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Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest Abella BS; Alvarado JP; Myklebust H; Edelson DP; Barry A; O'Hearn N; Vanden Hoek TL; Becker LBJAMA 2005[Jan]; 293 (3): 305-10CONTEXT: The survival benefit of well-performed cardiopulmonary resuscitation (CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. OBJECTIVES: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. DESIGN AND SETTING: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions (no-flow fraction) were recorded. MAIN OUTCOME MEASURE: Adherence to American Heart Association and international CPR guidelines. RESULTS: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1% of segments. Compression depth was too shallow (defined as <38 mm) for 37.4% of compressions. Ventilation rates were high, with 60.9% of segments containing a rate of more than 20/min. Additionally, the mean (SD) no-flow fraction was 0.24 (0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients (40.3%) achieved return of spontaneous circulation and 7 (10.4%) were discharged from the hospital. CONCLUSIONS: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Cardiopulmonary Resuscitation/methods/*standards[MESH]|Chicago[MESH]|Female[MESH]|Guideline Adherence/*statistics & numerical data[MESH]|Heart Arrest/*therapy[MESH]|Hospitalization[MESH]|Hospitals, University/standards[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Practice Guidelines as Topic[MESH]|Prospective Studies[MESH] |
