Quality of Chest Compressions in Prehospital Care: Can it be done effectively

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



1 % Target Rate

Key

CPR PeriodsTarget ZonesDepth of CompressionRate of Compression

Key

CPR PeriodsTarget Zones

Target Rate = 80 -120 minute



0 % in Target of both Rate and Depth



10 % in Target Depth




11 % in Target Rate




1 % in Target of both Rate and

Depth



2 % in Target Depth




26 % in Target Rate




2 % in Target of both Rate and

Depth



Delay in compressions average 47 seconds in 5

shocks

Post ART

Post ART 1 / Case # 74






81 % in Target Rate



Duration of Arrest = 21Minutes




99 % in Target Rate





90 % in Target depth




90 % in Target Rate



Delay in compressions average 3 seconds in 6

shocks


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, %


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, %


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 1% 2%

88%

81% 82%

Pre ART Post ART

http://www.currencies.co.uk/wp-content/uploads/2012/02/Crash-chart-JLL.jpg

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

Quality of Chest Compressions in Prehospital Care: Can it be done effectively

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