The association of race with CPR quality following out-of-hospital cardiac arrest

Introduction: Many regions around the world have reported declining survival rates from out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic. This has been attributed to COVID-19 infection and overwhelmed healthcare services in some regions and imposed social restrictions in others. However, the effect of the pandemic period on CPR quality, which has the potential to impact outcomes, has not yet been described. Methods: A retrospective observational study was performed using data collected in an established OHCA registry in Victoria, Australia. During a pre-pandemic period (11 February 2019-31 January 2020) and the COVID-19 pandemic period (1 February 2020-31 January 2021), 1,111 and 1,349 cases with attempted resuscitation had complete CPR quality data, respectively. The proportion of cases where CPR targets (chest compression fraction [CCF]≥90%, compression depth 5-10cm, compression rate 100-120 per minute, pre-shock pauses <6 seconds, post-shock pauses <5 seconds) were met was compared between the pre-pandemic and pandemic periods. Logistic regression was performed to identify the independent effect of the COVID-19 pandemic on achieving CPR targets. Results: The proportion of arrests where CCF≥90% significantly decreased during the pandemic (57% vs 74% in the pre-pandemic period, p<0.001) as did the proportion with pre-shock pauses <6 seconds (54% vs 62%, p=0.019) and post-shock pauses <5 seconds (68% vs 82%, p<0.001). However, the proportion within target compression rate significantly increased during the pandemic (64% vs 56%, p<0.001). Following multivariable adjustment, the COVID-19 pandemic period was independently associated with a decrease in the odds of achieving a CCF≥90% (adjusted odds ratio [AOR] 0.47 [95% CI 0.40, 0.56]), a decrease in the odds of achieving pre-shock pauses<6 seconds (AOR 0.71 [95% CI 0.52, 0.96]), and a decrease in the odds of achieving post-shock pauses<5 seconds (AOR 0.49 [95% CI 0.34, 0.71]). Conclusion: CPR quality was impacted during the COVID-19 pandemic period which may have contributed to a decrease in OHCA survival previously identified. These findings reinforce the importance of maintaining effective resuscitation practices despite changes to clinical context.

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Abstract 239: The Effect of an Interdisciplinary Simulation Training Program on Translational Outcomes for In-Hospital Cardiopulmonary Arrests

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.239 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

John Hunninghake ◽

Justin Reis ◽

Heather Delaney ◽

Matthew Borgman ◽

Raquel Trevino ◽

...

Keyword(s):

Cardiac Arrest ◽

Training Program ◽

Hospital Discharge ◽

Team Training ◽

Quality Data ◽

P Value ◽

Significant Difference ◽

Event Location ◽

Cpr Quality ◽

Hospital Cardiac Arrest

Purpose: High-quality cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) is the primary component influencing return of circulation (ROSC) and survival to hospital discharge, but few hospitals regularly track these metrics. Other studies have demonstrated significant improvements in survival after IHCA events following implementation of a dedicated code team training program. Therefore, we developed a unique curriculum for a Code Team Training (CTT) course, and evaluated its post-implementation effect on CPR quality and post-IHCA patient outcomes at our institution. Methods: CPR quality data was prospectively collected for quality improvement purposes once our institution had that capability, with 12-months pre-CTT and 21 months post-CTT. Pre-CTT data shaped the elements of the four-hour CTT course that included didactics, small group sessions, and high-fidelity simulation exercises. A total of 456 multi-professional code team members were trained in 22 courses. Data collection included CPR quality and translational outcomes for events where CPR was performed, except the ED. CodeNet® software was used for CPR quality measures, cardiac rhythm, defibrillation metrics, use of continuous waveform capnography, and pauses in compressions. Target metrics for CPR quality were based on 2015 AHA guidelines. Key translational outcomes measures included event location, ROSC, and survival to hospital discharge. Results: CPR quality was obtained from 140 of 230 (61%) in- and out-of-hospital pulseless adult cardiac arrest events over 33 months (50 [36%] before CTT and 90 [64%] following the first course). There was no significant difference between groups in terms of event location within the hospital nor initial event rhythm. A total of 116,908 chest compressions were evaluated. Median compressions in target rate improved from 32% before CTT to 49% after CTT (p<0.05). When accounting for target rate and depth, the median compressions rate improved to 38% post-CTT compared to 31% pre-CTT (p<0.05). While compression depth had a non-statistically significant decline (90.8% pre-CTT and 83.4% post-CTT), mean rate and median rate-in-target improved from 119.99 +/- 15.6 cpm and 32.4% pre-CTT to 113.7 +/- 16.1 cpm and 48.6% post-CTT (p<0.05). The rate of ROSC improved from 60% (30 of 50) to 78% (70 of 90) after implementation of CTT (p=0.003), excluding IHCA in the ED. Index IHCA survival rate for our institution improved from 26% to 33% before and after CTT [p-value NS], which far surpasses the national average (23.8%). Conclusions: After the initiation of a CTT course that targets key code team member personnel, CPR quality significantly improved, which was associated with an increase in ROSC and a trend towards increased survival for in-hospital cardiac arrest patients.

