This presentation was used to facilitate a discussion of the AHA CPR Quality Consensus Statement, CPR compliance vs. competency, key quality challenges, review of related science, the concept of “pit crew” CPR, and RQI tools and processes. Download the slides to enable video and other links. You will need to hover over video and other icons.

6. “Poor-quality CPR should be considered a
preventable harm. In healthcare environments,
variability in clinician performance has affected the
ability to reduce healthcare associated
complications, and a standardized approach has
been advocated to improve outcomes and reduce
preventable harms. The use of a systematic
continuous quality improvement (CQI) approach
has been shown to optimize outcomes in a number
of urgent healthcare conditions.”

7. “Despite this evidence, few healthcare organizations
apply these techniques to cardiac arrest by consistently
monitoring CPR quality and outcomes. As a result,
there remains an unacceptable disparity in the quality
of resuscitation care delivered, as well as the presence
of significant opportunities to save more lives.”

10. WE CAN’T EXPECT TO WIN “RACES”
WITHOUT MEANINGFUL PRACTICE
AND AN ONGOING ITERATIVE PROCESS
OF MEASURING AND IMPROVING…

18. Systole
Diastole

22. DEATH
BY HYPERVENTILATION
A COMMON EXPERIENCE
IN CARDIAC ARREST

25. THE PAINFUL TRUTH
•Perceived performance does not always match observed performance.
•Aufderheide et al. showed that duty cycle, chest compression depth and
complete recoil were performed significantly less well when directly observed
than EMT perceptions of their performance.
•Wik et al. showed that chest compression rate and depth were both
significantly below AHA guidelines by trained EMS providers, and no flow time
(when there was neither a pulse nor CPR being given) was almost 50% in
directly observed performance evaluations.
•The likelihood of ROSC increases significantly with higher mean chest
compression rate (in a hospital study 75% of patients achieved ROSC with 90
or more chest compressions/minute compared to only 42% with 72 or fewer
chest compressions/minute).

30. Fatigue and poor crew resource management (CRM)
contributed to the accident.
EA 401 gradually lost altitude while the flight crew was
preoccupied and eventually crashed.
The effect of this crash on the airline industry continues
today and has resulted in the development of Crew
Resource Management (CRM). CRM is a technique that
requires air crews to divide the work in the cockpit

34. “Quality CPR is a means to improve survival from
cardiac arrest. Scientific studies demonstrate
when CPR is performed according to guidelines,
the chances of successful resuscitation increase
substantially. Minimal breaks in compressions, full
chest recoil, adequate compression depth, and
adequate compression rate are all components of
CPR that can increase survival from cardiac arrest.
Together, these components combine to create
high performance CPR (HP CPR)”

37. http://www.youtube.com/watch?v=w32PUDL2lb8

38. Improved
survival
Intubation
Rapid
rhythm
analysis
Switch
compressor
s every 2
min.
Compress
Minimize
pauses
Hover hands
Minimize
interruptions
Paramedic
Advanced Life
Support
IV
placement
Administer
drugs
Prioritize
compressions
C-A-B
Full recoil
> 2 inches
EMT CPR Foundation
Rate between
100 and
120/min

40. •EMTs own CPR
•Minimize interruptions in CPR at all times
•Ensure proper depth of compressions (>2 inches)
•Ensure full chest recoil/decompression
•Ensure proper chest compression rate (100-120/min)
•Rotate compressors every 2 minutes
•Hover hands over chest during shock administration
and be ready to compress as soon as patient is cleared
•Intubate or place advanced airway with ongoing CPR
•Place IV or IO with ongoing CPR
•Coordination and teamwork between EMTs and paramedics

41. •C-A-B
•Minimize interruptions in compressions
•Compress at least 100/min
•Allow complete chest wall recoil/decompression between
compressions
•Rhythm assessment every 2 minutes
•Rotate compressors every 2 minutes
•Hover over patient with hands ready during defibrillation so
compressions can start immediately after the shock (or
analysis) has occurred

46. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.

48. 1
2
3
4
5
6

49. CPR 1
AIRWAY
VENTILATION
2
4
BOSS
1
6
AIRWAY
ASSISTANT
5
3
CPR 2
ACCESS
MEDS
MONITOR

53. A continuous process evaluates and improves clinical care and generates new guidelines
and therapy.
Meaney P et al. Circulation 2013;128:417-435
Copyright © American Heart Association

55. Illustration of proposed resuscitation “report cards.” Routine use of a brief tool to document
resuscitation quality would assist debriefing efforts and quality improvement efforts for
hospital and emergency medical services systems.
Meaney P et al. Circulation 2013;128:417-435
Copyright © American Heart Association

67. "Eisenberg has done a remarkable job in articulating the steps to be
taken for communities to improve survival from sudden cardiac arrest.
Resuscitate! is a 'best in class' and one of a kind guide that provides
inspiration as well as direction in translating resuscitation science into
practice. It is essential for all those who seek to establish strategies to
improve survival and quality of life for cardiac arrest victims whose
hearts are 'too young to die.'"
- David B. Hiltz, EMT-P Resuscitation Academy Alumni

68. www.resuscitationacademy.org
www.heart.org/cprquality