Abstract 72: Verbalization of the Phrase “There's No Pulse---Start Compressions” Is Associated with Faster Initiation of Chest Compressions
Introduction: When a patient is pulseless, chest compressions (CC) must be started immediately. Our research group has observed when in-hospital providers note a loss of pulse, many focus on advanced rather than basic life support. Human factors components in team resuscitation may be optimized to improve performance.
Hypothesis: We hypothesize that residents who verbalize the phrase “There's no pulse” directly followed by “start compressions” will: 1) be more likely to perform CC and 2) initiate CC more quickly than those that do not utter this phrase.
Methods: We performed a retrospective review of videos from an observational study of pediatric residents managing a high-fidelity manikin simulator programmed to develop pulseless ventricular tachycardia (PVT). We measured the proportion of residents that started CC, time to starting CC, words uttered in recognition of pulselessness and phrases and/or actions that followed.
Results: Seventy of eighty residents participated and data from 68/80 (85%) was reviewed. Once the manikin developed PVT, 42/68 (62%) stated “there's no pulse” during their initial assessment, 9/68 (13%) assessed pulses but did not make any verbal comment. The remaining 17/68 (25%) did not feel the pulse initially, focusing on the rhythm.Of the 42 residents who stated “there's no pulse”, only 16/42 (38%) followed that by stating “start compressions”. Other plans verbalized included: “defibrillation” 19/42 (45%), “intubation” 2/42 (5%), “blood pressure” 2/42 (5%), “IV” 1/42 (2%), “call the code team” 1/42 (2%) and “epinephrine” 1/42 (2%). A higher proportion of residents who stated “there's no pulse, start compressions” ultimately started CC vs. those that did not [16/16 (100%) vs. 30/52 (58%), p = 0.002]. Of those that ultimately started CC, residents uttering this phrase had a faster median time (Interquartile range - IQR) to starting CC than all others [30 seconds (IQR: 19-42) vs. 150 (51-242), p < 0.001].
Conclusions: In conclusion, residents who speak out loud and verbalize the phrase “There's no pulse, start compressions” are more likely and faster to start CC than those that do not. Further investigation into whether training providers to use this technique will be consistently associated with faster time to starting CC is warranted.
- Cardiopulmonary resuscitation
- Cardiac arrest
- Ventricular tachycardia
- Quality of medical care
- © 2011 by American Heart Association, Inc.