Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course)

The survival of patients after the sudden circulatory arrest (SCA) depends not only on immediate onset of resuscitative measures, but also on their quality.

The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course.

Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR) and chest compression (CC) technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video); CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor) and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest). The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR), minimum and maximum values. The difference was considered significant at P<0.05.

Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18). When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000). While only one provider was able to perform the target CC without the sensor and the tips (4%), 12 providers were able to do it with the sensor (48%) (P=0.0000). In all resuscitation teams, there was a lack in compliance with the ECR 2015 guidelines for expanded CPR, as well as ineffective team work was revealed. Chest compressions did not comply with recommended parameters; pauses before and after defibrillator discharge were too long. In most cases, there was hyperventilation during the artificial lung ventilation. The safety principle was not followed by one of resuscitation teams during the defibrillation procedure.

Conclusion. The obtained data demonstrate that healthcare providers have poor skills in basic and expanded CPR. Therefore, it is important to train and retrain healthcare providers in basic and expanded CPR within the frames of simulation training courses on a regular basis (in accordance with European Resuscitation Council Guidelines for Resuscitation 2015 and National Resuscitation Council). During training, the use of technical means of monitoring of the chest compression quality control in CPR should be warranted. It is important to arrange regular retraining in order to keep the skills uptodate, as well as regular debriefings on the CPR quality after each case of resuscitation measures in a hospital.

1. Monsieurs K.G., Nolan J.P., Bossaert L.L., Greif R., Maconochie I.K., Nikolaou N.I., Perkins G.D., Soar J., Truhlár… A., Wyllie J., Zideman D.A.; ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015; 95: 1–80. http://dx.doi.org/10.1016/j.resuscitation.2015.07.038. PMID: 26477410

2. Ligatyuk P.V., Perepelitsa S.A., Kuzovlev A.N., Ligatyuk D.D. Simulyatsionnoe obuchenie v meditsinskom institute – neotyemle maya chast uchebnogo protsessa. Obshchaya Reanimatologiya. [Simulation training at a medical institute: an integral part of the educational process. General Reanimatology]. 2015; 11 (1): 64–71. http://dx.doi.org/10.15360/18139779201516471. [In Russ.]

3. Wissenberg M., Lippert F., Folke F., Weeke P., Hansen C.M., Christensen E.F., Jans H., Hansen P.A., LangJensen T., Olesen J.B., Lindhardsen J., Fosbol E.L., Nielsen S.L., Gislason G.H., Kober L., Torp Pedersen C. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after outofhospital cardiac arrest. JAMA. 2013; 310 (13): 1377–1384. http://dx.doi.org/10.1001/jama.2013.278483. PMID: 24084923

4. HasselqvistAx I., Riva G., Herlitz J., Rosenqvist M., Hollenberg J., Nordberg P., Ringh M., Jonsson M., Axelsson C., Lindqvist J., Karlsson T., Svensson L. Early cardiopulmonary resuscitation in outofhospital cardiac arrest. N. Engl. J. Med. 2015; 372 (24): 2307–2315. http://dx.doi.org/10.1056/NEJMoa1405796. PMID: 26061835

5. Hupfl M., Selig H., Nagele P. Chestcompressiononly versus standard cardiopulmonary resuscitation: a metaanalysis. Lancet. 2010; 376 (9752): 1552–1557. http://dx.doi.org/10.1016/S01406736(10)614547. PMID: 20951422

6. Blom M., Beesems S., Homma P., Zijlstra J., Hulleman M., van Hoeijen D., Bardai A., Tijssen J., Tan H., Koster R. Improved survival after outof hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014; 130 (21): 1868–1875. http://dx.doi.org/10.1161/CIRCULATIONAHA.114.010905. PMID: 25399395

7. Berdowski J., Blom M., Bardai A., Tan H., Tijssen J., Koster R. Impact of on site or dispatched automated external defibrillator use on survival after outofhospital cardiac arrest. Circulation. 2011; 124 (20): 2225–2232. http://dx.doi.org/10.1161/CIRCULATIONAHA.110.015545. PMID: 22007075

