Cardiac Arrest Team Research Articles

First Responder for In-Hospital Resuscitation: 5-Year Experience with an Automated External Defibrillator-Based Program

BackgroundThe survival of in-hospital cardiac arrest (8–25%) has not changed substantially in the past. Until now, most hospitals in Germany had no standardized protocols available for a course of action in case of emergency, and there are no continuous registry data for in-hospital cardiac arrest and survival. ObjectiveOur aim was to improve survival and receive outcomes data, so we implemented a structured hospital-wide automated first-responder system in the hospital. Here our 5-year experience with 443 emergency calls is outlined. MethodsThroughout the hospital, 15 automated external defibrillator (AED) “access spots,” which can be easily reached within 30 s, were identified. AEDs were then installed at these locations (Lifepak 500 and Lifepak 1000, Medtronic equipped with a Biolog 3000i portable ECG monitor). At the same time, a training program was initiated in which the employees of the hospital participated once a year. Participants learned how to apply and activate an AED in case of cardiac arrest even before the designated Cardiac Arrest Team arrived at the scene. ResultsA witnessed cardiac arrest event was confirmed in 126 cases. In 56 of the 126 cases, the primary arrest rhythm was either ventricular tachycardia or ventricular fibrillation and the AED delivered a shock. In this group, spontaneous circulation was reached in 44 cases (79%) and 23 patients (41%) were discharged. In 44% (24 from 55 patients) of the cases, a shock was recommended by AED and delivered by the first responders before the rescue team arrived. ConclusionsThe first-responder AED program successfully gave training lessons to the hospital staff. The training included how to initiate the cardiac arrest call, how to use the AED, and how to start immediate resuscitation. As a result, a higher survival rate after in-hospital cardiac arrest can be accomplished.

In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines

To evaluate cardiac arrest outcomes following the introduction of the Australian Resuscitation Council (ARC) 2006 amended guidelines for basic and advanced life support. A retrospective study of all consecutive cardiac arrests during a 3-year phase pre-implementation (2004-06) and a 3-year phase post-implementation (2007-09) of the ARC 2006 guidelines was conducted at a tertiary referral hospital in Brisbane, Australia. Over the 6-year study phase 690 cardiac arrests were reported. Resuscitation was attempted in 248 patients pre-implementation and 271 patients post-implementation of the ARC 2006 guidelines. After adjusting for significant prognostic factors we found no significant change in return of spontaneous circulation (ROSC) (odds ratio 1.21, 95% confidence interval 0.80-1.85, P=0.37) or survival to discharge (odds ratio 1.49, 95% confidence interval 0.94-2.37, P=0.09) after the implementation of the ARC 2006 guidelines. Factors that remained significant in the final model for both outcomes included having an initial shockable rhythm, a shorter length of time from collapse to arrival of cardiac arrest team, location of the patient in a critical-care area, shorter length of resuscitation and a day-time arrest (0700-2259 hours). In addition the arrest being witnessed was significant for ROSC and younger age was significant for survival to discharge. There are multiple factors that influence clinical outcomes following an in-hospital cardiac arrest and further research to refine these significant variables will assist in the future management of cardiac arrests. WHAT IS KNOWN ABOUT THIS TOPIC? The evaluation of outcomes from in-hospital cardiac arrests focuses on immediate survival expressed as ROSC and survival to hospital discharge. These clinical outcomes have not improved substantially over the last two decades. WHAT DOES THIS PAPER ADD? This paper identifies the factors that are related to ROSC and survival to discharge following the implementation of the ARC 2006 guidelines, which included a refocus on providing quality cardiopulmonary resuscitation with minimal interruptions. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Given that multiple factors can influence clinical outcomes following an in-hospital cardiac arrest, focusing on maximising a range of factors surrounding cardiopulmonary resuscitation is essential to improve outcomes.

Influence of in-hospital cardiac arrest team dynamics on team performance: Mixed method case study.Status: PendingCategory: CPR Quality

Influence of in-hospital cardiac arrest team dynamics on team performance: Mixed method case study.Status: PendingCategory: CPR Quality

Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation*

This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p < .001), shorter preshock pauses (R = 0.18, p < .001), with lower total hands-off ratio (R = 0.24, p = .01), and shorter time to first shock (R = 0.14, p = .02). Leadership skills were not significantly associated with more simple technical skills such as chest-compression rate, depth, and ventilation rate. Prior training in team leader skills was independently associated with better leadership behavior. There is an association between team leadership skills and cardiac arrest simulation test score, preshock pause, and hands off ratio. Developing leadership skills should be considered an integral part of resuscitation training.

Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department

ObjectiveDetermine if implementing cardiac arrest teams trained with a ‘pit-crew’ protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation. MethodsA phased, prospective, non-randomized, before–after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge. Main resultsAfter implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10–0.19, p<0.005), and from 0.24 to 0.18 (decrease=0.06, 95% CI 0.01–0.11, p=0.02) for the next 5min. The mean time taken to apply Autopulse™ decreased from 208.8s to 141.6s (decrease=67.2, 95% CI, 22.3–112.1, p<0.005). The mean CPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9–46.9, p<0.005) and the mean total NFR for the first 10min decreased from 0.33 to 0.23 (decrease=0.10, 95% CI 0.07–0.14, p<0.005). ConclusionImplementation of cardiac arrest teams was associated with a reduction in NFR in the first 10min of resuscitation. Training cardiac arrest teams in a ‘pit-crew’ protocol may improve the quality of CPR at the ED.

In‐hospital mortality after serious adverse events on medical and surgical nursing units: a mixed methods study

To investigate the circumstances of nursing care eight hours before serious adverse events (=SAE's) on medical and surgical nursing units with subsequent in-hospital mortality in order to identify the extent to which these SAE's were potentially preventable. The prevention of SAE 's in acute care is coming under increasing scrutiny, while the role nursing care plays in the prevention of acute critical deterioration of patients is unclear. Retrospective review of patient records of 63 SAE's in a Belgian teaching hospital where death was the final outcome following a cardiac arrest team call or unplanned ICU admission from an acute care unit. Data from chart reviews were combined with data regarding working conditions on the nursing unit at the time of the events and experts' opinions regarding the preventability of the outcomes. Finally, a pilot survey of staff nurses about their experiences with deteriorating patients and knowledge of vital signs and call criteria was conducted independently of the chart abstractions and case reviews. Experts were almost five times more likely to designate a case as potentially preventable when a cardiac arrest team call was the terminal event and were 40% less likely to designate a case as potentially preventable when more observations were documented in patient records. Survey results revealed that nurses were often unaware that their patients were deteriorating before the crisis. Nurses also reported threshold levels for concern for abnormal vital signs that suggested they would call for assistance relatively late in clinical crises. Renewed attention to accurate recording, documentation and interpretation of vital signs in hospital nursing practice appears needed. Timely detection of deteriorating patients to assist staff to improve their outcomes appears to be jeopardised by a number of practices and factors and merits deeper study.

The sounds of cardiac arrest: Innovating to obtain an accurate record during in-hospital cardiac arrest

BackgroundTo obtain an accurate audit during in-hospital cardiac arrest, following recommendations of the Utstein style and measuring time intervals between the different interventions, is difficult. ObjectiveTo assess whether the use of an audio recording system during in-hospital cardiac arrest resuscitation allows the register of more items during cardiopulmonary resuscitation. Material and methodsProspective observational study between January 2008 and December 2009. The population that were included, were hospitalized patients and non-hospitalized patients assisted by a cardiac arrest team, except for critical areas. An audio recording system with a timer was turned on when cardiac arrest team was alerted. Recordings were reviewed to fill in the items recommended by the Utstein style. Time intervals were calculated. Mean number of completed items per patient were compared between recorded and non-recorded cardiac arrest. Results119 CA team alerts took place. 64 (53.7%) cases were real CA and 37 (57.8%) of them were properly recorded. A mean number of items per patient in recorded cardiac arrest cases were 18.18 (±3.2) vs. 15.96 (±4.1) in non-recorded cardiac arrest cases (p<0.05). In the recorded cases, mean times were: alert – arrival: 1.23 (±0.95)min; arrival – cardiopulmonary resuscitation initiation: 0.63 (±0.38)min; arrival – first defibrillation: 2.06 (±1.33)min; arrival – intubation: 8.42 (±4.64)min; arrival – first adrenaline: 3.30 (±1.98)min. ConclusionsThe audio recording system permits the register of a larger number of items per patient during in-hospital cardiac arrest and allows measurement of time intervals between the different interventions during cardiopulmonary resuscitation.

