Cardiopulmonary resuscitation quality and beyond: the need to improve real-time feedback and physiologic monitoring.

Steve Lin,Damon C Scales

doi:10.1186/s13054-016-1371-9

Abstract

High-quality cardiopulmonary resuscitation (CPR) has been shown to improve survival outcomes after cardiac arrest. The current standard in studies evaluating CPR quality is to measure CPR process measures—for example, chest compression rate, depth, and fraction. Published studies evaluating CPR feedback devices have yielded mixed results. Newer approaches that seek to optimize CPR by measuring physiological endpoints during the resuscitation may lead to individualized patient care and improved patient outcomes.

Highlights

There are several important cardiopulmonary resuscitation (CPR) process measures that currently define high-quality CPR: compression rate (100–120/minute), compression depth (5–6 cm in adults), allowing for complete chest recoil after each compression, and minimizing interruptions in compressions measured by chest compression fraction [5, 6]
There are multiple feedback devices that are commercially available to improve the quality of delivered CPR, but evaluations have yielded mixed results in published randomized controlled trial (RCT) and observational studies [3–6]
Another area of active investigation is the use of end-tidal carbon dioxide (ETCO2) measurements, which are an indirect correlate of cardiac output and are readily available to rescuers performing CPR in cardiac arrest patients; as yet there are no recommended ETCO2 target values for CPR, and their relationship with survival remains unclear [11]

Summary

Background

Vahedian-Azimi et al [1] conducted the first in-hospital randomized controlled trial (RCT) evaluating a new cardiopulmonary resuscitation (CPR) feedback device—the Cardio First Angel—in cardiac arrest patients. Highquality CPR has been shown to improve survival outcomes after cardiac arrest [2] and continues to be a focus of quality assurance and improvement programs. There are multiple feedback devices that are commercially available to improve the quality of delivered CPR, but evaluations have yielded mixed results in published RCTs and observational studies [3–6].

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Conclusion