HIGH PERFORMANCE CPR and RESUSCITATION QUALITY IMPROVEMENT
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This presentation was used to facilitate a discussion of the AHA CPR Quality Consensus Statement, CPR compliance vs. competency, key quality challenges, review of related science, the concept of “pit crew” CPR, and RQI tools and processes. Download the slides to enable video and other links. You will need to hover over video and other icons.
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HIGH PERFORMANCE CPR and RESUSCITATION QUALITY IMPROVEMENT
- 6. “Poor-quality CPR should be considered a preventable harm. In healthcare environments, variability in clinician performance has affected the ability to reduce healthcare associated complications, and a standardized approach has been advocated to improve outcomes and reduce preventable harms. The use of a systematic continuous quality improvement (CQI) approach has been shown to optimize outcomes in a number of urgent healthcare conditions.”
- 7. “Despite this evidence, few healthcare organizations apply these techniques to cardiac arrest by consistently monitoring CPR quality and outcomes. As a result, there remains an unacceptable disparity in the quality of resuscitation care delivered, as well as the presence of significant opportunities to save more lives.”
- 10. WE CAN’T EXPECT TO WIN “RACES” WITHOUT MEANINGFUL PRACTICE AND AN ONGOING ITERATIVE PROCESS OF MEASURING AND IMPROVING…
- 18. Systole Diastole
- 22. DEATH BY HYPERVENTILATION A COMMON EXPERIENCE IN CARDIAC ARREST
- 25. THE PAINFUL TRUTH •Perceived performance does not always match observed performance. •Aufderheide et al. showed that duty cycle, chest compression depth and complete recoil were performed significantly less well when directly observed than EMT perceptions of their performance. •Wik et al. showed that chest compression rate and depth were both significantly below AHA guidelines by trained EMS providers, and no flow time (when there was neither a pulse nor CPR being given) was almost 50% in directly observed performance evaluations. •The likelihood of ROSC increases significantly with higher mean chest compression rate (in a hospital study 75% of patients achieved ROSC with 90 or more chest compressions/minute compared to only 42% with 72 or fewer chest compressions/minute).
- 30. Fatigue and poor crew resource management (CRM) contributed to the accident. EA 401 gradually lost altitude while the flight crew was preoccupied and eventually crashed. The effect of this crash on the airline industry continues today and has resulted in the development of Crew Resource Management (CRM). CRM is a technique that requires air crews to divide the work in the cockpit
- 34. “Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)”
- 38. Improved survival Intubation Rapid rhythm analysis Switch compressor s every 2 min. Compress Minimize pauses Hover hands Minimize interruptions Paramedic Advanced Life Support IV placement Administer drugs Prioritize compressions C-A-B Full recoil > 2 inches EMT CPR Foundation Rate between 100 and 120/min
- 40. •EMTs own CPR •Minimize interruptions in CPR at all times •Ensure proper depth of compressions (>2 inches) •Ensure full chest recoil/decompression •Ensure proper chest compression rate (100-120/min) •Rotate compressors every 2 minutes •Hover hands over chest during shock administration and be ready to compress as soon as patient is cleared •Intubate or place advanced airway with ongoing CPR •Place IV or IO with ongoing CPR •Coordination and teamwork between EMTs and paramedics
- 41. •C-A-B •Minimize interruptions in compressions •Compress at least 100/min •Allow complete chest wall recoil/decompression between compressions •Rhythm assessment every 2 minutes •Rotate compressors every 2 minutes •Hover over patient with hands ready during defibrillation so compressions can start immediately after the shock (or analysis) has occurred
- 46. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 48. 1 2 3 4 5 6
- 53. A continuous process evaluates and improves clinical care and generates new guidelines and therapy. Meaney P et al. Circulation 2013;128:417-435 Copyright © American Heart Association
- 55. Illustration of proposed resuscitation “report cards.” Routine use of a brief tool to document resuscitation quality would assist debriefing efforts and quality improvement efforts for hospital and emergency medical services systems. Meaney P et al. Circulation 2013;128:417-435 Copyright © American Heart Association
- 67. "Eisenberg has done a remarkable job in articulating the steps to be taken for communities to improve survival from sudden cardiac arrest. Resuscitate! is a 'best in class' and one of a kind guide that provides inspiration as well as direction in translating resuscitation science into practice. It is essential for all those who seek to establish strategies to improve survival and quality of life for cardiac arrest victims whose hearts are 'too young to die.'" - David B. Hiltz, EMT-P Resuscitation Academy Alumni
Editor's Notes
- http://www.youtube.com/watch?v=VMoex059t3E&feature=share&list=UUQj31V_yV1cvduWyBETc80w
- Perceived performance does not always match observed performance.Aufderheide et al. showed that duty cycle, chest compression depth and complete recoil were performed significantly less well when directly observed than EMT perceptions of their performance.Wik et al. showed that chest compression rate and depth were both significantly below AHA guidelines by trained EMS providers, and no flow time (when there was neither a pulse nor CPR being given) was almost 50% in directly observed performance evaluations.The likelihood of ROSC increases significantly with higher mean chest compression rate (in a hospital study 75% of patients achieved ROSC with 90 or more chest compressions/minute compared to only 42% with 72 or fewer chest compressions/minute).
- The 2010 AHA Guidelines for CPR and ECC once againemphasize the need for high-quality CPR, including• A compression rate of at least 100/min (a change from“approximately” 100/min)• A compression depth of at least 2 inches (5 cm) in adults• Allowing for complete chest recoil after each compression• Minimizing interruptions in chest compressions• Avoiding excessive ventilation
- The quality of unprompted CPR in both in-hospital and out-of–hospital cardiac arrest events is often poor, and methods shouldbe developed to improve the quality of CPR delivered to victimsof cardiac arrest.73,91–93,287 Several studies have demonstratedimprovement in chest compression rate, depth, chest recoil,ventilation rate, and indicators of blood flow such as end-tidalCO2 (PETCO2) when real-time feedback or prompt devices areused to guide CPR performance.72,73,80,288–293 However, there areno studies to date that demonstrate a significant improvement inpatient survival related to the use of CPR feedback devicesduring actual cardiac arrest events. Other CPR feedback deviceswith accelerometers may overestimate compression depth whencompressions are performed on a soft surface such as a mattressbecause the depth of sternal movement may be partly due tomovement of the mattress rather than anterior-posterior (AP)compression of the chest.62,294 Nevertheless, real-time CPRprompting and feedback technology such as visual and auditoryprompting devices can improve the quality of CPR (Class IIa,LOE B).