The “Resus:Station”: The use of clinical simulations in a randomised crossover study to evaluate a novel resuscitation trolley

Background and aimInadequately designed equipment has been implicated in poor efficiency and critical incidents associated with resuscitation. A novel resuscitation trolley (Resus:Station) was designed and evaluated for impact on team efficiency, user opinion, and teamwork, compared with the standard trolley, in simulated cardiac arrest scenarios. MethodsFifteen experienced cardiac arrest teams were recruited (45 participants). Teams performed recorded resuscitation simulations using new and conventional trolleys, with order of use randomised.After each simulation, efficiency (“time to drugs”, un-locatable equipment, unnecessary drawer opening) and team performance (OSCAR) were assessed from the video recordings and participants were asked to complete questionnaires scoring various aspects of the trolley on a Likert scale. ResultsTime to locate the drugs was significantly faster (p=0.001) when using the Resus:Station (mean 5.19s (SD 3.34)) than when using the standard trolley (26.81s (SD16.05)).There were no reports of missing equipment when using the Resus:Station. However, during four of the fifteen study sessions using the standard trolley participants were unable to find equipment, with an average of 6.75 unnecessary drawer openings per simulation.User feedback results clearly indicated a highly significant preference for the newly designed Resus:Station for all aspects.Teams performed equally well for all dimensions of team performance using both trolleys, despite it being their first exposure to the Resus:Station. ConclusionWe conclude that in this simulated environment, the new design of trolley is safe to use, and has the potential to improve efficiency at a resuscitation attempt.

Resource allocation for emergency teams in Danish Emergency Departments

Results Nineteen of twenty (95%) departments responded. Three departments were excluded due to incomplete data. All departments (n=16) received unselected critically ill patients, patients in cardiac arrest and trauma patients. In 16 (100%) departments there were a designated team that responded to cardiac arrest and trauma patients. Only 5 (31%) departments had access to a designated medical emergency team in the emergency department. The cardiac arrest teams consisted of median 6,2 (range 5-10) different personnel groups. Of these, 3 (range 1-6) were physicians with only 0,9 (range 0-2) being senior consultants. The other summoned personnel groups included emergency department nurses, nurse anaesthetists, bioanalysts and porters. The trauma teams consisted of median 9,3 (range 711) different personnel groups. Of these, 4,3 (range 2-6) were physicians where 2,6 (range 2-4) were senior consultants. The other summoned personnel groups included emergency department nurses, nurse anaesthetists, radiographers, bioanalysts, and porters. In 4 (25%) departments there were not access to a medical emergency team, and in 5 (31%) an ad hoc team was created by the emergency department personnel. In 2 (14%) departments a team was created by the attending emergency physician. The staffing of the medical emergency teams relied on patient specific diagnosis, symptoms and triage scores.

Survival after cardiac arrest and changing task profile of the cardiac arrest team in a tertiary care center.

Background. The characteristics of in-hospital emergency response systems, survival rates, and variables associated with survival after in-hospital cardiac arrest vary significantly among medical centers worldwide. Aiming to optimize in-hospital emergency response, we performed an analysis of survival after in-hospital cardiopulmonary resuscitation and the task profile of our cardiac arrest team. Methods. In-hospital emergencies handled by the cardiac arrest team in the years 2004 to 2006 were analyzed retrospectively, and patient and event characteristics were tested for their associations with survival after cardiopulmonary resuscitation. The results were compared to a similar prior analysis for the years 1995 to 1997. Results. After cardiopulmonary resuscitation, the survival rate to discharge was 30.2% for the years 2004 to 2006 compared to 25.1% for the years 1995 to 1997 (difference not statistically significant). Survival after one year was 18.5 %. An increasing percentage of emergency calls not corresponding to medical emergencies other than cardiac arrest was observed. Conclusions. The observed survival rates are considerably high to published data. We suggest that for further improvement of in-hospital emergency response systems regular training of all hospital staff members in immediate life support is essential. Furthermore, future training of cardiac arrest team members must include basic emergency response to a variety of medical conditions besides cardiac arrest.

Effect of Cardiac Arrest Team Training Using Script on the Quality of Simulated Resuscitation

Background: The purpose of this study was to compare the quality of simulated resuscitation between the conventional simulation training group and the script based training group. Methods: This was a retrospective analysis of video clips from a previous study of cardiopulmonary resuscitation (CPR) team simulation training. A total of eighty-four video clips were analyzed. Each video clip belonged to either the conventional group or the script group, of either pre-training or post-training. One of the authors analyzed all the video clips. The qualities of resuscitation team plays were compared in terms of the hands-on compression time, the interval to meaningful measures and the number of utterances of the team leader and members. Results: The hands-on time of the conventional group improved after training whereas that of the script group deteriorated (22.2 vs -7.0 sec, p = 0.009). The time to defibrillation also improved in the conventional group whereas that of the script group deteriorated (-24.0 vs 33.0 sec, p = 0.002). There were no differences in the utterances of team leaders and members between groups and between preand post-training. Conclusions: This study suggested that the effect of script-based training on quality of CPR was less useful than that of conventional training using simulation and debriefing. Therefore, CPR team training using a script alone should not be recommended.

