Measuring and improving cardiopulmonary resuscitation quality inside the emergency department

Aim of study: To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. Methods: CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. Results: A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8 mm in P1 to 61.6 ± 2.8 mm in P2 (p< 0.001), with the percentage of CC ≥ 51 mm increasing from 30.6% in P1 to 87.4% in P2 (p< 0.001). CC release velocity increased from 314 ± 25 mm/s in P1 to 442 ± 20 mm/s in P2 (p< 0.001). No significant differences were identified in CC fraction (84.3% P1 vs. 88.4% P2, p= 0.1), CC rate (125 ± 3 cpm P1 vs. 125 ± 3 cpm P2, p= 0.7), or pre-shock pause (9.7 s P1 vs. 5.9 s P2, p= 0.5), though CC fraction and pre-shock pause were within guideline recommendations. Conclusion: Implementation of the bundle of scenario-based training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department.