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The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building

Emergency Medicine International ◽

10.1155/2018/7246964 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Jongho Kim ◽

Lyle Brewster ◽

Sonja Maria ◽

Jundong Moon

Keyword(s):

Cardiac Arrest ◽

Flow Time ◽

Supraglottic Airway ◽

Mechanical Compression ◽

Manual Compression ◽

High Rise ◽

High Rise Building ◽

Cpr Quality ◽

Mechanical Compression Device ◽

Hospital Cardiac Arrest

High-rise buildings present unique challenges to providing high-quality CPR. We investigated the effect of using a mechanical compressor and supraglottic airway on flow time and CPR quality in simulated cardiac arrests occurring within a high-rise building. Twelve teams of EMS providers performed CPR according to 4 scenarios: manual compression and ventilation through bag-valve-mask (MAB) or supraglottic airway (MAS); mechanical compression and ventilation through bag-valve-mask (MEB) or supraglottic airway (MES). Chest compression indices did not differ significantly among the groups. The mechanical compression groups had a higher flow time fraction from exiting the elevator until the manikin was loaded into the ambulance than the manual compression groups. The supraglottic airway groups had higher flow time fractions from entering the elevator until the end of the scenario than the bag-valve-mask groups. The total flow time fraction was lowest in the MAB group and was highest in the MEB group (P < 0.001). In simulated cardiac arrest in a high-rise building, the use of a supraglottic airway maintained flow time at a level similar to that observed with the use of a mechanical compressor. Moreover, the use of a mechanical compressor and a supraglottic airway increased the flow time most effectively.

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AS13 The association between end-tidal CO2 and CPR quality metrics in out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/s0300-9572(11)70014-4 ◽

2011 ◽

Vol 82 ◽

pp. S4

Author(s):

Daniel Spaite ◽

Uwe Stolz ◽

Annemarie Silver ◽

Christopher Kaufman ◽

Keith Pyers ◽

...

Keyword(s):

Cardiac Arrest ◽

Quality Metrics ◽

Cpr Quality ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

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Correlations Between CPR Quality Metrics and End-Tidal CO2 in Out-of-Hospital Cardiac Arrest

Resuscitation ◽

10.1016/j.resuscitation.2012.08.024 ◽

2012 ◽

Vol 83 ◽

pp. e9

Author(s):

Daniel W. Spaite ◽

Uwe Stolz ◽

Ryan Ann Murphy ◽

Madalyn Karamooz ◽

Annemarie Silver ◽

...

Keyword(s):

Cardiac Arrest ◽

Quality Metrics ◽

Cpr Quality ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

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Teamwork and leadership in out-of-hospital cardiac arrest – do these non-technical skills require attention?

Australasian Journal of Paramedicine ◽

10.33151/ajp.17.748 ◽

2020 ◽

Vol 17 ◽

Author(s):

Adam John Dagnell

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Patient Outcomes ◽

Patient Survival ◽

Training Programs ◽

Technical Skills ◽

Vital Role ◽

Cpr Quality ◽

Hospital Cardiac Arrest ◽

And Training

The science of cardiopulmonary resuscitation (CPR) is now well established and incorporated into training programs to maximise patient survival. There is an increased understanding that non-technical skills such as teamwork and leadership can play a vital role in improving CPR quality, patient outcomes and clinician occupational health. Despite this, these non-technical skills remain somewhat neglected in the context of out-of-hospital cardiac arrest. With reference to the literature this commentary provides a discussion to reinforce the need for a greater focus to this area of practice and build a case for further research and training.

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Abstract 15: Increasing Compression Rate and Depth Positively Correlate with End-Tidal Carbon Dioxide During Actual CPR Performance

Circulation ◽

10.1161/circ.130.suppl_2.15 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kelsey Sheak ◽

Douglas J Wiebe ◽

Saeed Babaeizadeh ◽

Trevor C Yuen ◽

Dana Zive ◽

...

Keyword(s):

Cardiac Arrest ◽

Linear Regression Analysis ◽

Ventilation Rate ◽

Quality Data ◽

Depth Range ◽

Rate Range ◽

Resuscitation Guidelines ◽

Cpr Quality ◽

End Tidal ◽

Hospital Cardiac Arrest

Background: Current resuscitation guidelines suggest the use of continuous capnography to monitor the effectiveness of CPR. While laboratory data support this concept, little published clinical data exist to support this recommendation. The quantitative relationship between chest compression (CC) delivery and capnographic measurement (specifically, end-tidal CO 2 (ETCO 2 )) is poorly understood, and has important implications for CPR quality assessment. Objectives: We hypothesized that increasing rate and depth of CC will be associated in real-time with increasing ETCO 2 during both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Methods: In a multicenter cohort study, we captured time synchronized ETCO 2 and CPR quality data from resuscitation events at 4 sites between 04/2006 [[Unable to Display Character: –]] 05/2013 using CPR-sensing defibrillators (Philips Mrx-QCPR). ETCO 2 and CC rate and depth were averaged over 15-sec epochs. A linear regression analysis was performed to evaluate the relationship between CCs and ETCO 2 . Results: 29,028 epochs were processed for analysis from 583 arrest events (227 IHCA, 356 OHCA). Average age of the entire cohort was 63.7±17.1 and 213 (37%) were female. ROSC was achieved in 42% of IHCA patients and 27% of OHCA patients. CC rate range was 95-125 per min, CC depth range was 31-59 mm and ventilation rate range was 4-48 per min. CC rate was not significantly associated with ETCO 2 . CC depth was significantly associated with increased ETCO 2 . For every 10 mm increase in depth, ETCO 2 increased by 1.4 mmHg (p<.001). Ventilation rate was inversely related to higher ETCO 2 . For every 10 breaths per min increase in ventilation rate, ETCO 2 was decreased by 3.0 mmHg (p<.001) (see table). Conclusions: ETCO 2 during CPR directly correlated with CC depth, supporting the possible role of capnography as an approach to monitor the quality of CPR delivery. Confounding by ventilation rate may be an important consideration for future work.

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