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

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

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

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. www.nicolekupchikconsulting Facebook: Nicole Kupchik Consulting

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

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!

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

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!!!

CPR Report Card

CPR Report Card ROSC

Ventilations Assisted ventilations given every 3 – 4 seconds

Fast rates & depth CC Rate 141

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

December 2014 – Case #1

Case #1 20 sec.

Case #2 - Issues with fast CC Rates

Case #2 ROSC

Case #3 – Continued issues with CC rate

Case #3 ROSC

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

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

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

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

Case #7 – Overall HUGE improvement!!!

Case #7 - Improvement

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

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!!!

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 30 - 40s 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

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

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!!!