Quality of Cardiopulmonary Resuscitation

1
Quality of Cardiopulmonary Resuscitation

• Out-of-Hospital Cardiac Arrest
• ---JAMA. Jan,19, 2005293299-304.
• In-Hospital Cardiac Arrest
• ---JAMA.  Jan,19,2005293305-310.
• Presented by ?????
• Supervised by ?????

2
Introduction
Low survival rate
Ventilation 10-12/min
Chest Compression 100 / min 38-45 mm
CPR
JAMA Guideline for CPR
2000
3
Introduction
Outcome
Some studies deteriorated over time High
ventilation rate Long pause over AED
Actual Quality ?
CPR
JAMA Guideline for CPR
2000
Out-of-hospital
In-hospital
4
Quality of CPR During Out-of-Hospital Cardiac
Arrest

• --- Paramedics nurse anesthetists

5
Methods

• Patient Inclusion and Recruitment
• Akershus (Norway) , Stockholm (Sweden) London
  (England)
• gt 18 years with all rhythms.
• Noncardiac causes
• 2002.3 2003.10
• Equipment
• Heartstart 4000
• 6 ambulances each regions
• Extra Chest pad accelerometer pressure sensor
• ( compression rate, depth lt  1.6 mmgt )

6
Treatment Protocol

• All ambulances paramedics
• Stockholm
• second rescue vehicle a nurse anesthetist
• refresher course (international CPR guidelines)
  use of the modified defibrillator
• Resuscitation ? guidelines

7
Data Collecting and processing

• 2 Data cards
• 2 computer programs
• Time markers
• start of the first chest compression,
• 5 mins thereafter,
• end of the resuscitation
• Compression depth
• appropriate (38 to 51 mm )
• too deep
• too shallow.

8
Data Collecting and processing

• Duty cycle
• downward movement /total cycle time
• Compression rate ( 2 com. lt 1.5s)
• No-flow time (NFT) Ttotal  Tcompressions
  Tspont. Circulation
• No-flow ratio (NFR) NFT / (Ttotal   Tspont.
  Circulation )
• without cerebral and myocardial circulation
• NFTadj  NFT  time defibrillator
• NFRadj NFTadj  / (Ttotal   Tspont. Circulation
  )

Potential to reduce time without circulation
9
Outcome Measure

• Primary outcomes (adherence to guideline)
• compression rate
• 100 120/min to 120/min
• compression depth
• 38 52 mm
• ventilation rate
• 2 / 15 before intubation
• 10 12/min. after intubation

10
Results
11
Results
243-67176

• Table 1

12
Results

• Table 2

13
Results

• Table 3

P 0.004
P 0.02
14
Results

• Table 4

15
Conclusions

• Chest compression was not performed half of the
  time
• Most compressions are too shallow
• Compression rate is too high
• Compression / decompression ratio is ok

16
Quality of CPR During In-Hospital Cardiac
Arrest

• --- well-trained hospital staff

17
Methods

• Patients enrollment
• 12.11,2002 4.5,2004
• University of Chicago Hospitals
• Patients of cardiac arrest
• gt 18 y/o
• Exclusion operating room or emergency
  department
• Measuring parameters of CPR Quality
• Heartstart 4000SP
• Extra Chest pad accelerometer pressure sensor
• ( compression rate, depth lt  1.6 mmgt )
• CPR performers certified in BLS or ACLS

18
Data Analysis

• Chest compression rate, depth, ventilation rate,
  no-flow time, and NFF
• chest compression depth 38 51 mm Pauses in
  chest
• Pauses in compressions gt 1.5 seconds (for pulse
  checks and intubation) were excluded from rate
  calculations
• NFT (no-flow-time), NFF (no-flow-fraction)

19
Outcome Measure

• First 5 minutes of CPR, divided in to 30-sec.
  Segments
• Segments in which either chest compression or
  ventilation signals were obscured by signal noise
  were excluded from analysis
• Segments without compressions or ventilations
  were excluded from calculations of mean
  compression or ventilation rates

20
Evaluation of clinical outcomes

• 2nd analysis
• ROSC vs Died (first 5-min performance)

21
Results
1073 seg. 536.5 min

• Table 1

22
Results

• Table 2

22.6
26.8
lt0.17
23
Results

• Table 3

24
Conclusion

• Compression rate lt 100/min
• Compression depth is shallow
• Ventilation rate was higher
• NFF was longer then adherence (lt0.17)
• Quality of parameters of CPR was not meet
  guideline recommendations, even well-trained
  staff