From the Guidelines
Hospital cardiopulmonary resuscitation (CPR) performance programs should prioritize high-quality CPR delivery by adhering to the 2020 American Heart Association guidelines, which emphasize pushing hard and fast with complete chest recoil, minimizing interruptions, and avoiding excessive ventilation 1. To achieve this, hospitals should implement regular training sessions for healthcare providers, focusing on proper technique, including chest compression depth of at least 2 inches and a rate of 100-120 compressions per minute.
- Key aspects of high-quality CPR include:
- Allowing complete chest recoil after each compression
- Minimizing interruptions in compressions
- Avoiding excessive ventilation
- Changing compressors every 2 minutes, or sooner if fatigued, as recommended by the 2020 guidelines 1
- Effective CPR performance programs should also incorporate:
- Regular simulation-based training sessions
- Coordinated team efforts with clear role assignments
- Standardized and readily accessible equipment, such as crash carts with defibrillators and airway management tools
- Post-event debriefings to analyze performance metrics and identify areas for improvement By prioritizing high-quality CPR delivery and adhering to current guidelines, hospital CPR performance programs can improve patient outcomes, reduce morbidity and mortality, and enhance overall quality of life 1.
From the Research
In-Hospital Cardiopulmonary Resuscitation Performance Program
- The program requires a multifaceted approach to deliver high-quality cardiopulmonary resuscitation (CPR) to patients with in-hospital cardiac arrest, as discussed in 2.
- This approach includes measuring patient outcomes, patient safety incident reporting, education, emphasis on human factors, briefing and debriefing of resuscitation teams, and the use of sensing devices that provide real-time prompts or feedback to rescuers during CPR.
Key Components of the Program
- Education of staff is essential in both technical and non-technical resuscitation skills (human factors) to improve resuscitation team performance, as highlighted in 2.
- The use of feedback and prompt devices can help improve adherence to guidelines for chest compression quality, but data are lacking in terms of showing improved patient outcomes, as noted in 2.
- Collecting data during arrests and feeding back in real-time and post-event during debriefings can be used to improve the delivery of high-quality CPR, as discussed in 2.
Factors Affecting CPR Quality
- Rescuer fitness can affect the quality of prolonged cardiopulmonary resuscitation, with higher anaerobic power and muscular strength being predictive of high-quality CPR, as found in 3.
- Sex (female) was also found to be predictive of better chest compression recoil percentages, as reported in 3.
Importance of High-Quality CPR
- Prompt delivery of high-quality CPR can dramatically improve survival outcomes, as emphasized in 4.
- The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality and its relative importance regarding return of spontaneous circulation and survival to hospital discharge, as discussed in 4.
Use of Automated External Defibrillators
- Early defibrillation and use of an automated external defibrillator (AED) can significantly improve survival rates following out-of-hospital cardiac arrest, as highlighted in 5.
- The AED will provide voice and/or visual prompts to guide the rescuer in its use and the delivery of defibrillatory shocks, as explained in 5.