Abstract 137: Quantitative Post--Cardiac Arrest Audiovisual Debriefing Improves Resuscitation Quality
Introduction: American Heart Association (AHA) targets of high quality CPR are associated with improved survival. We previously identified deficiencies in CPR quality in our ICU, despite CPR refresher training and real-time CPR feedback. We sought to assess the incremental impact of adding periodic quantitative debriefing on CPR.
Hypothesis: A departmental, multidisciplinary post-cardiac arrest audiovisual debriefing program will improve the quality of CPR provided during pediatric ICU resuscitations.
Methods: Audio recording/feedback-enabled defibrillators were used to train for and assess CPR quality during ICU cardiac arrests in children ≥ 8 yrs. Audiovisual feedback was provided during CPR events. The debriefing group of ICU providers received audiovisual PowerPoint review within 3 weeks of CPR events. A before - after study design was used to evaluate the effectiveness of the debriefing program to improve CPR quality (18mo before and after). CPR data included chest compression (CC) rate (CC/min), depth (mm), significant leaning during CC (> 2.5 kg), and no flow fraction (NFF). The primary outcome was a composite variable, excellent CPR, prospectively defined as a CC depth ≥ 38mm, rate ≥ 100/min, ≤ 10% of CCs with leaning, and an NFF ≤ 10% during a given 30sec epoch. Differences in the proportion of CPR epochs achieving excellent CPR were assessed using generalized estimating equations.
Results: Between 12/2008 and 12/2011, 21 eligible CPR events occurred in the ICU (11 before; 10 after) and yielded 639 epochs. Nine debriefings were completed. Compared to CPR quality before the debriefings, percentage of epochs achieving quality targets improved after the implementation of the debriefing program: depth: 81 ± 2 vs. 92 ± 2%; rate: 71 ± 2 vs. 82 ± 3%; and NFF: 66 ± 2 vs. 81 ± 3% (p<0.01 for all comparisons). In the primary analysis, CPR epochs during the after period were 3.4x more likely to meet the target of excellent CPR (CI95: 1.53, 7.62, p=0.003).
Conclusion: Implementation of a quantitative audiovisual debriefing program after cardiac arrest events was associated with improved CPR quality. Even in settings where intensive CPR refresher training and real-time feedback are in place, a debriefing program appears to further incrementally improve CPR quality.
- © 2012 by American Heart Association, Inc.