Feb. 4--Every few seconds, the sonorous male voice issues a command:

Compress a little deeper.

Increase duration of each compression.

Release pressure between compressions.

Ernest Kwiatkowski obediently adjusts the force of his hands on the breastbone of Resuscitation Anne, a vinyl dummy long used to teach cardiopulmonary resuscitation.

As an emergency department nurse at the Hospital of the University of Pennsylvania, Kwiatkowski already knows CPR. But this is the first time he can tell exactly how well he is doing it, because Anne is connected to a new CPR monitoring device.

Within a minute, the voice falls silent, satisfied with Kwiatkowski's technique.

"That is the best teacher you could ever have," he enthuses.

That "teacher," introduced to him last week, is part of a wave of technology and research aimed at breathing new life into CPR, the emergency treatment for cardiac arrest.

Developed almost half a century ago, the procedure allows someone to work a victim's heart and lungs manually. A rescuer pushes -- twice per second -- on the victim's chest, and that rescuer or a helper also gives intermittent mouth-to-mouth breaths. The two maneuvers temporarily force enough oxygenated blood through the victim to protect vital organs.

Studies show that high-quality CPR can double or triple the chance of survival, and that each minute without CPR cuts that chance by about 10 percent. Yet only about 15 percent of the estimated 215,000 Americans who suffer heart attacks outside hospitals each year get CPR right away.

"Sometimes, even if bystanders have taken a CPR course, they're paralyzed," says Vinay Nadkarni, a physician and resuscitation expert at Children's Hospital of Philadelphia. "They don't want to do it wrong."

Few people do it right, studies show. Even in hospitals, the quality of CPR is surprisingly poor, partly because there have been no quality-control instruments, according to research led by Penn emergency physician Benjamin Abella.

"We've been treating CPR as if we're still in the 1950s," Abella says. "We need to bring it into the modern era."

Three years ago, the American Heart Association reviewed the latest studies and updated CPR guidelines, putting more emphasis on chest compressions and less on the breaths -- which many rescuers find disgusting, not to mention germy.