A study in AACN Advanced Critical Care finds interruptions greater than 10 seconds during cardiopulmonary resuscitation (CPR) associated with increased mortality at each of four milestones on the path to survival, announced the American Association of Critical-Care Nurses (AACN) in a news release.
Cardiac arrests are high-stress and high-stakes events, with prompt, high-quality CPR a vital element on the path to survival. Despite advances in healthcare technology, treatment and training, survival for individuals who experience cardiac arrest has improved only slightly over the past decade. Mortality remains about 85 percent for patients who experience in-hospital cardiac arrest (IHCA) and even higher when cardiac arrest happens outside the hospital.
An analysis of CPR interventions after IHCAs at an Atlanta hospital found the sole factor that consistently impacted survival was the number of pauses in chest compressions greater than 10 seconds during resuscitation efforts. In addition, the researchers looked at the influence of patient acuity, quality of chest compressions and other factors on survival rates.
“Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest” describes an observational study of prospectively collected data from a convenience sample of 200 patients at Emory University Hospital, Atlanta.
The study appears to be the first to assess participants at four points following resuscitation efforts. Of the 200 participants, 125 attained return of spontaneous circulation, with 94 of them alive 24 hours after resuscitation. A quarter of the participants were discharged from the intensive care unit alive, with 47 leaving the hospital alive.
“When seconds count, clinicians can use the enhanced feedback technology that’s now integrated into cardiac monitors and defibrillators to adjust their compressions,” said study co-author Roberta Kaplow, PhD, APRN-CCNS, AOCNS, CCRN, a critical care clinical nurse specialist at Emory University Hospital, a part of Emory Healthcare. “By improving CPR quality, hopefully we can also improve IHCA survival.”
Key to the data collection was the hospital’s use of the ZOLL R Series monitor/defibrillator and RescueNet Code Review software. The ZOLL device has been the standard defibrillator on all of the hospital’s inpatient units since 2013. All nurses and nurse technicians are trained annually on device operation, which includes placing a pad between the patient’s sternum and the rescuer’s hands. The pad contains sensors that calculate chest compression rates and depths, and the ZOLL device is able to provide real-time audio and visual feedback during compressions.
The mean overall compression adherence to CPR guidelines, as calculated by the ZOLL device – combining the rate of 100 to 120 compressions per minute and a depth of at least two inches – was 27.4 percent. For compression depth during each code, 63.9 percent was within the target depth, with 34.7 percent too shallow. For compression rates, more than half were too fast, while 37 percent were at the target rate.
Other variables associated with increased mortality at the four patient outcome milestones included higher patient acuity, requiring defibrillator shocks and experiencing IHCA during the night shift.
The researchers looked at specific data from medical records and cardiopulmonary arrest forms for patients who sustained an IHCA, underwent attempted resuscitation on an inpatient unit, for whom this was the first IHCA for this hospital admission and for whom complete data were available.
The article is one of several published in the winter 2021 issue of the journal that address issues related to improving cardiac arrest care.
