Abstract 105: Accuracy of Team Perception of Performance With Actual CPR Quality Metrics in Children

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Lynda Knight ◽  
Todd Sweberg ◽  
Pual Mullan ◽  
Anita Sen ◽  
Matthew Braga ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Language Processing ◽  
American Heart ◽  
Qualitative Content Analysis ◽  
Heart Association ◽  
Prospective Data ◽  
Team Members ◽  
Assessment Measure ◽  
Cpr Quality ◽  
Perception Of Performance

Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patient outcomes. Few reports compare team members’ perceptions of CPR quality with quantitative CPR data during actual pediatric CPR. Hypothesis: Self-reported team perception of CPR performance will not meet quantitative CPR metrics using AHA BLS guideline criteria. Methods: Prospective data from an international pediatric (pediRES-Q) resuscitation collaborative from February 2016 to August 2017. A modified Team Emergency Assessment Measure framework for qualitative content analysis was used to assess data from “hot” debriefings (held soon after arrest) by language processing experts blinded to CPR data. Events without reported perception of CPR and quantitative CPR data were excluded. Comments regarding CPR perception were grouped as either Plus perceptions of performance (PPP) or Delta perceptions of performance (DPP). Grouped events were matched and compared to quantitative CPR data of chest compression (CC) fraction (CCF), rate, and depth as collected by CPR-recording defibrillators. Compliance with AHA BLS guidelines were defined as events with mean: CCF >60%, CC rate 100-120/min; and CC depth for infants <1yo, ~4 cm (3.6-4.4 cm.); children 1-18 yo, 5-≤6 cm. Results: Of 227 arrests, 108 (48%) hot debriefings were reported. Reported CPR perceptions with paired quantitative CPR data were available for 53/108 (49%) events; 32/53 (60%) PPP and 21/53 (39%) DPP. Event CPR metric summaries (median [IQR]) for PPP - CCF 0.87 [0.77, 0.93]; CC rate 116/min [108.5, 120]; CC depth age <1yo 2.35 [2.01, 3.0] cm; >1yr 4.2 [3.3, 5.05] cm. DPP - CCF 0.79 [0.69, 0.92]; CC rate 118/min [109,129]; CC depth < 1 yo 2.03 [1.95, 2.2] cm; >1yo 3.93 [3.3, 5.06] cm. PPP events, 28/32 (87%) met guideline criteria for CCF, 25/32 (78%) for CC rate; 6/32 (19%) for CC depth; and 4/32 (12%) met criteria for all 3 categories. For DPP events, 17/21 (80%) met guideline criteria for CCF; 15/21 (71%) for CC rate; and 3/21 (15%) for CC depth, and 2/21 (9%) met criteria for all 3 categories. Conclusions: Self-reported team perception of CPR quality does not match quantitative CPR metrics using AHA guideline criteria whether CPR was positively perceived or not, depth being main reason for non-compliance.

scholarly journals Safe Lines to Life Savers—A Focus on Rescuer Safety

2021 ◽  
Vol 06 (02) ◽  
pp. 123-129
Author(s):  
Ashima Sharma ◽  
Sreelekha Narla ◽  
Shalini Pasupuleti
Keyword(s):  
American Heart ◽  
Heart Association ◽  
Research Society ◽  
Team Members ◽  
Safety Control ◽  
European Guidelines ◽  
Care Workers ◽  
Resuscitation Guidelines ◽  
The Government ◽  
Made In

Abstract Objective To describe and discuss the new cardiopulmonary resuscitation (CPR) guidelines during the coronavirus disease 2019 (COVID-19) period. Background The ongoing COVID-19 pandemic has affected the entire humankind despite immense efforts by the government, like mandatory personal protection, lockdown, and so forth. Numerous health care workers (HCW) lay rescuers during resuscitation are at risk of acquiring infection. This resulted in the formulation of additional guidelines during CPR, specific to COVID-19. Method A narrative overview of new resuscitation guidelines made for protecting rescuers during COVID-19 by American Heart Association (AHA), European guidelines on resuscitation update, Research Society of Anesthesiology and Clinical Pharmacology, and Indian Resuscitation Council (IRC). Discussion An overview of all new steps of resuscitation starting from the checking responsiveness of the patient, rescuer safety, control of aerosolization, number of team members, CPR, airway management, drugs and dosages, defibrillation, appropriateness of continuing resuscitation, and discussing the changes made in standard guidelines.

