Despite the widespread availability of defibrillators and advanced cardiovascular life support (ACLS)‐trained personnel, survival from in‐hospital cardiac arrest remains poor. We have previously shown that cardiopulmonary resuscitation (CPR) quality is highly variable and often not in compliance with published ACLS guidelines. Furthermore, we have demonstrated that the use of real‐time audiovisual feedback alone provides only modest improvement in CPR quality without affecting patient outcomes. We hypothesized that the addition of a debriefing educational intervention, aimed at resuscitators, would improve CPR quality and patient outcomes during in‐hospital cardiac arrest.
Resuscitation team members at a tertiary‐care hospital underwent weekly debriefing sessions between March 2006 and November 2006. A commercially available defibrillator with CPR‐sensing and real‐time audiovisual feedback capabilities was used. Chest compression and ventilation characteristics were recorded and compared to a historical control cohort (which utilized an investigational prototype of the same device without debriefing) from December 2004 to December 2005. Data were prospectively collected from adult inpatients who suffered a cardiac arrest during the study period and underwent CPR with the study device.
A total of 100 patients met inclusion criteria for the intervention period, compared with 101 in the control period. There were no statistically significant differences in baseline characteristics. Compared with the control period, in the intervention period mean ventilation rate was decreased (12 ± 7/min vs. 17 ± 9/min, P = .01), compression rate and compression depth were increased (rate: 105 ± 8/min vs. 101 ± 10/min, P < .001; depth: 50 ± 9 vs. 44 ± 9 mm, P < .001), and a smaller fraction of time was spent without compressions (0.11 ± 0.09 vs. 0.22 ± 0.15, P < .001). Furthermore, a significantly smaller fraction of arrest time was spent outside the ACLS guideline‐recommended range for compression rate and depth as well as ventilation rate. These changes correlated with an increase in the rate of return of spontaneous circulation (ROSC) in the intervention group (59% vs. 45%, P = .04). There was no statistically significant difference between the groups in survival to discharge.
The combination of team debriefing and real‐time audiovisual feedback improved CPR quality above that with feedback alone. These changes were associated with an increased rate of ROSC. The results are somewhat confounded by the release of the 2005 ACLS guidelines in November 2005, which decreased the recommended ventilation rate and increased the amount of CPR recommended between pulse checks. However, this study provides further evidence that CPR quality affects patient outcomes and argues that current training, which only requires ACLS recertification every 2 years, is insufficient.
D. P. Edelson, Philips Medical, Andover, MA, research grants, consulting fees or other remuneration (payment); Laerdal Medical, Stavanger, Norway, consulting fees or other remuneration (payment); B. Litzinger, None; S. Kim, None; D. Walsh, None; A. M. Barry, None; J. Poston, None; D. G. Beiser, None; T. L. Vanden Hoek, None; L. B. Becker, Philips Medical Systems, Seattle, WA, research grants, consulting fees or other remuneration (payment); Laerdal Medical, Stavanger, Norway, research grants; Alsius Corporation, Irvine, CA, research grants; Abbott Labs, Abbot Park, IL, consulting fees or other remuneration (payment); Cold Core Therapeutics LLC, ownership or partnership; Kleen Slate Corporation (nonmedical business), stock options or bond holdings; High Desert Foods (nonmedical business), stock options or bond holdings; B. S. Abella, Philips Medical, Andover, MA, research grants, consulting fees or other remuneration (payment); Zoll Medical Corporation, Chelmsford, MA, consulting fees or other remuneration (payment); Laerdal Medical, Stavanger, Norway, consulting fees or other remuneration (payment); Alsius Corporation, Irvine, CA, consulting fees or other remuneration (payment).
To cite this abstract:Edelson D, Litzinger B, Kim S, Walsh D, Barry A, Poston J, Beiser D, Hoek T, Becker L, Abella B. Cardiac Arrest Team Debriefing: A Novel Method for Improving CPR Quality during In‐Hospital Cardiac Arrest. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 17. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/cardiac-arrest-team-debriefing-a-novel-method-for-improving-cpr-quality-during-inhospital-cardiac-arrest/. Accessed March 28, 2020.