A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation |
| |
| Institution: | 1. Anchorage Fire Department, Anchorage, AK, United States;2. University of Alaska, Anchorage, United States;3. Redmond Fire Department, Redmond, WA, United States;4. Resurgent Biomedical Consulting, Seattle, WA, United States;5. Physio-Control Inc., Redmond, WA, United States;1. Kantonsspital St Gallen Klinik für Anästhesiologie, Raron, Switzerland;2. Hochtaunus-Kliniken gGmbH, Krankenhaus Bad Homburg, Abteilung für Anästhesie und operative Intensivmedizin, Raron, Switzerland;3. Schwarzwald-Baar-Klinikum, Villingen-Schwennigen Klinik für Neurochirurgie, Villingen-Schwenningen, Germany;1. University of Toronto, Toronto, ON, Canada;2. University of Washington, Seattle, WA, United States;3. University of British Columbia, Vancouver, BC, Canada;4. University of Ottawa, Ottawa, ON, Canada;5. Oregon Health and Science University, Portland, OR, United States;6. University of California/San Diego, San Diego, CA, United States;7. St. Paul''s Hospital, Vancouver, BC, Canada;1. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan;2. Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan;1. Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland;2. Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;3. Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland;4. Faculty of Medicine, University of Geneva, Geneva, Switzerland;5. Geneva Hemodynamic Research Group, Geneva, Switzerland;1. University of Utah School of Medicine, Division of Emergency Medicine, Salt Lake City, UT, United States;2. The Salt Lake City Fire Department, Salt Lake City, UT, United States;3. The University of North Carolina School of Medicine, Chapel Hill, NC, United States;4. The Utah Department of Health, Bureau of Emergency Medical Services, United States;1. Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada;2. Division of Biostatistics, University of Minnesota, Minneapolis, MN, US;3. Department of Biostatistics, University of Washington, Seattle, WA, US;4. University of British Columbia, Vancouver, BC, Canada;5. University of Pittsburgh, Pittsburgh, PA, US;6. Medical College of Wisconsin, Milwaukee, WI, US;7. University of Washington, Seattle, WA, US;8. University of Pennsylvania, The Children''s Hospital of Philadelphia, PA, US;9. University of Pittsburgh, Pittsburgh, PA, US;10. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US;11. Air Methods Corporation, Greenwood Village, CO, US;12. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US;13. National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, US;14. Doctors Without Borders, Toronto, ON, Canada;15. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;p. Lake Chelan Community Hospital EMS, Chelan, WA, US;q. Departments of Emergency Medicine, Pediatrics and the Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, US;r. Clackamas County EMS, Oregon City, OR, US;s. Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada |
| |
| Abstract: | BackgroundMinimizing the chest compression pause associated with application of a mechanical CPR device is a key component of optimal integration into the overall resuscitation process. As part of a multi-agency implementation project, Anchorage Fire Department deployed LUCAS CPR devices on BLS and ALS fire apparatus for initiation early in resuscitation efforts. A 2012 report identified the pause interval for device application as a key opportunity for quality improvement (QI). In early 2013 we began a QI initiative to reduce device application time interval and optimize the overall CPR process. To assess QI initiative effectiveness, we compared key CPR process metrics from before to during and after its implementation.MethodsWe included all cases of EMS-treated out-of-hospital cardiac arrest during 2012 and 2013 in which a mechanical CPR device was used and the defibrillator electronic record was available. Continuous ECG and impedance data were analyzed to measure chest compression fraction, duration of the pause from last manual to first mechanical compression, and duration of the longest overall pause in the resuscitation effort.ResultsCompared to cases from 2012 (n = 61), median duration of the pause prior to first mechanical compression for cases from 2013 (n = 71) decreased from 21 (15, 31) to 7 (4, 12) s (p < 0.001), while median chest compression fraction increased from 0.90 (0.88, 0.93) to 0.95 (0.93, 0.96) (p < 0.001). Median duration of the longest pause decreased from 25 (20, 35) to 13 (10, 20) s (p < 0.001), while the proportion of cases where the longest pause was for mechanical CPR application decreased from 74% to 31% (p < 0.001).ConclusionsOur QI initiative substantially reduced the duration of the pause prior to first mechanical compression. Combined with the simultaneous significant increase in compression fraction and significant decrease in duration of the longest pause, this finding strongly suggests a large improvement in mechanical CPR device application efficiency within an overall high-performance CPR process. |
| |
| Keywords: | High performance CPR Mechanical chest compression OHCA Chest compression fraction Cardiac arrest resuscitation |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
