Abstract 62: Resuscitation with Actual Performance Integrated Debriefing (RAPID) Improves CPR Quality and Initial Patient Survival

Abstract

Introduction Recent investigations have documented poor cardiopulmonary resuscitation (CPR) performance in clinical practice. We hypothesized that a debriefing intervention using CPR quality data from actual cardiac arrests (Resuscitation with Actual Performance Integrated Debriefing, or RAPID) would improve CPR performance and initial patient survival. Methods Rescuers at a university teaching hospital underwent weekly RAPID sessions between March, 2006 and February, 2007. During the intervention period, facilitators led debriefing discussions using actual performance data, obtained from a CPR-sensing defibrillator with audiovisual feedback capability, and highlighted deficiencies in CPR quality and defibrillation. These data were compared to an historical control in which a similar defibrillator was used. The main outcomes were objective metrics of CPR performance and initial return of spontaneous circulation (ROSC). Results CPR quality and outcome data from 123 patients resuscitated during the intervention period were compared to 101 patients in the baseline cohort. Compared to the control period, CPR quality parameters and defibrillation accuracy were improved (table ). These were associated with a significant improvement in the unadjusted rate of ROSC (table ). After adjusting for shockable vs. non-shockable rhythm, time and location of arrest, and patient demographics, the RAPID intervention was associated with a significant increase in the adjusted odds of ROSC (OR 1.84 [1.06 –3.20]; p=0.03). Conclusions The combination of RAPID and real-time audiovisual feedback improved CPR quality over the use of feedback alone, and was associated with an increased rate of ROSC. CPR sensing and recording devices allow for methods of debriefing that were previously available only for simulation based education; such methods have the potential to fundamentally alter resuscitation training and improve patient outcomes. Resuscitation Performance and Patient Outcomes by Cohort