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Improving In-Hospital Cardiac Arrest Process and Outcomes With Performance Debriefing
Dana P. Edelson, MD, MS;
Barbara Litzinger, BS;
Vineet Arora, MD, MAPP;
Deborah Walsh, MS, RN;
Salem Kim, BA;
Diane S. Lauderdale, PhD;
Terry L. Vanden Hoek, MD;
Lance B. Becker, MD, FAHA;
Benjamin S. Abella, MD, MPhil
Arch Intern Med. 2008;168(10):1063-1069.
Background Recent investigations have documented poor cardiopulmonary resuscitation (CPR) performance in clinical practice. We hypothesized that a debriefing intervention using CPR quality data from actual in-hospital cardiac arrests (resuscitation with actual performance integrated debriefing [RAPID]) would improve CPR performance and initial patient survival.
Methods Internal medicine residents at a university hospital attended weekly debriefing sessions of the prior week's resuscitations, between March 2006 and February 2007, reviewing CPR performance transcripts obtained from a CPR-sensing and feedback-enabled defibrillator. Objective metrics of CPR performance and initial return of spontaneous circulation were compared with a historical cohort in which a similar feedback-delivering defibrillator was used but without RAPID.
Results Cardiopulmonary resuscitation quality and outcome data from 123 patients resuscitated during the intervention period were compared with 101 patients in the baseline cohort. Compared with the control period, the mean (SD) ventilation rate decreased (13 [7]/min vs 18 [8]/min; P < .001) and compression depth increased (50 [10] vs 44 [10] mm; P = .001), among other CPR improvements. These changes correlated with an increase in the rate of return of spontaneous circulation in the RAPID group (59.4% vs 44.6%; P = .03) but no change in survival to discharge (7.4% vs 8.9%; P = .69).
Conclusions The combination of RAPID and real-time audiovisual feedback improved CPR quality compared with the use of feedback alone and was associated with an increased rate of return of spontaneous circulation. Cardiopulmonary resuscitation sensing and recording devices allow for methods of debriefing that were previously available only for simulation-based education; such methods have the potential to fundamentally alter resuscitation training and improve patient outcomes.
Trial Registration clinicaltrials.gov Identifier: NCT00228293
Author Affiliations: Section of General Internal Medicine (Drs Edelson and Arora), Emergency Resuscitation Center (Drs Edelson and Vanden Hoek and Mss Litzinger and Walsh), Department of Health Studies (Dr Lauderdale), and Section of Emergency Medicine (Dr Vanden Hoek), University of Chicago, Chicago, Illinois; and Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia (Ms Kim and Drs Becker and Abella).
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