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CPR Knowledge & Performance in the ED

CPR Knowledge & Performance in the ED

Despite advances in cardiopulmonary resuscitation (CPR), survival and recovery for patients receiving this care remain suboptimal, according to recent reports. Studies indicate that early and effective CPR can improve survival after cardiopulmonary arrest, but out-of-hospital and in-hospital providers often have difficulty performing high-quality CPR. Research has shown that providing poor-quality CPR has similar outcomes to not performing CPR at all. Recent recommendations have focused on chest compressions as an important focus to optimizing CPR, and some of the specific components of these compressions—including rate, depth, and recoil—have been found to affect outcome measures. “Chest compression technique in CPR is important,” says Thomas E. Terndrup, MD. “While ED personnel are trained in effective CPR techniques, they often struggle to perform chest compressions that adhere to American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care.” Studies have also shown that knowledge of these guidelines and motor skills for CPR are not well retained, even within a year of training. However, other factors may improve performance, including having more CPR training and having more experience performing CPR. Analyzing Provider Performance Dr. Terndrup and colleagues had a study published in the Western Journal of Emergency Medicine that evaluated CPR knowledge and how well chest compressions were performed by a group of in-hospital providers with different levels of training and experience. “Most studies evaluating the performance of CPR have looked at personnel who provide care outside the hospital,” Dr. Terndrup says. “We wanted to see how well medical students and ED personnel with current CPR certification knew and understood CPR parameters and how this knowledge affected performance of chest compressions.” Dr. Terndrup...
Improving Survival After In-Hospital Cardiac Arrest

Improving Survival After In-Hospital Cardiac Arrest

According to the American Heart Association (AHA), more than 200,000 adults and 6,000 children have in-hospital cardiac arrests (IHCAs) each year, and survival has remained relatively unchanged for decades. Research shows that only about one-quarter of IHCA patients survive to hospital discharge. “IHCA has not received the same level of focused research as out-of-hospital cardiac arrest (OHCA),” says Laurie J. Morrison, MD, MSc. “There are many gaps in science, policy, and institutional application and accountability for the care of IHCA patients.” Recently, the AHA released a consensus statement on strategies for improving survival after IHCA. Published in an issue of Circulation, the scientific statement is organized into four sections, based on scientific evidence from IHCA studies or reasonable extrapolation from the literature on OHCA. These include: 1) epidemiology, 2) best practices, 3) culture change and standardized reporting and benchmarking, and 4) conclusions and recommendations. “The consensus statement on IHCA gives healthcare providers, clinical leaders, administrators, regulators, and policymakers an overview of the various issues related to reporting, planning, and performing best practices for IHCA,” says Dr. Morrison, who was lead author of the AHA’s scientific statement. “It also documents what is known and should be applied to ongoing care and what is unknown about IHCA and should be researched to advance care.” Gathering Reliable Data on In-Hospital Cardiac Arrest According to the AHA, there is great variation across the country in how IHCAs are defined and counted and whether or not they are reported annually. “A serious obstacle to providing better care for IHCAs is the inability to gather reliable data,” says Dr. Morrison. “We must be able to...

Resuscitation Efforts Impact Survival After Cardiac Arrest

Systematically increasing the duration of resuscitation in patients with cardiac arrest may improve survival, according to American investigators. The average duration of resuscitation was 12 minutes for patients who returned to spontaneous circulation, compared with 20 minutes for non-survivors. Patients at hospitals in the quartile with the longest attempts (25 minutes) were more likely to return to spontaneous circulation and survive to discharge when compared with patients at hospitals in the quartile with the shortest attempts in non-survivors (16 minutes). Abstract: Lancet, September 5,...
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