Abstract 76: A Survey of Airway Skills and Equipment Available During In-Hospital Cardiac Arrest in the United Kingdom

Objectives The Resuscitation Council (RC (UK)) recommends that cardiac arrest teams include members skilled in tracheal intubation and provides a list of the equipment that should be available at cardiac arrests. We surveyed intensive care unit (ICU) residents in all general adult ICUs in the UK to determine compliance with these guidelines. The Royal College of Anaesthetists “Initial Assessment of Competency”, normally taken after 3 months of anaesthetic training, was used to define competency in tracheal intubation. Method Using a standardised questionnaire, a resident in each of the 254 general adult ICUs in the UK was surveyed by telephone. Results Responses were obtained from a resident in 192 (76%) of ICUs. ICU residents attended cardiac arrests in 129 (67%) of hospitals; 34% of these residents were not competent in tracheal intubation. Only 124 (65%) of the arrest teams always included a member with at least 6 months anaesthetics experience. Operating department practitioners (anaesthetic assistants) were sole airway operators in 2% of teams. Cardiac arrest airway equipment data was obtained from 181 hospitals (table). Of the 25 cardiac arrest teams not using LMAs, 12 used alternative supraglottic airway devices (SADs). Capnography was routinely available to 22% of arrest teams. Conclusions One third of ICU residents in cardiac arrest teams are not competent in tracheal intubation. Capnography is available to only one fifth of teams. The need for intubation skills at cardiac arrests has been questioned, and may be unnecessary if members of the arrest team are competent in the use of SADs. Capnography is now recommended for confirming intubation at cardiac arrests; it also provides feedback on CPR quality and an early indication of return of spontaneous circulation. All cardiac arrest teams in the UK should have capnography available and implement its use urgently.

Abstract 79: Improving the Quality of Cardiopulmonary Resuscitation by Training Dedicated Cardiac Arrest Teams in the Usage of a Mechanical Load-Distributing Device at the Emergency Department

Study Objective: To determine if implementing cardiac arrest teams trained with a sequence protocol in using a load distributing band mechanical CPR device (AutoPulse ZOLL), improves the quality of CPR, as determined by the No-Flow Ratio [NFR] in the 1st 10 minutes of resuscitation. The NFR is a function of compressions to pauses during the CPR cycle. Methods: This is a phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100-before and 107-after cases. Continuous video and chest compression data with the Physiocontrol Codestat Suite 7.0, of all study subjects were analyzed. All non-traumatic, collapsed patients older than 18 years old, presenting to the Emergency Department were eligible. Results: After implementation, the mean total NFR for the 1st 5 minutes and the next 5 minutes respectively decreased from 0.42 to 0.27 (difference = 0.15, 95%CI 0.10 to 0.19, p&lt;0.005), and from 0.24 to 0.18 (difference = 0.06, 95%CI 0.01 to 0.11, p=0.01). The mean time taken to apply AutoPulse (seconds) decreased from 208.8s to 144.5s (difference = 64.3, 95%C.I, 18.0 to 110.6, p=0.007). Overall, the mean CPR ratio, which is the percentage of time with active CPR in a resuscitation, increased from 46.4% to 88.6% (difference = 42.2%, 95%CI 37.1% to 47.2%, p&lt;0.005) and the mean total NFR for the 1st 10 minutes decreased from 0.33 to 0.23 (difference = 0.10, 95%CI 0.07 to 0.14, p&lt;0.005). Conclusion: Implementation of cardiac arrest teams was associated with a reduction in no-flow ratio in the 1st 10 minutes of resuscitation. We recommend that training cardiac arrest teams in a specially sequenced protocol can improve the quality of CPR at the ED.

