Importance of CPR Quality

In recent years, it has become increasingly clear that the quality of cardiopulmonary resuscitation (CPR) has a direct effect on sudden cardiac arrest (SCA) patient outcomes.1,2 However, healthcare professionals typically do not perform CPR within established guidelines, making CPR quality improvement an area in critical need of attention to help improve in-hospital SCA survival rates.3,4 Yet, CPR is one of the few therapies performed without any “objective” performance feedback. The challenge is giving your team actionable information and tools to improve the quality of their CPR performance.

The 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) and the European Resuscitation Council (ERC) Guidelines for Resuscitation 2010 emphasize the importance of high-quality chest compressions.5,6   In July 2013, the American Heart Association released a consensus statement identifying five critical components of high-quality CPR. However, studies have demonstrated that improvement is needed in the quality of chest compressions, as well as the rate and depth, to help improve the patient’s chance of survival and increase the opportunity for a complete neurological recovery.7,8

 

1. Wik, L, Steen, PA Bircher, NG. Quality of Bystander Cardiopulmonary Resuscitation Influences Outcome After Prehospital Cardiac Arrest. Resuscitation.1994;195-203.
2. Ko PC, Chen W, Lin C, et al. Evaluating the Quality of Prehospital Cardiopulmonary Resuscitation by Reviewing Automated External Defibrillator Records and Survival for Out-of-Hospital Witnessed Arrests. Resuscitation. 2005;64:163-169.
3. Abella, BS, Sandbo N, Vassilatos P, et al. Chest Compression Rates During Cardiopulmonary Resuscitation are Suboptimal – A Prospective Study During In-Hospital Cardiac Arrest. Circulation. 2005;111:428-434.
4. Abella, BS, Alvarado JP, Myklebust H, et al. Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest. JAMA. 2005;293(3):305-310.
5. Travers AH, Rea TD, Bobrow BJ, et al. Part 4: CPR Overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S676-S684.
6. Abella, BS, Sandbo N, Vassilatos P, et al. Chest Compression Rates During Cardiopulmonary Resuscitation are Suboptimal – A Prospective Study During In-Hospital Cardiac Arrest. Circulation. 2005;111:428-434.
7. Abella, BS, Sandbo N, Vassilatos P, et al. Chest Compression Rates During Cardiopulmonary Resuscitation are Suboptimal – A Prospective Study During In-Hospital Cardiac Arrest. Circulation. 2005;111:428-434.
8. Abella, BS, Alvarado JP, Myklebust H, et al. Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest. JAMA. 2005;293(3):305-310.

Q-CPR Measurement and Feedback Tool

Helping your team reach its full potential for CPR quality improvement and saving lives is easier with the Philips Q-CPR™ measurement and feedback tool. Philips monitors and defibrillators with Q-CPR display dynamic, real-time feedback on a display right on the patient’s chest allowing care-givers to focus on providing high-quality CPR.

Minimizing delays and interruptions to chest compression is a recommendation of the 2010 AHA and ERC Guidelines as this can improve the chance of shock success and patient survival.6,9 Philips technology helps reduce the time between hands-off and shock delivery to minimize CPR interruptions.

  • Q-CPR is simple to set up and easy to use, allowing clinicians to focus on treating the patient.
  • Compatible with the HeartStart MRx monitor/defibrillator to automatically measure CPR performance the moment you place the connected Q-CPR Meter on your patient’s chest and begin compressions.
  • Helps caregivers meet compression depth, rate, and complete release targets, which are all critical components of delivering high-quality CPR.
  • Indicates that ventilation is sufficient to avoid hyperventilation.
  • View real-time feedback on the Q-CPR Meter display or directly on the HeartStart MRx monitor to quickly adjust your performance.
  • Activate voice prompts and the HeartStart MRx - with Q-CPR will coach you along the way.
  • Small and lightweight, the Q-CPR Meter can be easily stored with the Philips monitor/defibrillator or AED so that it is always available when needed.

 

Q-CPR Capabilities Overview

Ventilation rate Philips exclusive
Ventilation feedback from bag valve mask (BVM) or intubation Philips exclusive
Chest compression depth – too shallow Yes
Chest compression rate high Philips exclusive
Chest compression rate low Yes
Complete chest recoil Yes
“Hands-off” time Yes
Compliant vs. non-compliant surface capability Yes

 

6. Nolan JP, Soar J, Zideman DA, et al. European Resuscitation Council Guidelines for Resuscitation 2010. Resuscitation. 2010;81:1219-1276.
9. Field JM, Hazinski MF, Sayre MR, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation. 2010;122:S640-S656.

You can’t improve what you don’t measure

The 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) state, “Improving care requires assessment of performance. Only when performance is measured can participants in a system effectively intervene to improve care.”10

 

CPR is one of the few therapies typically performed without any “objective” performance feedback. So how does your team know where to focus its CPR quality improvement efforts?

When used in combination with Philips HeartStart Event Review Pro clinical software, the Q-CPR measurement and feedback tool is a comprehensive and flexible retrospective data review tool for debriefing, training, and continuous improvement. Event Review Pro captures and stores an entire code – including Q-CPR data for post-event review. The software is equipped with easy-to-use tools that allow you to pinpoint key areas in a specific patient’s code event for learning and improvement.

In an independent study, the HeartStart MRx with Q-CPR was used to provide real-time measurement and feedback, and to capture CPR performance data during actual cardiac arrests. Medical professionals then participated in weekly CPR performance debriefing sessions on those events. The study demonstrated a positive correlation between the use of Q-CPR with performance debriefing and CPR improvement quality that led to an increase in return of spontaneous circulation (ROSC).11

"Similar to post-game analysis for professional athletes, medical responders learn from their past resuscitation performance and apply it to future resuscitations. CPR performance review has broad applicability for improving resuscitation,” said Dana Edelson, MD, director of Clinical Research for the Emergency Resuscitation Center at the University of Chicago Medical Center.

 

10. Travers AH, Rea TD, Bobrow BJ, et al. Part 4: CPR Overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S676-S684.
11. Edelson DP, Litzinger B, Arora V, et al. Improving In-Hospital Cardiac Arrest Process and Outcomes using Performance Debriefing. Arch Intern Med. 2008;168(10):1063-1069.