scholarly journals Optimizing patient outcomes by improving STEMI target times

2020 ◽  
Vol 43 (2) ◽  
pp. 4-5
Author(s):  
Danielle Binda
Keyword(s):  
Early Intervention ◽  
Patient Outcomes ◽  
American Heart Association ◽  
American Heart ◽  
Myocardial Damage ◽  
Heart Association ◽  
Project Team ◽  
Southern Alberta ◽  
Implementing Strategies

It is widely recognized that delays in STEMI identification and treatment can negatively affect patient outcomes. Early intervention to achieve reperfusion of the blocked vessel is crucial in minimizing myocardial damage and optimizing patient outcomes.   In April 2017, the Southern Alberta STEMI program identified a delay in SHC ED achieving STEMI target times as outlined by the American College of Cardiology and the American Heart Association. Of all walk-in STEMI patients presenting to SHC ED between October 2016 and October 2017 requiring urgent transfer to FMC cardiac cath lab: 24% met the ‘Triage to 1st ECG target’ of ≤ 10 mins 6% met the ‘Door in-Door out target’ of ≤ 30 mins     A multi-disciplinary project team was formed to examine barriers to both targets and begin implementing strategies aimed at improving these times.

scholarly journals A contribuição do debriefing no ensino baseado em simulação

2020 ◽  
Vol 14 ◽  
Author(s):  
Christina Silva da Costa Klippe ◽  
Evellin Camargo Bastos Nieto ◽  
Heloisa Andreia Silva Dos Santos ◽  
Liszety Guimarães Emmerick ◽  
Luiza Cerqueira Reis Da Costa ◽  
...  
Keyword(s):  
Nursing Education ◽  
American Heart Association ◽  
Professional Training ◽  
American Heart ◽  
Heart Association ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Team Members ◽  
Complex Patients ◽  
Quantitative Descriptive