8. Ringh M., Rosenqvist M., Hollenberg J., Jonsson M., Fredman D., Nordberg P., JärnbertPettersson H., HasselqvistAx I., Riva G., Svensson L. Mobilephone dispatch of laypersonsfor CPR in outofhospital cardiac arrest. N. Engl. J. Med. 2015; 372 (24): 2316–2325. http://dx.doi.org/10.1056/NEJMoa1406038. PMID: 26061836

9. Cunningham L., Mattu A., O’Connor R., Brady W. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am. J. Emerg. Med. 2012; 30 (8): 1630–1638. http://dx.doi.org/10.1016/j.ajem.2012.02.015.PMID: 22633716

10. Moroz V.V. (ed.). Rekomendatsii Evropeiskogo soveta po reanimatsii po provedeniyu reanimatsionnykh meropriyatii. [European Resuscitation Council Guidelines for Resuscitation]. Moscow: National Resuscitation Council; 2016: 198. [In Russ.]

11. Eftestøl T., Sunde K., Aase S., Husøy J., Steen P.A. «Probability of successful defibrillation» as a monitor during CPR in outofhospital cardiac arrested patients. Resuscitation. 2001; 48 (3): 245–254. http://dx.doi.org/10.1016/S03009572(00)002665. PMID: 11278090

12. Kolarova J., Ayoub I., Yi Z., Gazmuri R. Optimal timing for electrical defibrillation after prolonged untreated ventricular fibrillation. Crit. Сare Med. 2003; 31 (7): 2022–2028. http://dx.doi.org/10.1097/01.CCM.0000070446.84095.F4. PMID: 12847399

13. Cheskes S., Schmicker R., Verbeek P., Salcido D., Brown S., Brooks S., Menegazzi J., Vaillancourt C., Powell J., May S., Berg R., Sell R., Idris A., Kampp M., Schmidt T., Christenson J.; Resuscitation Outcomes Consortium (ROC) Investigators. The impact of perishock pause on survival from outofhospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation. 2014; 85 (3): 336–342. http://dx.doi.org/10.1016/j.resuscitation.2013.10.014. PMID: 24513129

14. Cheskes S., Schmicker R., Christenson J., Salcido D., Rea T., Powell J., Edelson D., Sell R., May S., Menegazzi J., Van Ottingham L., Olsufka M., Pennington S., Simonini J., Berg R., Stiell I., Idris A., Bigham B., Morrison L.; Resuscitation Outcomes Consortium (ROC) Investigators. Perishock pause: an independent predictor of survival from outofhospital shockable cardiac arrest. Circulation. 2011; 124 (1): 58–66. http://dx.doi.org/10.1161/CIRCULATIONAHA.110.010736.PMID: 21690495

15. Vaillancourt C., EversonStewart S., Christenson J., Andrusiek D., Powell J., Nichol G., Cheskes S., Aufderheide T.P., Berg R., Stiell I.G.; Resuscitation Outcomes Consortium Investigators. The impact of increased chest compression fraction on return of spontaneous circulation for outofhospital cardiac arrest patients not in ventricular fibrillation. Resuscitation. 2011; 82 (12): 1501–1507. http://dx.doi.org/10.1016/ j.resuscitation.2011.07.011. PMID: 21763252

16. Sell R., Sarno R., Lawrence B., Castillo E.M., Fisher R., Brainard C., Dunford J.V., Davis D. Minimizing pre and postdefibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC). Resuscitation. 2010; 81 (7): 822–825. http://dx.doi.org/10.1016/j.resuscitation.2010.03.013. PMID: 20398991

17. Christenson J., Andrusiek D., EversonStewart S., Kudenchuk P., Hostler D., Powell J., Callaway C.W., Bishop D., Vaillancourt C., Davis D., Aufderheide T.P., Idris A., Stouffer J.A., Stiell I., Berg R.; Resuscitation Outcomes Consortium Investigators. Chest compression fraction deter mines survival in patients with outofhospital ventricular fibrillation. Circulation. 2009; 120 (13): 1241–1247. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.852202. PMID: 19752324

18. Vadeboncoeur T., Stolz U., Panchal A., Silver A., Venuti M., Tobin J., Smith G., Nunez M., Karamooz M., Spaite D., Bobrow B. Chest compression depth and survival in outofhospital cardiac arrest. Resuscitation. 2014; 85 (2): 182–188. http://dx.doi.org/10.1016/j.resuscitation.2013.10.002. PMID: 24125742

