doi: 10.1161/01.CIR.0000153811.84257.59
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2005;111:428-434.)
© 2005 American Heart Association, Inc.
Heart Failure |
Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal
A Prospective Study During In-Hospital Cardiac Arrest
From the Emergency Resuscitation Center and Section of Emergency Medicine (B.S.A., J.P.A., T.L.V.H., L.B.B.), Section of Pulmonary and Critical Care (N.S.), and Department of Critical Care (N.O.), University of Chicago Hospitals, Chicago, Ill; Department of Computer Science (P.V.), University of Chicago, Chicago, Ill; Department of Emergency Medicine (H.N.W.) and Respiratory Care Services (P.H.), Advocate Lutheran General Hospital, Park Ridge, Ill; and Department of Internal Medicine (K.T.), MacNeal Hospital, Berwyn, Ill.
Correspondence to Dr L.B. Becker, University of Chicago Hospitals, Section of Emergency Medicine, 5841 S Maryland Ave, MC 5068, Chicago, IL 60637. E-mail lbecker{at}medicine.bsd.uchicago.edu
Received June 23, 2004; revision received October 8, 2004; accepted October 22, 2004.
Background— Recent data highlight a vital link between well-performed cardiopulmonary resuscitation (CPR) and survival after cardiac arrest; however, the quality of CPR as actually performed by trained healthcare providers is largely unknown. We sought to measure in-hospital chest compression rates and to determine compliance with published international guidelines.
Methods and Results— We developed and validated a handheld recording device to measure chest compression rate as a surrogate for CPR quality. A prospective observational study of adult cardiac arrests was performed at 3 hospitals from April 2002 to October 2003. Resuscitations were witnessed by trained observers using a customized personal digital assistant programmed to store the exact time of each chest compression, allowing offline calculation of compression rates at serial time points. In 97 arrests, data from 813 minutes during which chest compressions were delivered were analyzed in 30-second time segments. In 36.9% of the total number of segments, compression rates were <80 compressions per minute (cpm), and 21.7% had rates <70 cpm. Higher chest compression rates were significantly correlated with initial return of spontaneous circulation (mean chest compression rates for initial survivors and nonsurvivors, 90±17 and 79±18 cpm, respectively; P=0.0033).
Conclusions— In-hospital chest compression rates were below published resuscitation recommendations, and suboptimal compression rates in our study correlated with poor return of spontaneous circulation. CPR quality is likely a critical determinant of survival after cardiac arrest, suggesting the need for routine measurement, monitoring, and feedback systems during actual resuscitation.
Key Words: cardiopulmonary resuscitation • death, sudden • heart arrest
This article has been cited by other articles:
 |
|
 |
|
  C R TAPPING and A D CULVERWELL Are radiologists able to manage serious anaphylactic reactions and cardiopulmonary arrest? Br. J. Radiol., October 1, 2009; 82(982): 793 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Sutton, D. Niles, J. Nysaether, B. S. Abella, K. B. Arbogast, A. Nishisaki, M. R. Maltese, A. Donoghue, R. Bishnoi, M. A. Helfaer, et al. Quantitative Analysis of CPR Quality During In-Hospital Resuscitation of Older Children and Adolescents Pediatrics, August 1, 2009; 124(2): 494 - 499. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hollenberg, G. Riva, K. Bohm, P. Nordberg, R. Larsen, J. Herlitz, H. Pettersson, M. Rosenqvist, and L. Svensson Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot Eur. Heart J., July 2, 2009; 30(14): 1781 - 1789. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Doherty, C. S. Parshuram, I. Gaboury, A. Hoskote, J. Lacroix, M. Tucci, A. Joffe, K. Choong, R. Farrell, D. J. Bohn, et al. Hypothermia Therapy After Pediatric Cardiac Arrest Circulation, March 24, 2009; 119(11): 1492 - 1500. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dichtwald, I. Matot, and S. Einav Improving the Outcome of In-Hospital Cardiac Arrest: The Importance of Being EARNEST Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2009; 13(1): 19 - 30. [Abstract] [PDF]
