Abstract 263: Reduction in Chest Compression Fraction During Transition From Pre-Hospital to in-Hospital Care
Introduction: CPR quality has a strong impact on survival from out-of-hospital cardiac arrest. The purpose of this investigation was to compare CPR quality during the early minutes at the emergency department (ED), when the patient is transferred from pre-hospital to in-hospital care.
Methods: A defibrillator (E-series, ZOLL Medical) with an accelerometer-based system for measurement of chest compression (CC) quality was utilized during resuscitation attempts for 219 consecutive adult non-traumatic cardiac arrest patients treated by 3 EMS agencies and 5 receiving hospitals between September 2008 and February 2010. Real-time audiovisual feedback was disabled. Minute-by-minute CC quality data were extracted for each minute of treatment at the scene, during transport, and upon arrival at the ED (from arrival until removal of pre-hospital electrodes or defibrillator shut-down in which the patient was without spontaneous circulation). Paired t-tests were utilized to compare CC quality in the pre-hospital and in-hospital settings. Variability was defined as the average of minute-by-minute standard deviations in depth or rate.
Results: Valid compression data was available from the pre-hospital scene (duration=16±6 min), during ambulance transport (8±5 min), and in the early minutes in-hospital (4±2 min) for 59 patients. CC fraction (% of time CCs performed) was substantially lower in the ED (50±32%) compared with at the scene (60±15%, p=0.01) and during transport (65±19, p=0.0001). Variability in CC depth (0.31 in/min hospital vs. 0.20 scene, p=0.0003) and rate (26 cpm vs. 18 cpm, p<0.0001) were substantially higher in-hospital compared with pre-hospital. Variability in both CC depth and rate was similar for in-hospital and during ambulance transport (P=0.1–0.9). Mean depth and rate of CCs did not differ between in-hospital and pre-hospital settings. (p=0.1–0.6).
Conclusions: These results suggest that CPR quality is affected during transition from field to ED. This may be due to the difficulties of performing high quality CPR while transferring the patient into the ED and transferring from pre-hospital to in-hospital providers. Manual CPR quality during this transition time may be an area in need of expanded training.
- © 2010 by American Heart Association, Inc.