Abstract
IntroductionThe American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS).MethodsCameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of “record, then review” method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS.ResultsOver 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P<0.0001]) overall; decreased from 16.6 to 10.5 seconds (P<0.0001) without POCUS; and with POCUS from 19.8 to 9.88 seconds (P<0.0001) with POCUS. Pulse check times decreased significantly over the study period of educational interventions. The strongest effect size was found in POCUS pulse check duration (P = −0.3640, P = 0.002).ConclusionConsistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio.
Highlights
The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds
Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving point-of-care ultrasound (POCUS)
The American Heart Association recommends that pulse checks last a maximum of 10 seconds and that the ratio of time spent performing compressions to the total duration of CPR be 80% or higher, as these correlate with increased return of spontaneous circulation (ROSC) and survival to hospital discharge.[2]
Summary
The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. Minute changes in CPR quality, such as the percentage of hands-on time, correlate with survival.[1] The American Heart Association recommends that pulse checks last a maximum of 10 seconds and that the ratio of time spent performing compressions to the total duration of CPR be 80% or higher, as these correlate with increased ROSC and survival to hospital discharge.[2] Prior studies found improved survival in patients with cardiac arrest due to ventricular fibrillation with chest compression fraction (CCF) of 0.60.8 and improved ROSC in patients with cardiac arrest without ventricular fibrillation with a CCF of 0.8-1.0.3,4 In 2005 Valenzuela et al found that “frequent interruption of chest compressions results in no circulatory support during more than half of resuscitation efforts.”. Post-arrest debriefing as a means of quality improvement has not been shown to be a positive effect.[8]
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