Post on 10-Jan-2016
description
Quality of Chest Compressions in
Prehospital Care: Can it be done effectively
Baxter Larmon, PhD, MICPProfessor Medicine and Emergency MedicineDavid Geffen School of Medicine at UCLADirectorUCLA Center for Prehospital Care
No Conflicts to Declare
May 20th 2013
More than 150 published within
the last year
I will focus on two UCLA projects
• Los Angeles Quality Improvement project– On going
• Study by UCLA Center for Prehospital Care– Currently submitted for publication and presented
at ECC Scientific Assembly
CARDIAC ARRESTA TIME FOR CHANGE
Quality Improvement Project Los Angeles County
Dr. Dan DavisUCSD Center for Resuscitation ScienceAssistance by: William Koenig MD, Baxter Larmon, PhD, Susan Mori, RN, Todd LeGassick, MPH
QI Project• Partnership–UCSD–LA County DHS–UCLA Center for Prehospital Care–Zoll Corporation• Equipment and Education support ONLY
• Started December 2010• Five Fire Departments in LA County–1 Department dropped out
QI Project• Pre – ART–Defib pads were modified, monitors
had memory cards placed–No educational intervention–Providers were asked to contact a ART
Coordinator when a cardiac arrest occurred–ART coordinator would gather data
with 48 hours of arrest when possible
QI Project• Pre-ART–Standard Procedures
• Post – ART–Same as above–Feedback on monitor turned on–Intervention / during regular CE• First Month 2 hour lecture• Next Month 1.5 skills
–Data collected
Data Collection• Duration
– Total time of arrest in minutes
• Compression Depth within Target- % of Target >2 and < 3.5 inches
• Compression Rate within Target – % Target 100 -120 compressions per minute
• Time in Compressions– % of time that chest compression performed
during entire arrest
Data Collection• Overall quality entire duration – % of time that both depth and rate are within target
• Time to Shock – Time in minutes of stopping compression to deliver shock
• Number of Shocks
Data Presentation• 109 cases Collected–71 pre ART–38 post ART
• Convenient Sampling from 1 Fire Department–3 Pre ART and 3 Post ART–All presented data was in a 3 month
window
Still collecting data
Pre ART
Pre ART 1 / Case # 62
Duration of Arrest = 20 Minutes
0 % in Depth Target
Target = 2- 3.5 inches
Pre ART 1 / Case # 62
Duration of Arrest = 20 Minutes
1 % Target Rate
Key
CPR PeriodsTarget ZonesDepth of CompressionRate of Compression
Key
CPR PeriodsTarget Zones
Target Rate = 80 -120 minute
Pre ART 1 / Case # 62
Duration of Arrest = 20 Minutes
0 % in Target of both Rate and Depth
Pre ART 2 / Case # 65
Duration of Arrest = 26 Minutes
10 % in Target Depth
Target = 2- 3.5 inches
Pre ART 2 / Case # 65
Duration of Arrest = 26 Minutes
11 % in Target Rate
Target Rate = 80 -120 minute
Pre ART 2 / Case # 65
Duration of Arrest = 26 Minutes
1 % in Target of both Rate and
Depth
Pre ART 3 / Case # 55
Duration of Arrest = 30 Minutes
2 % in Target Depth
Target = 2- 3.5 inches
Pre ART 3 / Case # 55
Duration of Arrest = 30 Minutes
26 % in Target Rate
Target Rate = 80 -120 minute
Pre ART 3 / Case # 55
Duration of Arrest = 30 Minutes
2 % in Target of both Rate and
Depth
Pre ART 3 / Case # 55
Duration of Arrest = 30 Minutes
Delay in compressions average 47 seconds in 5
shocks
Post ART
Post ART 1 / Case # 74
Duration of Arrest = 34 Minutes
92 % in Target Depth
Target = 2- 3.5 inches
Post ART 1 / Case # 74
Duration of Arrest = 34 Minutes
81 % in Target Rate
Target Rate = 80 -120 minute
Post ART 1 / Case # 74
Duration of Arrest = 34 Minutes
88 % in Target of both Rate and Depth
Post ART 2 / Case # 72
Duration of Arrest = 21Minutes
81 % in Target Depth
Target = 2- 3.5 inches
Post ART 2 / Case # 72
99 % in Target Rate
Duration of Arrest = 21Minutes
Target Rate = 80 -120 minute
Post ART 2 / Case # 72
81 % in Target of both Rate and Depth
Duration of Arrest = 21Minutes
Post ART 3 / Case # 71
Duration of Arrest = 43 Minutes
90 % in Target depth
Target = 2- 3.5 inches
Post ART 3 / Case # 71
Duration of Arrest = 43 Minutes
90 % in Target Rate
Target Rate = 80 -120 minute
Post ART 3 / Case # 71
Duration of Arrest = 43 Minutes
82 % in Target of both Rate and Depth
Post ART 3 / Case # 71
Delay in compressions average 3 seconds in 6
shocks
Duration of Arrest = 43 Minutes
Comparison Pre and Post ART
Total Elapsed Time of Cardiac Arrest (minutes)
Need Graph, %
Case 62 (pre) Case 65 (pre) Case 55 (pre) Case 74 (post) Case 72 (post) Case 71 (post)0
5
10
15
20
25
30
35
40
45
50
20
26
30
34
21
43Pre ART Post ART
Comparison Pre and Post ARTCompression Depth in Target (%)
Need Graph, %
Case 62 (pre) Case 65 (pre) Case 55 (pre) Case 74 (post) Case 72 (post) Case 71 (post)0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0%
10%
2%
92%
81%
90%Pre ART Post ART
Comparison Pre and Post ARTCompression Rate in Target (%)
Need Graph, %
Case 62 (pre) Case 65 (pre) Case 55 (pre) Case 74 (post) Case 72 (post) Case 71 (post)0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1%
11%
26%
81%
99%
90%Pre ART Post ART
Comparison Pre and Post ARTOverall Chest Compression Quality
Need Graph, %
Case 62 (pre) Case 65 (pre) Case 55 (pre) Case 74 (post) Case 72 (post) Case 71 (post)0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0% 1% 2%
88%
81% 82%
Pre ART Post ART
Hard To TeachAn Old DogA NEW Trick
Feedback Graph
Presented toAHA ECC
Method• 35 Paramedic students recently completing a
AHA HCP BLS Course• Each subject randomly drew three cards• Each card allowed them to perform chest
compressions for a 2 minute period of time in three different positions– Backboard on the ground– Backboard on the stretcher in the lowered position– Backboard on a stretcher in the raised position
Method continued
• They were given a six minute rest between each attempt
• Data was collected
Conclusion• Effective compressions must be done on the
ground or on a stretcher in the lowered position
• There is a degradation of chest compression over time
Currently studying this Summer
• Quality of Chest Compressions on a moving gurney
• Does body mass index effect the quality of chest compressions
Thank you to Dr Koenig