19. Stiell I., Brown S., Christenson J., Cheskes S., Nichol G., Powell J., Bigham B., Morrison L., Larsen J., Hess E., Vaillancourt C., Davis D., Callaway C.W.; Resuscitation Outcomes Consortium (ROC) Investigators. What is the role of chest compression depth during outofhospital cardiac arrest resuscitation? Crit. Care Med. 2012; 40 (4): 1192–1198. http://dx.doi.org/ 10.1097/CCM.0b013e31823bc8bb. PMID: 22202708

20. Idris A.H., Guffey D., Aufderheide T.P., Brown S., Morrison L.J., Nichols P., Powell J., Daya M., Bigham B.L., Atkins D.L., Berg R., Davis D., Stiell I., Sopko G., Nichol G.; Resuscitation Outcomes Consortium (ROC) Investigators. Relationship between chest compression rates and out comes from cardiac arrest. Circulation. 2012; 125 (24): 3004–3012. http://dx.doi.org/10.1161/CIRCULATIONAHA.111.059535. PMID: 22623717

21. Aufderheide T., Pirrallo R., Yannopoulos D., Klein J.P., von Briesen C., Sparks C.W., Deja K.A., Kitscha D.J., Provo T.A., Lurie K.G. Incomplete chest wall decompression: a clinical evaluation of CPR performance by trained laypersons and an assessment of alternative manual chest com pressiondecompression techniques. Resuscitation. 2006; 71 (3): 341–351. http://dx.doi.org/10.1016/j.resuscitation.2006.03.021.PMID: 17070644

22. Kovacs A., Vadeboncoeur T., Stolz U., Spaite D., Irisawa T., Silver A., Bobrow B.J. Chest compression release velocity: association with survival and favorable neurologic outcome after outofhospital cardiac arrest. Resuscitation. 2015; 92: 107– 114. http://dx.doi.org/10.1016/j.resuscitation.2015.04.026. PMID: 25936931

23. Aufderheide T., Sigurdsson G., Pirrallo R., Yannopoulos D., McKnite S., von Briesen C., Sparks C., Conrad C.J., Provo T.A., Lurie K.G. Hyperventilationinduced hypotension during cardiopulmonary resuscitation. Circulation. 2004; 109 (16): 1960– 1965. http://dx.doi.org/10.1161/01.CIR.0000126594.79136.61. PMID: 15066941

24. Cheng A., Overly F., Kessler D., Nadkarni V., Lin Y., Doan Q., Duff J., Tofil N., Bhanji F., Adler M., Charnovich A., Hunt E., Brown L.; International Network for Simulationbased Pediatric Innovation, Research, Education (INSPIRE) CPR Investigators. Perception of CPR quality: Influence of CPR feedback, JustinTime CPR training and provider role. Resuscitation. 2015; 87: 44–50. http://dx.doi.org/10.1016/j.resuscitation.2014.11.015. PMID: 25433294

25. KramerJohansen J., Myklebust H., Wik L., Fellows B., Svensson L., Sørebø H., Steen P.A. Quality of outofhospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation. 2006; 71 (3): 283–292. http://dx.doi.org/10.1016/j.resuscitation.2006.05.011. PMID: 17070980

26. Bobrow B., Vadeboncoeur T., Stolz U., Silver A., Tobin J., Crawford S., Mason T., Schirmer J., Smith G.A., Spaite D. The influence of scenariobased training and realtime audiovisual feedback on outofhospital cardiopul monary resuscitation quality and survival from outofhospital cardiac arrest. Ann. Emerg. Med. 2013; 62 (1): 47–56. http://dx.doi.org/10. 1016/j.annemergmed.201212.020. PMID: 23465553

27. Wolfe H., Zebuhr C., Topjian A., Nishisaki A., Niles D.E., Meaney P.A., Boyle L., Giordano R.T., Davis D., Priestley M., Apkon M., Berg R.A., Nadkarni V.M., Sutton R.M. Interdisciplinary ICU cardiac arrest debriefing improves survival outcome. Crit. Care Med. 2014; 42 (7): 1688–1695. http://dx.doi.org/10.1097/CCM.0000000000000327.PMID: 24717462