## 4 Discussion  
An infant suffering from cardiac arrest (CA) generally has a high probability of immediate mortality and poor prognosis after a CA episode [1; 2; 3; 4; 5]. Therefore, the rescuer's quality of infant CPR should be improved during in and out of hospital cardiac arrest. Literature studies have reported that rescuers delivered poor chest compression quality during the performance of infant CPR without feedback and suggested using a real-time feedback system while performing infant CPR for monitoring and measuring the quality of infant CPR during CA [22; 23; 24]. In addition, CPR performance with a feedback assistance system required less time and fewer instructors as compared to no performance feedback [25]. Few studies have presented an optimal infant CPR feedback system in contrast to an adequate number of adult CPR systems. Some previous studies investigated the chest compression technique TT and TF during CPR performance and tried to decide the optimal chest compression technique for infant CPR performance [5; 23; 26; 27; 28]. This study aimed to develop a real-time CPR feedback system for monitoring, measuring, and improving the quality of chest compression depth, compression rate, chest release force and compression duty cycle during simulated CPR performance on an infant manikin. This section discusses the results of a series of investigations, comparing these results against literature studies and current CPR international guidelines [12; 13; 14; 29]. From the results it can be seen that, in general, the assistance of the feedback CPR system has a significant effect on the quality of chest compression during simulated infant CPR. Moreover, the internationally recommended targets [12; 13; 14; 29] of the four CPR parameters were achieved with the proposed feedback CPR system. As the study was presented using two CPR methods (TT and TF), it can be seen that, in general, when feedback was not provided to the rescuer, the quality of compression depth decreased. Interestingly, when observing the feedback group, the mean compression depth achieved by rescuers was observed to be the highest. In addition, with feedback on CPR performance, the rescuers achieved deeper chest compression depth through the TT compression technique. The compression depths achieved in this study were consistent with the literature [19; 20]  
Related to chest release force, the recommended international target for chest release force is at least 0.5 Kg and not to exceed 2.5 kg [29]. This study detected rescuers' failure to achieve the recommended target of chest release force without feedback infant CPR. This was comparable with previous studies that reported the role of the feedback system is  
Figure 6: The overall CPR quality performance during TT and TF. to improve the rescuers' infant CPR performance [30; 31]. However, it was observed that participants achieved the target of chest release force during simulated infant CPR using TT compression technique more easily than the TF technique, which is consistent with the outcomes reported in previous studies [26; 32]. Related to the compression rate, the recommended target for compression rate was rarely achieved by rescuers who were in the group performing CPR without feedback, and most often, rescuers were not able to reach the minimum required target, which is 100 min\({}^{-1}\). The feedback group demonstrated a significant difference across the two CPR methods. However, the rescuers achieved the recommended target compression rate during simulated infant CPR more easily when using the TT compression technique than the TF technique. This was consistent with the compression rate parameter reported by [6; 32; 33]. The compression duty cycle proved difficult to maintain, particularly when feedback was not provided. This could be due to difficulty in understanding how to maintain the duty cycle within the required limits, or due to a loss of concentration, perhaps as a result of focusing on the compression rates and depths.