CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system

ArticleinResuscitation 73(1):54-61 · May 2007with20 Reads
DOI: 10.1016/j.resuscitation.2006.10.027 · Source: PubMed
Cardiopulmonary resuscitation (CPR) quality during actual cardiac arrest has been found to be deficient in several recent investigations. We hypothesized that real-time feedback during CPR would improve the performance of chest compressions and ventilations during in-hospital cardiac arrest. An investigational monitor/defibrillator with CPR-sensing and feedback capabilities was used during in-hospital cardiac arrests from December 2004 to December 2005. Chest compression and ventilation characteristics were recorded and quantified for the first 5 min of resuscitation and compared to a baseline cohort of arrest episodes without feedback, from December 2002 to April 2004. Data from 55 resuscitation episodes in the baseline pre-intervention group were compared to 101 resuscitations in the feedback intervention group. There was a trend toward improvement in the mean values of CPR variables in the feedback group with a statistically significant narrowing of CPR variable distributions including chest compression rate (104+/-18 to 100+/-13 min(-1); test of means, p=0.16; test of variance, p=0.003) and ventilation rate (20+/-10 to 18+/-8 min(-1); test of means, p=0.12; test of variance, p=0.04). There were no statistically significant differences between the groups in either return of spontaneous circulation or survival to hospital discharge. Real-time CPR-sensing and feedback technology modestly improved the quality of CPR during in-hospital cardiac arrest, and may serve as a useful adjunct for rescuers during resuscitation efforts. However, feedback specifics should be optimized for maximal benefit and additional studies will be required to assess whether gains in CPR quality translate to improvements in survival.
    • "The ACLS guideline for using ETCO 2 monitoring during CPR provides the basis on which providers can have real-time feedback about the quality of chest compressions , thus offering patients a better chance of survival [18, 19] . To our knowledge, ours is the first study regarding possible survival benefits with ETCO 2 monitoring in real clinical situations. "
    [Show abstract] [Hide abstract] ABSTRACT: During cardiac arrest, end-tidal carbon dioxide (ETCO 2 ) monitoring is recommended as a chest compression performance indicator. However, its frequency of use during out-of-hospital cardiac arrest (OHCA) and its benefits have never been evaluated in real clinical situations. We investigated OHCA patients in Taiwan to evaluate the frequency of ETCO 2 monitoring and its effects on sustained return of spontaneous circulation (ROSC). We sampled the Taiwan National Health Insurance claims database, which contains 1 million beneficiaries. All adult beneficiaries older than 18 years who presented with OHCA and received chest compression between 1 January 2005 and 31 December 2012 were enrolled. We further identified patients with ETCO 2 monitoring and matched each 1 with 20 patients who did not receive ETCO 2 monitoring based on their propensity scores. A simple conditional logistic regression model was applied to compare the odds ratio (OR) for sustained ROSC in the matched cohorts. A total of 5041 OHCA patients were enrolled. The frequency of ETCO 2 monitoring has increased since 2010 but still is low. After matching, 53 patients with ETCO 2 monitoring and 1060 without ETCO 2 monitoring were selected. The OR of sustained ROSC in the ETCO 2 group was significantly increased (2.38, 95 % CI 1.28–4.42). Patients who received ETCO 2 monitoring during OHCA had a higher possibility of sustained ROSC, but the overall use of ETCO 2 monitoring is still low despite strong recommendations for its use.
    Full-text · Article · Dec 2015
    • "In the past decade, in the in-hospital setting, quality measures of CPR effectiveness have evolved from survival rate of individual CPR events, to survival to hospital discharge, to assessment of neurological disability at the time of hospital discharge [6,21222324 . Girotra et al, identified all adults (>18 years) who had treated IHCA at 374 hospitals that participated in the Get with the guidelines-Resuscitation registry in the past decade and showed that both survival and neurologic outcomes improved. "
    [Show abstract] [Hide abstract] ABSTRACT: Current prevalence estimates of gastrostomy tube (GT)/tracheostomy placement in hospitalized patients with anoxic/hypoxic ischemic encephalopathic injury (AHIE) post cardiopulmonary resuscitation (CPR) are unknown. We sought, to estimate the prevalence of AHIE in hospitalized patients who had CPR and to identify patient/hospital level factors that predict the performance of GT/tracheostomy in those with AHIE.We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2004-2010). All patients who developed AHIE following CPR were included. In this cohort the odds of having GT and tracheostomy was computed by multivariable logistic regression analysis. Patient and hospital level factors were the independent variables.During the study period, a total of 686,578 CPR events occurred in hospitalized patients. Of these, 94,336 (13.7%) patients developed AHIE. In this AHIE cohort, 6.8% received GT and 8.3% tracheostomy. When compared to the 40-49 yrs age group, those aged >70 yrs were associated with lower odds for GT (OR = 0.65, 95% CI:0.53-0.80, p
    Full-text · Article · Jul 2015
    • "Regular TiltFigure 3: Root-mean-square error (RMSE) in mean rate and depth as a function of the duration of the analysis interval for the regular session and the tilt session. the field [27, 31, 32]. Currently, most real-time devices for CPR feedback are based on the double integration of the acceleration which inevitably requires adding drift compensation techniques [18, 33] that result in bulky devices and/or occasional inaccurate depth feedback [19, 34]. "
    [Show abstract] [Hide abstract] ABSTRACT: Quality of cardiopulmonary resuscitation (CPR) improves through the use of CPR feedback devices. Most feedback devices integrate the acceleration twice to estimate compression depth. However, they use additional sensors or processing techniques to compensate for large displacement drifts caused by integration. This study introduces an accelerometer-based method that avoids integration by using spectral techniques on short duration acceleration intervals. We used a manikin placed on a hard surface, a sternal triaxial accelerometer, and a photoelectric distance sensor (gold standard). Twenty volunteers provided 60 s of continuous compressions to test various rates (80-140 min(-1)), depths (3-5 cm), and accelerometer misalignment conditions. A total of 320 records with 35312 compressions were analysed. The global root-mean-square errors in rate and depth were below 1.5 min(-1) and 2 mm for analysis intervals between 2 and 5 s. For 3 s analysis intervals the 95% levels of agreement between the method and the gold standard were within -1.64-1.67 min(-1) and -1.69-1.72 mm, respectively. Accurate feedback on chest compression rate and depth is feasible applying spectral techniques to the acceleration. The method avoids additional techniques to compensate for the integration displacement drift, improving accuracy, and simplifying current accelerometer-based devices.
    Full-text · Article · Aug 2014
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