1. Utilizing Feedback to Improve CPR Performance
Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC
&
Cindy Ruiz APN, MS, CCRN

2. Presenter Disclosure Information
Nicole Kupchik
Utilizing Feedback to Improve CPR Performance
FINANCIAL DISCLOSURE:
Physio-Control Inc., Covidien (Speaker’s Bureau)
UNLABELED/UNAPPROVED USES DISCLOSURE:
None

3. Presenter Disclosure Information
Cindy Ruiz
Utilizing Feedback to Improve CPR Performance
FINANCIAL DISCLOSURE:
None
UNLABELED/UNAPPROVED USES DISCLOSURE:

4. Objectives
Describe the importance of measuring CPR rate, depth & chest compression fraction to improve CPR quality in hospital resuscitation events.
Discuss ways to provide feedback and training to staff on CPR quality to improve performance.
Facebook: Nicole Kupchik Consulting

5. Compression rate Too Slow Too Fast 100 – 120 per minute (Before 2010)
(After 2010)
100 – 120 per minute

6. Chest Compression Fraction
The amount of time spent providing compressions
May also be called “compression ratio”
Goal: At least 80%!
Many high performing EMS systems shoot for >90%
HUGE issue in hospital – Too many interruptions!

7. AHA Consensus Recommendation
2013 Consensus Recommendation “…resuscitation data from the defibrillator or any other device or source documentation that captures data at the scene should be used for feedback to the team.”
Circulation, 2013

8. How do you implement change?
Resuscitations feel disorganized
Humans + Adrenaline = Compressions that are WAY too fast!!!
Too fast = too shallow & unlikely to have good recoil
Metronomes + Capnography
Need to measure performance & provide feedback!!!

9. CPR Report Card

10. CPR Report Card
ROSC

11. Ventilations
Assisted ventilations given every 3 – 4 seconds

12. Fast rates & depth
CC Rate 141

13. Northwest Community Hospital’s story
In winter of 2014 Code Blue Committee wanted to increase our focus on high quality CPR & ETCO2
Had no way to assess CPR quality
Inconsistent getting the ETCO2 device to codes
We discovered we could download the CPR data from our defibs and review cases
So we looked at some baseline data

14. December 2014 – Case #1

15. Case #1
20 sec.

16. Case #2 - Issues with fast CC Rates

17. Case #2
ROSC

18. Case #3 – Continued issues with CC rate

19. Case #3
ROSC

20. Case #4 - Pre shock pause issues
38 second pre-shock pause

21. Continued work to improve
Started Mock Codes
Decided to focus on first responder activities:
Activating the code
Starting compressions
Quality of compressions
Airway
AED
Suction

22. Case #5 – 2 mos later - Improvement
8 second pulse check

23. Case #6 – Minimized pre & post shock pauses
2 seconds

24. Case #7 – Overall HUGE improvement!!!

25. Case #7 - Improvement

26. Case #7 - Rhythm check
ONLY 3 second
pulse check!!!!

27. More work to improve
It was discovered at the mock codes staff fumbled to find to CPR mask – red stickers were posted on the drawer with the mask
Pre-implementation survey
Post-implementation staff surveys very positive!!
But we wanted to do more to recognize their efforts!!!

28. How long is too long to attempt resuscitation?
58 y/o male admitted to the ortho unit post laminectomy
8 hours post-op he suffered 70 min Vfib arrest
ETCO2 remained in the s during the code
Taken to cath lab & stented
The next day he was awake & alert but remained intubated
Discharged to home on day 7 fully intact

29. Vfib arrest, shocked 8 times
Short pre & post shock pauses!!!!
CCF was 81%
CC rates were a bit fast, 120s – 130s

31. In conclusion…
High Quality CPR is one of the most important aspects of successful resuscitation!
Focus on minimizing interruptions in compressions
Defibrillate early with minimal pre/post shock pauses
You will not improve what you don’t measure!!!