Early cardiopulmonary resuscitation (CPR) can make a remarkable difference in a successful outcome for a victim of cardiac arrest. The chest compressions maintain a minimal flow of oxygenated blood to the vital organs, and an automated external defibrillator (AED) delivers an electrical pulse to sustain the cardiac muscle until advanced care can be given at the hospital. 

However, studies have shown that both professionals and laypeople may have trouble applying the proper rates and depths of compressions when administering CPR. That is why using manikins with measurable statistics has been recommended for certification classes since 2019. These feedback devices measure CPR performance in real-time and provide audiovisual messages to guide students to reach an accurate depth and rate every time. 

On 1/31/19, the American Heart Association (AHA) required instructors to have skills performed on adult manikins with instrumented directive feedback devices. As of Feb 2021, new policy requires feedback devices in the following courses:

  • Basic Life Support (BLS)
  • Advanced Cardiovascular Life Support (ACLS)
  • ACLS for Experienced Providers (ACLS EP)
  • Pediatric Advanced Life Support (PALS) 
  • Pediatric Emergency Assessment Recognition and Stabilization (PEARS) 
  • First Aid courses where BLS is also taught (SFA-BLS and EFA-BLS)
  • The policy recommends the use of feedback devices in the following courses:
  • First Aid (SFA) (SFAR) (EFA)
  • Heartsaver®
  • Hands-only CPR programs
  • Correct rate – 100-120 compressions per minute
  • Correct depth – Adult and Adolescent 5-6 cm; Infant 4 cm
  • Full chest wall recoil (also referred to as full chest release)

Make sure you are fully compliant with industry guidelines. The technology can show instructors how students improve both in-person and virtually, allowing instructors to easily monitor several students at once on a tablet or smartphone app. 

Mailable Manikins with Measurable Stats

When students can’t meet with an instructor, manikins with a CPR feedback device can be mailed to them. The instructor can then monitor compression rate, depth, hand placement, and chest recoil from any location. They know when the student is not performing the technique properly and help them make corrections until they master it. More engagement during training also improves student retention of the training methods.

Types of CPR Feedback Devices

CPR feedback devices range in quality and cost. The difference is in the feedback, technology, and durability they provide. The least expensive version only has a flashing red or green LED light to acknowledge the proper compression rate or offer an audible alarm if the compression depth isn’t achieved. If they are 1999 and newer, it is possible to update CPR manikins to meet current American Heart Association (AHA) guidelines. You can add components to get real-time compression rate, depth, release, ventilation volume, and number of cycles:

  • Practi-crm (rate only)
  • Practi-crdm
  • CPRmeter 2
  • Heartisense Kit

Buying a newer manikin built with the latest technology may be easier to maintain, and they can be purchased in package deals if you are teaching or replacing old manikins. Having adult, child, and infant manikins let students learn to adapt compression rates and depths accordingly. Each comes with warranties on eligible repair and replacement.

The most advanced manikins have better options and performance. They are more realistic to the eye and touch, come in different skin tones, have an automated pulse, and can be manipulated like a real person. Feedback is shown in real-time with tablet applications used by the instructor. These dolls have warranties and service plans for repairs by trained technicians. Compare models to find a lightweight manikin that is fast and simple to set up.

Recommended AHA compliant devices must have audio or visual feedback for compression depth (clicker or other feedback devices) and compression rate (progressive illuminating lights or other feedback devices). They include:

  • Prestan Professional Adult Training Manikin
  • Little Anne QCPR 
  • Little Anne Manikins with the retrofit upgrade kit

Equipment for a Basic Life Support (BLS) Instructor

Your healthcare facility equipment list should include an adult manikin that may be used for child skills, an infant manikin, bag valve masks (BVM), pocket masks with one-way valves, an AED trainer, disposable non-latex gloves, instructor and student manuals, and videos. 

Equipment for Non-Healthcare Provider Instructors

The list will vary depending on the modules being taught. American Red Cross instructors are not currently required to have feedback devices, but they are still recommended. Have an adult manikin, which can also be used for child skills, and an infant manikin, each with face shields/breathing barriers. You’ll need an AED, instructor and student manuals and videos, disposable non-latex gloves, gauze pads, and roller bandages.

Outside of COVID, AHA allows for a 1:3 (manikin:student) ratio while American Red Cross (ARC) allows for a 1:2 ratio. During COVID, instructors should have a 1:1 ratio to allow for social distancing requirements.

COVID Provisional Certification

A  Provisional Certificate provides students with a one year certification after the completion of an online course.  Students then have a full year to take an Instructor-led Skill Session. The student must bring their provisional certificate to the session. After successfully completing of the Instructor-led Skill Session, the student receives the standard two-year Red Cross Certificate. 

Consult your certifying organization for the most up-to-date guidelines or contact Safety Solved.


González-Otero, D.,  Ruiz de Gauna, S., Ruiz, J.,  Gutiérrez, J. , Leturiondo, S., Leturiondo, M., 2017. Audiovisual Feedback Devices for Chest Compression Quality during CPR, https://www.intechopen.com/books/resuscitation-aspects/audiovisual-feedback-devices-for-chest-compression-quality-during-cpr

Prestan, 2021. https://www.prestanproducts.com/products/cpr-training-manikins/professional-adult-manikin/

Main, MEd, NRP, R., 2020. CPR Feedback Devices: Improving Resuscitation Technique, https://www.distancecme.com/blog/cpr-feedback-devices-improving-resuscitation-technique/ 

American Red Cross, file:///C:/Users/scrib/Downloads/First%20Aid%20CPR%20AED%20Provisional%20Certification%20Course%20Details.pdf