Abstract 218: CPR Quality in an Urban Teaching Hospital Emergency Department: Are 2010 AHA Guidelines Being Implemented?

Abstract

Background: CPR quality is closely linked to outcome in cardiac arrest. AHA 2010 Guidelines recommend monitoring CPR quality performed by healthcare providers both inside and outside the hospital. We recently reported that CPR quality varies significantly during the transition from the prehospital to emergency department (ED) setting in cases of out-of-hospital cardiac arrest (OHCA). While many EMS systems are now monitoring CPR quality, most EDs do not. We began an ongoing ED CPR quality improvement program based upon the 2010 AHA Guidelines. This two-phase study will measure the baseline quality of ED CPR, followed by measurement of CPR quality with the initiation of real-time CPR feedback technology. Here we report preliminary data showing the baseline CPR quality from Phase I. Methods: Prospective, IRB-approved study at an urban, teaching hospital ED. Chest compression (CC) quality was measured using accelerometer-equipped monitor/defibrillators (ZOLL R-Series, Chelmsford, MA). These baseline data were collected with the real-time audiovisual CPR feedback feature disabled. Results: CC data were captured over 7 months from 31 adult patients in cardiac arrest resulting in 6.5 hours of CPR and 37,348 individual CCs. CC fraction was 76.2%. Mean CC depth was 1.89 ± 0.61 inches and average rate was 122.4 ± 16.5 compressions/min. Using the 2010 AHA Guideline-recommended CC depth >2 inches, 61.0% of compressions were too shallow. The rate of compressions was below 100/min in 6.3%. The mean pre-shock and post-shock pauses in CC were 7.8 and 7.4 sec, respectively (n=24 defibrillations/cardioversions). Conclusions: We describe the quality of CPR in a large urban teaching hospital ED. At the beginning of our ED CPR QI program, a large proportion of chest compression depth was less than the 2010 AHA Guideline of 2 inches. These data will be used for resuscitation training during the next phase of the program which will include real-time audiovisual CPR feedback and debriefing sessions for the ED providers.