.978 *−0.640 *-0.910 *
Final test: Overall mean depth0.933 *−0.554 *0.934 *0.953 *0.888 *−0.584 *0.910 *-
Note: Pearson’s test. * p < 0.01.
Table 4. Frequency and depth of chest compressions according to gender.
Table 4. Frequency and depth of chest compressions according to gender.
WomanMan
MeanStandard DeviationMeanStandard Deviationp-Values *
Initial test: Time within recommended frequency range20157.5524974.880.006
Initial test: Overall mean frequency1113.221093.900.229
Initial test: Time within recommended depth range19756.5024573.780.006
Initial test: Overall mean depth543.15572.970.000
Final test: Time within recommended frequency range22164.7627176.600.004
Final test: Overall mean frequency1103.721083.650.018
Final test: Time within recommended depth range21161.4125977.660.008
Final test: Overall mean depth532.91562.860.000
Notes: Duration time (seconds), frequency (chest compressions per minute), depth (millimeters). * Independent-samples Student’s t-test.
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García-Álvarez, J.M.; García-Sánchez, A. Effect of Plus/Delta Structured Debriefing on the Duration of Guideline-Compliant Chest Compressions During Simulated Cardiopulmonary Resuscitation. Emerg. Care Med. 2026, 3, 12. https://doi.org/10.3390/ecm3020012

AMA Style

García-Álvarez JM, García-Sánchez A. Effect of Plus/Delta Structured Debriefing on the Duration of Guideline-Compliant Chest Compressions During Simulated Cardiopulmonary Resuscitation. Emergency Care and Medicine. 2026; 3(2):12. https://doi.org/10.3390/ecm3020012

Chicago/Turabian Style

García-Álvarez, José Manuel, and Alfonso García-Sánchez. 2026. "Effect of Plus/Delta Structured Debriefing on the Duration of Guideline-Compliant Chest Compressions During Simulated Cardiopulmonary Resuscitation" Emergency Care and Medicine 3, no. 2: 12. https://doi.org/10.3390/ecm3020012

APA Style

García-Álvarez, J. M., & García-Sánchez, A. (2026). Effect of Plus/Delta Structured Debriefing on the Duration of Guideline-Compliant Chest Compressions During Simulated Cardiopulmonary Resuscitation. Emergency Care and Medicine, 3(2), 12. https://doi.org/10.3390/ecm3020012

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