Objetivo: analisar a percepção de residentes de enfermagem quanto à contribuição do debriefing para a sua aprendizagem a partir de uma experiência de Simulação de Alta Fidelidade. Método: trata-se de um estudo quantitativo, descritivo, transversal, com 103 enfermeiros do 1o ano do Programa de Residência de Enfermagem de uma universidade federal brasileira. Criou-se o workshop “Simulação na assistência de enfermagem ao paciente em alta complexidade” em cinco etapas: aula expositiva sobre o Protocolo ACLS 2015 da American Heart Association; oficina de habilidades práticas; instrução sobre o ambiente de simulação e as funções dos membros da equipe para a atuação nos cenários; debriefing e preenchimento do instrumento “Escala de Experiência com o debriefing” (EED). Considerou-se, para a análise e classificação dos dados, o ponto de corte de 70% de concordância entre os itens avaliados pela EED. Resultados: indicou-se, por 75% dos respondentes, o índice Likert “concordo totalmente” e 25%, o índice “concordo parcialmente”. Conclusão: demonstra-se, no estudo, que residentes de Enfermagem consideraram o processo de debriefing como fator de grande contribuição para sua aprendizagem e formação profissional. Descritores: Simulação; Enfermagem; Educação em Enfermagem; Aprendizagem Metodologia; Aprendizagem; Reeducação Profissional.AbstractObjective: to analyze the perception of nursing residents regarding the contribution of debriefing to their learning from a High Fidelity Simulation experience. Method: this is a quantitative, descriptive, cross-sectional study with 103 nurses from the 1st year of the Nursing Residency Program of a Brazilian federal university. The workshop “Simulation in nursing care for highly complex patients” was created in five stages: lecture on the ACLS Protocol 2015 of the American Heart Association; practical skills workshop; instruction on the simulation environment and the functions of the team members to act in the scenarios; debriefing and filling in the instrument "Debriefing Experience Scale" (DES). For the analysis and classification of the data, the cut-off point of 70% of agreement between the items evaluated by the DES was considered. Results: the Likert index “totally agree” and 25% the “partially agree” index was indicated by 75% of respondents. Conclusion: in the study, it is shown that nursing residents considered the debriefing process as a factor of great contribution to their learning and professional training. Descriptors: Simulation; Nursing; Education, Nursing; Learning Methodology; Learning; Education, Professional.ResumenObjetivo: analizar la percepción de los residentes de enfermería con respecto a la contribución del debriefing  para su aprendizaje a partir de una experiencia de Simulación de Alta Fidelidad. Método: este es un estudio cuantitativo, descriptivo, transversal con 103 enfermeros del primer año del Programa de Residencia de Enfermería de una universidad federal brasileña. El taller "Simulación de la atención de pacientes de enfermería altamente compleja" se creó en cinco pasos: conferencia sobre el Protocolo ACLS 2015 de la American Heart Association; taller de habilidades prácticas; instrucción sobre el entorno de simulación y los roles de los miembros del equipo para desempeñarse en los escenarios; debriefing y completar el instrumento "Debriefing Experience Scale" (DES). Para el análisis y la clasificación de los datos, se consideró el punto de corte del 70% de acuerdo entre los elementos evaluados por el DSE. Resultados: el 75% de los encuestados indicó el índice Likert "totalmente de acuerdo" y el 25% índice "parcialmente de acuerdo". Conclusión: el estudio muestra que los residentes de Enfermería consideraron el proceso de debriefing como un factor de gran contribución a su aprendizaje y formación profesional. Descriptores: Simulación; Enfermería; Educación en Enfermería; Aprenizage Metodología; Aprendizage; Reentrenamiento en Educación Profesional.

Clinical Review and Implications of the Guideline for the Early Management of Patients With Acute Ischemic Stroke

2014 ◽  
Vol 25 (2) ◽  
pp. 130-141
Author(s):  
Sarah L. Livesay
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Evidence Based ◽  
Early Management

Stroke is the fourth leading cause of death and the leading cause of significant, long-term disability in the United States. Clinicians’ knowledge and use of evidence to guide the care of patients with ischemic stroke are paramount to improving patient outcomes. The recently updated “Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association” provides clinicians with evidence-based, expert consensus to guide the recognition and early management of patients with acute ischemic stroke. The guideline provides 115 recommendations for the management of patients with acute ischemic stroke, including 24 new recommendations and 51 revised recommendations divided into 14 major topic areas. This article reviews the recommendations and related literature and provides suggestions for use and implementation of the guideline within a stroke program of care.

Abstract 370: Delivery of CPR in Patients With Single and Biventricular Cardiac Disease

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Todd Sweberg ◽  
Heather Griffis ◽  
Priscilla Yu ◽  
Ivie Esangbedo ◽  
Kelly Bora ◽  
...  
Keyword(s):  
Single Ventricle ◽  
American Heart ◽  
Heart Association ◽  
Quality Metric ◽  
Guideline Compliance ◽  
Shockable Rhythm ◽  
Observational Cohort ◽  
Cpr Quality ◽  
Epinephrine Dose ◽  
Hospital Cardiac Arrest