Abstract 234: Assessment of a Newly Designed Resuscitation Trolley in a Simulated Environment

Introduction In 2006, data from the UK National Reporting and Learning System (NRLS) database highlighted the fact that ill-stocked resuscitation trolleys directly led to a number of preventable deaths. Of 86 reported incidents involving resuscitation trolleys, 10 contributed to the deaths of patients. In light of this data the National Patient Safety Agency (NPSA) sponsored a redesign of the resuscitation trolley. Over the past 2 years a complex design process culminated in a new ergonomically designed “Resus:Station” prototype. Objectives To assess the usability and impact on teamwork of “Resus:Station” when compared with the standard resuscitation trolley in a series of simulated cardiac arrest scenarios. Methods 15 expert Cardiac Arrest Teams comprising an Anesthesiologist, a Physician, and a Nurse were recruited (45 participants in total). Teams performed resuscitation simulations using both trolleys, with order of use randomised. All research sessions were recorded to facilitate structured debriefing. Following each simulation participants completed questionnaires scoring trolley usability, safety, effects on Resuscitation, and design on 7-point Likert scales. They also indicated their preference for trolley (Resus:Station or old trolley). Team performance was assessed from the video recordings by two trained blinded raters using a validated tool to assess quality of teamworking with each trolley, and to determine differences in efficiency of resuscitation. Results Strongly significant (p&lt;0.001) differences favouring the Resus:Station over the old trolley were obtained on all user-rated aspects (usability, safety, effects on Resuscitation, and design). Quality of teamworking in the observed teams did not differ significantly between trolleys, however efficiency of the team was seen to improve when using the new Resus:Station. Conclusions The Resus:Station is safe to use in a simulated environment, there is no detrimental effect on team performance, some improvement in efficiency, and it is strongly preferred by clinical staff. In view of these strongly positive results, the “Resus:Station is being assessed further in a real clinical environment.

Survival from in‐hospital cardiac arrest in Auckland City Hospital

To describe in-hospital resuscitation outcomes and factors associated with survival at Auckland City Hospital, New Zealand. The Utstein template for in-hospital cardiac arrests was used. A retrospective audit of all cardiac arrests 2004-06 determined patient demographics, resuscitation time intervals, interventions, survival and neurological outcome at 12 months. Factors associated with survival to discharge were explored with logistic regression. There were 3470 in-hospital deaths. Resuscitation was attempted in 415 patients (12%), with survival to discharge 27.2%. Survival was higher in first rhythm VT/VF (52.7% vs 13.1%, χ(2) = 75.3, P < 0.001), when the arrest was 'In-Hours' (41.4% vs 17%, χ(2) = 30.1, P < 0.001) and with younger age (mean [SD] for survivors 59.4 [7.1]vs 69.1 [14] for non-survivors). These associations were independent predictors of survival after multivariate logistic regression, with OR 6.2 (95% CI 3.6-10.5), 3.1 (95% CI 1.8-5.4) and 1.04 (95% CI 1.02-1.06), respectively (all P < 0.001). Other univariate predictors of survival; cardiac arrest team on site, monitored arrest and time to CPR were not significant after multivariate logistic regression. Time intervals to arrest interventions were short. Twelve month neurological outcome was good (CPC1 or 2) in 97.1% (95% CI 91.6-99.4) of survivors. Survival from cardiac arrest in our hospital compared well to similar centres and good neurological outcome was higher than reported previously. Reduced survival during the 'After-Hours' period is cause for concern, and further research into the factors underlying this is required.

The impact of the medical emergency team on the resuscitation practice of critical care nurses

BackgroundMedical Emergency Teams (MET)/rapid response are replacing Cardiac Arrest teams in acute hospitals. There is a lack of knowledge about how Critical Care Nurses (CCNs), rostered on MET construct their...

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: A cohort study: trial protocol

BackgroundCardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest.Methods/designThe primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. Methods: All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites.ConclusionThis trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing.Trial registrationISRCTN56583860

In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

BackgroundInterruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team.MethodsA prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team.ResultsData from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254) and detected initial rhythm after median 311 seconds (283-349). A significant difference in no flow ratio (NFR) was observed between the first responders, median NFR 38% (32-46), and the resuscitation teams, median NFR 25% (19-29), p < 0.001. The difference was significant even after adjusting for pulse and rhythm check and shock delivery.ConclusionThe main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient outcome.

Development, reliability, and content validation of the observational skill-based Clinical Assessment tool for Resuscitation (OSCAR)

Objectives: Evidence shows that clinicians’ non-technical skills have a significant impact on teamworking, patient safety, efficiency of care provided and patient outcomes.1 Such skills are key for Cardiac Arrest Teams (CATs), which are multi-professional (Anaesthetists, Physicians and Nurses) and function under high pressure. To date, most tools to assess nontechnical skills in healthcare have focused on surgery2 and anaesthesia.3 No validated, robust tools are currently available for assessing non-technical skills in CATs.

Unusual conditions for CPR: Three different cases

Introduction: Cardiac arrest team members can meet many different conditions of cardiopulmonary arrests. Every team members should be trained about these conditions. We present three CPR cases that are eventuated in different places of our hospital.