Using CPR feedback to improve resuscitation quality

CPR quality improvement during in-hospital cardiac arrest Using a real-time audiovisual feedback system Abella et al, Resuscitation 2007

Quality of out-of-hospital cardiopulmonary resuscitation with CPR Real time automated feeback: A prospective interventional study

recording

CPR delivery

Kramer-Johansen et al, Resuscitation 2006

Feedback to rescuers

Can also use CPR data for DEBREIFING

Study of resuscitation event review:

All residents and students rotating through resuscitation team roles Debrief teams on their events Weekly 30-45 min resuscitation debriefing/teaching sessions

CPR is much more important that medications

60% 50% 40% 30% 20% 10% 0%

P=0.04 59%

40%

45%

Baseline

Feedback

Feedback +

Edelson et al, 2008 Training effect confirmed by Dine et al, 2008

CPR is much more important that medications Some important background information on resuscitation care

ACLS

Advanced cardiovascular life support

For ALL cases of cardiac arrest, providers should give 1 mg of epinephrine every 3-5 minutes during resuscitation care
Epinephrine (adrenaline) Natural hormone that is your fight or flight energizer

CPR is much more important that medications Intravenous drug administration during out-of-hospital cardiac arrest Olasveengen et al, JAMA 2009

Randomized trial of epinephrine versus no epinephrine For EMS treated cardiac arrest NO SURVIVAL BENEFIT!

Different methods to ensure CPR quality

Manual CPR support devices

Zoll AED, R series

Philips MRx

Mechanical CPR devices

Autopulse
LUCAS

Major studies of the Zoll Autopulse device

Ong et al, 2006 Out-of-hospital, Richmond, VA (single site)

Manual
ROSC 101/499 (20.2%)

Autopulse
96/278 (34.5%)

D/C

14/486 (2.9%)

27/278 (9.7%)

Major studies of the Zoll Autopulse device

Hallstrom et al, 2006 (ASPIRE) Out-of-hospital, multicenter randomized trial Sites in US, Canada

Manual ROSC D/C 92/373 (24.7%) 37/373 (9.9%)

Autopulse 104/394 (26.4%) 23/394 (5.8%)

What can professional rescues do to improve CPR?

Minimally interrupted cardiac resuscitation by emergency medical Services for out-of-hospital cardiac arrest Bobrow et al, 2008

EMS leaders in Arizona recognized the Importance of high quality CPR Interventions: 1. Delay intubation 2. 200 compressions before first shock 3. Minimize pre and post shock pauses

Tripled survival to hospital discharge (3.8% 9.1%)

What can professional rescues do to improve CPR?

Minimally interrupted cardiac resuscitation by emergency medical Services for out-of-hospital cardiac arrest Bobrow et al, 2008

Important to note: EMS leaders in Arizona recognized the Importance of high quality CPR These were SIMPLE interventions without new drugs or new devices Interventions: 1. Delay intubation Only armed with new knowledge 2. 200 compressions before first shock And education 3. Minimize pre and post shock pauses

Tripled survival to hospital discharge (3.8% 9.1%)

The million dollar (and million lives.) question:

What is the CPR quality like in YOUR community EMS agency?

If your loved one collapsed right now, and you called 911 would the EMS providers give resuscitation care following the Arizona protocol?

Summary key learning points

1. Cardiac arrest is not hopeless! 2. CPR quality has big impact 3. Minimize ventilations 4. Maximize chest compression rate and depth 5. For professional responders: consider CPR feedback tools and code debriefing

6. For the lay public: learn CPR!

Upcoming Coursera lectures in this program

Lecture 2:

Rethinking CPR: quality of care and new ideas about training

Lecture 3:
Lecture 4: Lecture 5: Lecture 6:

Finding the AEDs the role of social media

Therapeutic hypothermia and postresuscitation care Frontiers in resuscitation: reperfusion medicine and cardiac bypass Survivorship and end-of-life issues after cardiac arrest