Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest

• Published in: JAMA : the journal of the American Medical Association Vol. 293; no. 3; pp. 305 - 310
• Main Authors: Abella, Benjamin S, Alvarado, Jason P, Myklebust, Helge, Edelson, Dana P, Barry, Anne, O’Hearn, Nicholas, Vanden Hoek, Terry L, Becker, Lance B
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 19.01.2005
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - standards; Cardiovascular disease; Chicago; Clinical outcomes; CPR; Defibrillators; Female; General aspects; Guideline Adherence - statistics & numerical data; Heart Arrest - therapy; Hospitalization; Hospitals, University - standards; Humans; Male; Medical personnel; Medical sciences; Middle Aged; Practice Guidelines as Topic; Prospective Studies; Chicago; Medicine; Intensive cardiocirculatory care; Cardiocirculatory arrest; Quality; Cardiovascular disease; Hospital; Public health
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.293.3.305

CONTEXT The survival benefit of well-performed cardiopulmonary resuscitation (CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. OBJECTIVES To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. DESIGN AND SETTING A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions (no-flow fraction) were recorded. MAIN OUTCOME MEASURE Adherence to American Heart Association and international CPR guidelines. RESULTS Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1% of segments. Compression depth was too shallow (defined as <38 mm) for 37.4% of compressions. Ventilation rates were high, with 60.9% of segments containing a rate of more than 20/min. Additionally, the mean (SD) no-flow fraction was 0.24 (0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients (40.3%) achieved return of spontaneous circulation and 7 (10.4%) were discharged from the hospital. CONCLUSIONS In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.