1. BRADY Chris Fraser Introduction to High- Performance CPR

2. BRADY Disclaimer 2

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4. Objectives Importance of maximizing CPR. Compression to ventilation ratio 30:2 ◦ Complete chest wall recoil ◦ Danger of hyperventilation CPR First vs shock first Compressions 100 to 120 per min (switch every 2 min) ◦ Fit ventilations in without delaying Compressions Minimize delays when shocking 4

5. BRADY Working Together 5

6. BRADY “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.” The Experts Evolving View 6

7. BRADY “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.” Experts View (continued) 7

8. BRADY WE CAN’T EXPECT TO WIN “RACES” WITHOUT MEANINGFUL PRACTICE AND AN ONGOING ITERATIVE PROCESS OF MEASURING AND IMPROVING… Future Training 8

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10. The Measure of Success 10

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13. BRADY Systole Diastole Duty Cycle 13

14. BRADY The Numbers 14

15. BRADY More Numbers 15

16. BRADY The Message IS 16

17. BRADY Demonstration Video 17

18. BRADY The Take Away Message “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)” 18

19. BRADY 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 19

20. BRADY BLS Owns the Resuscitation! Out of hospital Cardiac Arrest is a BLS event Includes ALS and BLS providers Interventions that work are Basic Life Support interventions Everybody (ALS, BLS, Driver, Attendant) has the same chance to positively effect the outcome There is NO reason to “wait” for ALS to resuscitate someone 20

21. BRADY 1 3 2 4 5 6 BOSS ACCESS MEDS MONITOR CPR 1 CPR 2 AIRWAY VENTILATION AIRWAY ASSISTANT 21

22. BRADY THE END 22

23. BRADY BACK UP Material 23

24. BRADY Compress > 2 inches Minimize interruptions Full recoil Rate between 100 and 120/min Switch compressor s every 2 min. Hover hands Prioritize compression s C-A-B Improved survival Rapid rhythm analysis Minimize pauses Administer drugs Intubation IV placement EMT CPR Foundation Paramedic Advanced Life Support The Building Block To Success 24

25. BRADY 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 Be ready to compress as soon as patient is cleared by: Hovering hands over chest during shock administration Intubate or place advanced airway with ongoing CPR Place IV or IO with ongoing CPR Coordination and teamwork between EMTs and paramedics 25

26. BRADY 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). THE PAINFUL TRUTH 26

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28. BRADY Eastern Airlines 401 crashed into the Everglades in December of 1972 as a result of the flight crew's failure to recognize a deactivation of the autopilot during their attempt to troubleshoot a malfunction of the landing gear position indicator system (an indicator light) 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 amongst available crew ensuring that someone continues focusing on flying the plane while troubleshooting continues. Crew Management 28

29. BRADY Management Skills 29

30. BRADY 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 Measure of Performance 30 Copyright © American Heart Association

31. BRADY Legacy CPR 31

32. BRADY High Performance CRP 32