High Perfromance CPR for NCEMSF
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Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR). This presentation will provide you with an introduction to HP CPR for implementation in your EMS system.
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High Perfromance CPR for NCEMSF
- 1. Presented by: David Hiltz Mike Smith
- 14. Systole Diastole
- 18. DEATH BY HYPERVENTILATION A COMMON EXPERIENCE IN CARDIAC ARREST
- 21. THE PAINFUL TRUTH •Perceived performance does not always match observed performance. •Aufderheide et al. showed that duty cycle, chest compression depth and complete recoil were performed significantly less well when directly observed than EMT perceptions of their performance. •Wik et al. showed that chest compression rate and depth were both significantly below AHA guidelines by trained EMS providers, and no flow time (when there was neither a pulse nor CPR being given) was almost 50% in directly observed performance evaluations. •The likelihood of ROSC increases significantly with higher mean chest compression rate (in a hospital study 75% of patients achieved ROSC with 90 or more chest compressions/minute compared to only 42% with 72 or fewer chest compressions/minute).
- 26. Fatigue and poor crew resource management (CRM) contributed to the accident. EA 401 gradually lost altitude while the flight crew was preoccupied and eventually crashed. The effect of this crash on the airline industry continues today and has resulted in the development of Crew Resource Management (CRM). CRM is a technique that requires air crews to divide the work in the cockpit
- 30. “Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)”
- 33. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 35. Improved survival Paramedic Intubation IV Advanced Life placement Support Rapid rhythm Minimize Administer analysis pauses drugs Prioritize Switch compressions compressor C-A-B s every 2 Hover hands min. Rate between Compress Minimize Full recoil 100 and interruptions 120/min > 2 inches EMT CPR Foundation
- 38. BLS Continuous BLS 30:2 Compression/ventilation ratio 10:1 30:2 Stop for ventilations no yes Rhythm assessment every 2 minutes every 2 minutes* Compressions prior to rhythm 2 minutes or 200 variable* assessment compressions
- 39. •EMTs own CPR •Minimize interruptions in CPR at all times •Ensure proper depth of compressions (>2 inches) •Ensure full chest recoil/decompression •Ensure proper chest compression rate (100-120/min) •Rotate compressors every 2 minutes •Hover hands over chest during shock administration and be ready to compress as soon as patient is cleared •Intubate or place advanced airway with ongoing CPR •Place IV or IO with ongoing CPR •Coordination and teamwork between EMTs and paramedics
- 40. •C-A-B •Minimize interruptions in compressions •Compress at least 100/min •Allow complete chest wall recoil/decompression between compressions •Rhythm assessment every 2 minutes •Rotate compressors every 2 minutes •Hover over patient with hands ready during defibrillation so compressions can start immediately after the shock (or analysis) has occurred
- 44. 1 2 3 4 5 6
- 45. CPR 1 AIRWAY VENTILATION 4 BOSS 2 1 6 5 3 AIRWAY ASSISTANT CPR 2 ACCESS MEDS MONITOR
- 62. Compressions Ventilations Shock 1 Delivered Medics on scene: no Analysis 2: no shock break in CPR advised
- 69. Are you interested in high quality resuscitation related news, discussion topics and other associated interests? HEARTSafe Community and American Heart Association- Public Safety
Editor's Notes
- Perceived performance does not always match observed performance.Aufderheide et al. showed that duty cycle, chest compression depth and complete recoil were performed significantly less well when directly observed than EMT perceptions of their performance.Wik et al. showed that chest compression rate and depth were both significantly below AHA guidelines by trained EMS providers, and no flow time (when there was neither a pulse nor CPR being given) was almost 50% in directly observed performance evaluations.The likelihood of ROSC increases significantly with higher mean chest compression rate (in a hospital study 75% of patients achieved ROSC with 90 or more chest compressions/minute compared to only 42% with 72 or fewer chest compressions/minute).
- The 2010 AHA Guidelines for CPR and ECC once againemphasize the need for high-quality CPR, including• A compression rate of at least 100/min (a change from“approximately” 100/min)• A compression depth of at least 2 inches (5 cm) in adults• Allowing for complete chest recoil after each compression• Minimizing interruptions in chest compressions• Avoiding excessive ventilation
- The quality of unprompted CPR in both in-hospital and out-of–hospital cardiac arrest events is often poor, and methods shouldbe developed to improve the quality of CPR delivered to victimsof cardiac arrest.73,91–93,287 Several studies have demonstratedimprovement in chest compression rate, depth, chest recoil,ventilation rate, and indicators of blood flow such as end-tidalCO2 (PETCO2) when real-time feedback or prompt devices areused to guide CPR performance.72,73,80,288–293 However, there areno studies to date that demonstrate a significant improvement inpatient survival related to the use of CPR feedback devicesduring actual cardiac arrest events. Other CPR feedback deviceswith accelerometers may overestimate compression depth whencompressions are performed on a soft surface such as a mattressbecause the depth of sternal movement may be partly due tomovement of the mattress rather than anterior-posterior (AP)compression of the chest.62,294 Nevertheless, real-time CPRprompting and feedback technology such as visual and auditoryprompting devices can improve the quality of CPR (Class IIa,LOE B).
- Cardiac arrest is an important public health issue. Resuscitationinvolves a broad spectrum of individual stakeholdersand groups. Individuals include victims, family members,rescuers, and healthcare providers. Key stakeholdergroups include the public, emergency medical dispatchers,public safety organizations, EMS systems, hospitals, civicgroups, and policy makers at the local, state, and federallevels.Because the links in the Chain of Survival are interdependent,an effective resuscitation strategy requires theseindividuals and groups to work in an integrated fashion andfunction as a system of care.40 Fundamental to a successfulresuscitation system of care is the collective appreciationof the challenges and opportunities presented by the Chainof Survival. Thus individuals and groups must worktogether, sharing ideas and information, to evaluate andimprove their resuscitation system. Leadership and accountabilityare important components of this teamapproach.A conceptual appreciation of the system and its workingcomponents is only a starting point. Improving carerequires assessment of performance. Only when performanceis evaluated can participants in a system effectively intervene to improve care. This process of quality improvementconsists of an iterative and continuous cycle of(1) systematic evaluation of resuscitation care and outcome,(2) benchmarking with stakeholder feedback, and(3) strategic efforts to address identified deficiencies (seeFigure 4).There is wide community and hospital variability incardiac arrest survival.3,8,13 High-performing systems haveused this continuous quality improvement approach withgreat success,41 as have systems that have more recentlyadopted this strategy.42 These successes have occurred in avariety of systems, suggesting that all communities andhospitals can substantially improve care and outcomes.Since each system has different characteristics and challenges,there is no single prescriptive strategy for improvement.However, each system has an obligation to addressthe fundamental principles of quality improvement: measurement,benchmarking, and feedback and change.