1. ResultsBackground
Discussion
Summary
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Methods Conclusions
“No-Interruption CPR” in ED Resuscitations: Are we practicing what we preach?
A no interruption standard (no greater than
10 second pause from chest compressions)
is part of the current AHA (2010) guidelines
for CPR. Previous studies on in and out of
hospital cardiac arrest have demonstrated
significant interruptions in compressions.
We believe that interruptions in the ED may
be as frequent as previously observed. The
purpose of this study is to measure the
number, duration, and types of interruptions
in an urban ED.
A QI study was performed for a
convenience sample of ED CPR over a 6-
month period. A research associate was
notified and came to bedside for CPR in
progress. They recorded data during every
ED CPR as a silent observer using a
standardized data instrument. A Laerdal
CPR meterTM (Wappingers Falls, NY) was
applied to the sternum of every subject
during CPR to record depth of
compression, complete release, average
rate (sec), and flow time. Associates
recorded interruption types.
Analysis of preliminary data from 50 cases
revealed substandard results in complete
release, flow time and interruption length.
This data is consistent with previous
research outside of the ED. Pulse check
was the most common interruption
measured in this study, and duration was
almost double the recommended allowable
time interval.
Measurement of these CPR metrics remains
essential to the improvement of quality and
feedback on resuscitations in the ED
50 cases were evaluated over a 8-month time period. The total
number of interruptions was 290. AHA recommendation for mean
depth is 50 mm; mean was 55.07 mm (SD: ±7.61). AHA
recommendation for complete release is 100%, mean was 70.5%
(SD: ±27.1). AHA recommendation for average rate is 100
compressions per min, mean was 124.47 (SD: ±10.40). AHA
recommendation for flow time is 91.67%; mean was 80.75% (SD:
±15.2). AHA recommendation for duration of interruption is less
than 10 sec, mean was 16.61 sec (SD: ±13.62).
Interruptions were classified as: airway management (n=7, range
3-80 sec mean duration 26.42 SD: ±26.57), defibrillation (n=20,
range 2-23 sec, mean duration 9.38sec SD: ±5.59), patient
positioning (n=14, range 2-59 sec, mean duration 17.14 sec SD:
±23.34), pulse check (n=192, range 2-88 sec, mean duration 17.60
sec SD: ±11.98), chest compressor change (n=31, range 1-84 sec,
mean duration 13.84 sec SD: ±14.95), Ultrasound (n=8, range 6-
79 sec, mean duration 29.62 sec SD: ±23.18).
John J Kelly, DO, Theo Leriotis, DO, Kenneth Dietch, DO,
Paul Dominici, MD, Gina Domingo MD, Charles Bortle, Ed.D.
AHA
Recommendation
Mean (SD)
Average Depth
(mm)
50 mm 55.32 ±7.41
Average Rate (sec) 100 124.74 ±10.22)
Complete Release 100% 71.3% (SD: ±26.6).
Flow Time 91.67%* 80.33% (SD: ±14.7).
Interruption Length
(sec)
10 16.61 sec (SD: ±13.62).