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Quality of Cardiopulmonary Resuscitation Among Highly Trained Staff in an Emergency Department Setting
Heidrun Losert, MD;
Fritz Sterz, MD;
Klemens Köhler, MD;
Gottfried Sodeck, MD;
Roman Fleischhackl, MD;
Philip Eisenburger, MD;
Andreas Kliegel, MD;
Harald Herkner, MD;
Helge Myklebust, BEng;
Jon Nysæther, PhD;
Anton N. Laggner, MD
Arch Intern Med. 2006;166:2375-2380.
Background Recent reports have highlighted the poor standard of cardiopulmonary resuscitation (CPR) achieved by health care professionals in diverse situations. We explored what can be achieved in an emergency department by highly trained permanent staff.
Methods In a prospective observational study conducted from June 1, 2002, to August 31, 2005, 80 of 213 patients requiring CPR and admitted to the emergency department of a tertiary care hospital were eligible for study participation. Owing to several logistic problems with CPR, 133 patients could not be studied. The CPR team consisted of emergency- and critical care–trained physicians with more than 10 years of acute care experience, most of whom were instructors of European Resuscitation Council courses in basic and advanced life support. A specially designed defibrillator was used to assess the quality of CPR.
Results For 80 patients, 95 data sets were available for analysis, yielding a total of 1065 minutes of cardiac arrest time. Chest compressions were performed at a rate of 114 (95% confidence interval [CI], 112-116) per minute, resulting in a mean of 96 (95% CI, 93-99) delivered chest compressions per minute. We further observed a mean hands-off ratio of 12.7% (95% CI, 12.3%-13.1%), and the hands-off ratio was linearly associated with the duration of CPR (R2 = 0.95; mean, 4.3% increments per 5-10 minutes; P<.001). Patients were hyperventilated with a median of 18 (interquartile range, 14-24) ventilations per minute.
Conclusions Highly trained professionals in an emergency department can achieve appropriate chest compression rates during CPR with a low hands-off ratio. Increased attention must be paid in all situations to the avoidance of hyperventilation.
Author Affiliations: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria (Drs Losert, Sterz, Köhler, Sodeck, Fleischhackl, Eisenburger, Kliegel, Herkner, and Laggner); and Laerdal Medical, Stavanger, Norway (Mr Myklebust and Dr Nysæther).
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