How good’s your CPR? Key tips for improving…

cpr_quality

CPR is a skill we all have to varying degrees, and not one that we have to use very often (all things going well). We also receive little feedback about the quality of our CPR (patient outcome is not necessarily a good indicator), nor how we could improve—often everyone is a little too busy during the resuscitation to give much feedback.

The AHA released this article last year, which I think provides a really nice summary of the things to think about when doing, practising or thinking about CPR. These include the mechanics of chest compressions and ventilation, human factors and team management, debrief and feedback, and system issues:

  1. High-quality CPR should be recognized as the foundation on which all other resuscitative efforts are built. Target CPR performance metrics include
    1. Chest compression fraction (percent of time spent performing chest compressions) >80%
    2. Compression rate of 100–120/min
    3. Compression depth of ≥50 mm in adults with no residual leaning (allow full recoil of the chest wall)
      1. (At least one third the anterior-posterior dimension of the chest in infants and children)
    4. Avoid excessive ventilation
      1. (Only minimal chest rise and a rate of <12 breaths/min)
  2. At every cardiac arrest attended by professional rescuers
    1. Use at least 1 modality of monitoring the team’s CPR performance
    2. Depending on available resources, use at least 1 modality of monitoring the patient’s physiological response to resuscitative efforts
      1. In patients with an arterial line, they suggest targeting a diastolic pressure of > 25 mmHg, titrating vasopressors to achieve this.
    3. Continually adjust resuscitative efforts based on the patient’s physiological response
  3. Resuscitation teams should coordinate efforts to optimize CPR during cardiac arrest by
    1. Starting compressions rapidly and optimizing CPR performance early
    2. Making sure that a team leader oversees the effort and delegates effectively to ensure rapid and optimal CPR performance
    3. Maintaining optimal CPR delivery while integrating advanced care and transport
  4. Systems of care (EMS system, hospital, and other professional rescuer programs) should
    1. Determine a coordinated code team response with specific role responsibilities to ensure that high-quality CPR is delivered during the entire event
    2. Capture CPR performance data in every cardiac arrest and use an ongoing CPR CQI program to optimize future resuscitative efforts
    3. Implement strategies for continuous improvement in CPR quality and incorporate education, maintenance of competency, and review of arrest characteristics that include available CPR quality metrics

 

 

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