CONTEXT: The survival benefit of well-performed cardiopulmonary resuscitation (CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. OBJECTIVES: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. DESIGN AND SETTING: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions (no-flow fraction) were recorded. MAIN OUTCOME MEASURE: Adherence to American Heart Association and international CPR guidelines. RESULTS: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1% of segments. Compression depth was too shallow (defined as <38 mm) for 37.4% of compressions. Ventilation rates were high, with 60.9% of segments containing a rate of more than 20/min. Additionally, the mean (SD) no-flow fraction was 0.24 (0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients (40.3%) achieved return of spontaneous circulation and 7 (10.4%) were discharged from the hospital. CONCLUSIONS: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.
CONTEXT: The survival benefit of well-performed cardiopulmonary resuscitation (CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. OBJECTIVES: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. DESIGN AND SETTING: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions (no-flow fraction) were recorded. MAIN OUTCOME MEASURE: Adherence to American Heart Association and international CPR guidelines. RESULTS: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1% of segments. Compression depth was too shallow (defined as <38 mm) for 37.4% of compressions. Ventilation rates were high, with 60.9% of segments containing a rate of more than 20/min. Additionally, the mean (SD) no-flow fraction was 0.24 (0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients (40.3%) achieved return of spontaneous circulation and 7 (10.4%) were discharged from the hospital. CONCLUSIONS: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.
Authors: Dana E Niles; Akira Nishisaki; Robert M Sutton; Jon Nysæther; Joar Eilevstjønn; Jessica Leffelman; Matthew R Maltese; Kristy B Arbogast; Benjamin S Abella; Mark A Helfaer; Robert A Berg; Vinay M Nadkarni Journal: Resuscitation Date: 2011-11-09 Impact factor: 5.262
Authors: Monica E Kleinman; Allan R de Caen; Leon Chameides; Dianne L Atkins; Robert A Berg; Marc D Berg; Farhan Bhanji; Dominique Biarent; Robert Bingham; Ashraf H Coovadia; Mary Fran Hazinski; Robert W Hickey; Vinay M Nadkarni; Amelia G Reis; Antonio Rodriguez-Nunez; James Tibballs; Arno L Zaritsky; David Zideman Journal: Circulation Date: 2010-10-19 Impact factor: 29.690
Authors: Monica E Kleinman; Allan R de Caen; Leon Chameides; Dianne L Atkins; Robert A Berg; Marc D Berg; Farhan Bhanji; Dominique Biarent; Robert Bingham; Ashraf H Coovadia; Mary Fran Hazinski; Robert W Hickey; Vinay M Nadkarni; Amelia G Reis; Antonio Rodriguez-Nunez; James Tibballs; Arno L Zaritsky; David Zideman Journal: Pediatrics Date: 2010-10-18 Impact factor: 7.124
Authors: C Zebuhr; R M Sutton; W Morrison; D Niles; L Boyle; A Nishisaki; P Meaney; J Leffelman; R A Berg; V M Nadkarni Journal: Resuscitation Date: 2012-02-03 Impact factor: 5.262
Authors: Audrey L Blewer; David G Buckler; Jiaqi Li; Marion Leary; Lance B Becker; Judy A Shea; Peter W Groeneveld; Mary E Putt; Benjamin S Abella Journal: World J Emerg Med Date: 2015
Authors: J Hope Kilgannon; Michael Kirchhoff; Lisa Pierce; Nicholas Aunchman; Stephen Trzeciak; Brian W Roberts Journal: Resuscitation Date: 2016-09-22 Impact factor: 5.262
Authors: Robert M Sutton; Erin Case; Siobhan P Brown; Dianne L Atkins; Vinay M Nadkarni; Jonathan Kaltman; Clifton Callaway; Ahamed Idris; Graham Nichol; Jamie Hutchison; Ian R Drennan; Michael Austin; Mohamud Daya; Sheldon Cheskes; Jack Nuttall; Heather Herren; James Christenson; Dug Andrusiek; Christian Vaillancourt; James J Menegazzi; Thomas D Rea; Robert A Berg Journal: Resuscitation Date: 2015-04-25 Impact factor: 5.262