Introduction: Diminished survival after cardiopulmonary resuscitation (CPR) has been shown in patients with congenital heart disease (CHD) and single ventricle (SV) anatomy compared to biventricular anatomy (BV). The role guideline-compliant CPR plays in SV outcomes is unknown. Hypothesis: During pediatric in-hospital cardiac arrest (IHCA), there will be a difference in CPR delivery and outcomes of patients with SV compared to BV anatomy. Methods: Prospective observational cohort from 12 pediRES-Q sites of IHCA in children ≤ 18 years with CPR quality metric data (chest compression (CC) rate, depth, and fraction (CCF)) (Zoll R-Series, Chelmsford, MA). We compared 60-sec CC epoch compliance with 2015 American Heart Association guideline targets defined as: CC rate 100-120/min; depth ≥4.0 cm in <1 yo, ≥5 to ≤6 cm in 1-<18 yo; and CCF ≥0.80. Total guideline compliance was defined as a CC event with ≥ 60% epochs meeting all targets. Metric summaries were reported as median [IQR] and compliance as frequency (%). Differences were assessed using Wilcoxon rank-sum and Fishers exact tests, respectively. Logistic regression assessed for associations with outcomes, including anatomy and proportion of guideline-compliant CPR. Results: From 10/2015 to 3/2019, we analyzed 82 events (> 5 epochs) in patients with CHD. Thirty-seven percent had SV anatomy and more SV patients were post-operative (70% vs 2%). There were no differences in time to first epinephrine dose (1 vs 2 min), shockable rhythm (7% vs 6%), or need for ECMO (27% vs 23%). Total guideline compliance across all ages was not different (SV 10.0% vs BV 5.8%, P=0.67) and not associated with ROSC or survival to hospital discharge (SHD). There was a 75% lower adjusted odds of SHD in 1-<8 yo vs <1 yo. Conclusion: There were no meaningful differences in resuscitative practice or delivery of guideline-compliant CPR in those with SV versus BV anatomy. Guideline-compliant CPR was not associated with outcomes regardless of cardiac anatomy.

Evidenzbasierte Indikationen zur chirurgischen Therapie extrakranieller Karotisstenosen

2003 ◽  
Vol 22 (05) ◽  
pp. 222-232
Author(s):  
H.-H. Eckstein
Keyword(s):  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Amaurosis Fugax

ZusammenfassungNach Durchführung prospektiv-randomisierter Studien liegen für die Karotis-Thrombendarteriektomie (KarotisTEA) höhergradiger Karotisstenosen gesicherte Indikationen auf dem Evidenzlevel Ia mit dem Empfehlungsgrad A vor. Dies betrifft sowohl >50%ige symptomatische als auch >60%ige asymptomatische Stenosen (NASCET-Kriterien). In Subgruppen-Analysen aus NASCET konnten klinische und morphologische Variablen identifiziert werden, die auf ein besonders hohes Risiko eines karotisbedingten Schlaganfalls im natürlichen Verlauf hinweisen. Patienten mit folgenden Variablen profitieren daher besonders von der Karotis-TEA: Stenosegrad >90%, schlechter Kollateralkreislauf, kontralateraler Karotisverschluss, Plaque-Ulzerationen, Tandemstenosen, intraluminale Thromben, nicht-lakunärer Hirninfarkt, Lebensalter >75 Jahre, komplexes klinisches Risikoprofil, Hemisphären-TIA (vs. Amaurosis fugax), männliches Geschlecht. Der präventive Effekt der Karotis-TEA kann jedoch nur unter Beachtung eines niedrigen perioperativen Schlaganfallbzw. Letalitätrisikos realisiert werden. Nach Empfehlungen der American Heart Association (AHA) darf das perioperative Risiko 3% bei asymptomatischen Stenosen ohne kontralaterale Stenose, 5% bei asymptomatischen Stenosen mit hochgradiger kontralateraler Stenose oder Verschluss und 6% bei symptomatischen >50%ige Stenosen (NASCET-Kriterien) nicht überschreiten. Die Ergebnisse der Qualitätssicherung Karotis-TEA der Deutschen Gesellschaft für Gefäßchirurgie (DGG) zeigen, dass diese maximal akzeptablen Obergrenzen zum Teil deutlich unterschritten werden. Vor diesem Hintergrund stellt das Stenting von Karotisstenosen einen klinischen Heilversuch dar, der nur nach interdisziplinärem Konsil und/oder i. R. randomisierter Studien zulässig ist.

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