"Putting it all together" to improve resuscitation quality

Abstract

Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Fig. 1

Resuscitation quality after training. Curve A depicts quality decline after traditional instruction. Note fall into gray shaded zone of poor quality several months after initial training. Curve B represents the theoretical addition of high realism simulation and expert debriefing. Although there is no change in rate of psychomotor skill quality decrement over time, resuscitation quality is maintained longer owing to higher level of initial skill acquisition. Curve C represents addition of frequent refresher training in addition to simulation to prevent decrement to poor quality.

Fig. 2

Using end-tidal (ET) CO2 to detect ROSC. From onset of arrest (#), note slow increase in end-tidal CO2 as compressions are delivered. With ROSC (arrow), organized ECG rhythm begins to appear under chest compression artifact (asterisk) and end-tidal CO2 rises suddenly to greater than 50 mmHg. Providers could have used the rapid rise in end-tidal CO2 as a clinical guide that there was a return of spontaneous circulation, without having to pause chest compressions and risk interruption of CPR for a rhythm check.

Fig. 3

Representative CPR quantitative recording. Provides ability to review ECG, ventilation, and chest compression data after events to improve future resuscitation quality. Note prompts given to rescuers to “compress deeper” when the chest compressions are too shallow. The arrow heads indicate ventilations, in this recording provided at a rate of approximately 60 per minute (too fast!). These recordings can be used to provide a structured quantitative postevent review for rescuers who participated in the resuscitation.