|
|
|
|
|
|
A. A. Topjian, R. A. Berg, and V. M. Nadkarni Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes Pediatrics, November 1, 2008; 122(5): 1086 - 1098. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Edelson, B. Litzinger, V. Arora, D. Walsh, S. Kim, D. S. Lauderdale, T. L. Vanden Hoek, L. B. Becker, and B. S. Abella Improving In-Hospital Cardiac Arrest Process and Outcomes With Performance Debriefing Arch Intern Med, May 26, 2008; 168(10): 1063 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. M Draper and J A. Eppert Association of Pharmacist Presence on Compliance with Advanced Cardiac Life Support Guidelines During In-Hospital Cardiac Arrest Ann. Pharmacother., April 1, 2008; 42(4): 469 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Peberdy and J. P. Ornato Progress in Resuscitation: An Evolution, Not a Revolution JAMA, March 12, 2008; 299(10): 1188 - 1190. [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Anstadt and J. E. Lowe Cardiopulmonary Resuscitation Card. Surg. Adult, January 1, 2008; 3(2008): 487 - 506. [Full Text]
|
|
|
|
 |
|
 M. K. Bader, M. Rovzar, L. Baumgartner, R. Winokur, J. Cline, and G. Schiffman Keeping Cool: A Case for Hypothermia After Cardiopulmonary Resuscitation Am. J. Crit. Care., November 1, 2007; 16(6): 636 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. H Ibrahim Recent advances and controversies in adult cardiopulmonary resuscitation Postgrad. Med. J., October 1, 2007; 83(984): 649 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ali and A. M. Zafari Narrative Review: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Review of the Current Guidelines Ann Intern Med, August 7, 2007; 147(3): 171 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Ornato and M. A. Peberdy Measuring Progress in Resuscitation: It's Time for a Better Tool Circulation, December 19, 2006; 114(25): 2754 - 2756. [Full Text] [PDF]
|
|
|
|
|
|
H. Losert, F. Sterz, K. Kohler, G. Sodeck, R. Fleischhackl, P. Eisenburger, A. Kliegel, H. Herkner, H. Myklebust, J. Nysaether, et al. Quality of Cardiopulmonary Resuscitation Among Highly Trained Staff in an Emergency Department Setting Arch Intern Med, November 27, 2006; 166(21): 2375 - 2380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. H. Ong, J. P. Ornato, D. P. Edwards, H. S. Dhindsa, A. M. Best, C. S. Ines, S. Hickey, B. Clark, D. C. Williams, R. G. Powell, et al. Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA, June 14, 2006; 295(22): 2629 - 2637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. White 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation: Physiologic and Educational Rationale for Changes Mayo Clin. Proc., June 1, 2006; 81(6): 736 - 740. [Full Text] [PDF]
|
|
|
|
|
|
American Heart Association 2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Basic Life Support Pediatrics, May 1, 2006; 117(5): e989 - e1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 3: Overview of CPR Circulation, December 13, 2005; 112(24_suppl): IV-12 - IV-18. [Full Text] [PDF]
|
|
|
|
|
|
Part 4: Adult Basic Life Support Circulation, December 13, 2005; 112(24_suppl): IV-19 - IV-34. [Full Text] [PDF]
|
|
|
|
|
|
Part 11: Pediatric Basic Life Support Circulation, December 13, 2005; 112(24_suppl): IV-156 - IV-166. [Full Text] [PDF]
|
|
|
|
|
|
Part 1: Introduction Circulation, November 29, 2005; 112(22_suppl): III-1 - III-4. [Full Text] [PDF]
|
|
|
|
|
|
Part 2: Adult Basic Life Support Circulation, November 29, 2005; 112(22_suppl): III-5 - III-16. [Full Text] [PDF]
|
|
|
|
|
|
Part 6: Pediatric Basic and Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-73 - III-90. [Full Text] [PDF]
|
|
|
|
 |
|
 CPR Chest-Compression Rate Slower Than Recommended Journal Watch Emergency Medicine, March 16, 2005; 2005(316): 3 - 3. [Full Text]
|
|