A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation

Michael Levy; Dana Yost; Robert G Walker; Erich Scheunemann; Steve R Mendive

doi:10.1016/j.resuscitation.2015.04.005

A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation

Resuscitation. 2015 Jul:92:32-7. doi: 10.1016/j.resuscitation.2015.04.005. Epub 2015 Apr 22.

Authors

Michael Levy¹, Dana Yost², Robert G Walker³, Erich Scheunemann¹, Steve R Mendive¹

Affiliations

¹ Anchorage Fire Department, Anchorage, AK, United States; University of Alaska, Anchorage, United States.
² Redmond Fire Department, Redmond, WA, United States; Resurgent Biomedical Consulting, Seattle, WA, United States. Electronic address: dyost@resurgentbiomedical.com.
³ Physio-Control Inc., Redmond, WA, United States.

PMID: 25913223
DOI: 10.1016/j.resuscitation.2015.04.005

Abstract

Background: Minimizing the chest compression pause associated with application of a mechanical CPR device is a key component of optimal integration into the overall resuscitation process. As part of a multi-agency implementation project, Anchorage Fire Department deployed LUCAS CPR devices on BLS and ALS fire apparatus for initiation early in resuscitation efforts. A 2012 report identified the pause interval for device application as a key opportunity for quality improvement (QI). In early 2013 we began a QI initiative to reduce device application time interval and optimize the overall CPR process. To assess QI initiative effectiveness, we compared key CPR process metrics from before to during and after its implementation.

Methods: We included all cases of EMS-treated out-of-hospital cardiac arrest during 2012 and 2013 in which a mechanical CPR device was used and the defibrillator electronic record was available. Continuous ECG and impedance data were analyzed to measure chest compression fraction, duration of the pause from last manual to first mechanical compression, and duration of the longest overall pause in the resuscitation effort.

Results: Compared to cases from 2012 (n = 61), median duration of the pause prior to first mechanical compression for cases from 2013 (n = 71) decreased from 21 (15, 31) to 7 (4, 12)s (p < 0.001), while median chest compression fraction increased from 0.90 (0.88, 0.93) to 0.95 (0.93, 0.96) (p < 0.001). Median duration of the longest pause decreased from 25 (20, 35) to 13 (10, 20)s (p < 0.001), while the proportion of cases where the longest pause was for mechanical CPR application decreased from 74% to 31% (p < 0.001).

Conclusions: Our QI initiative substantially reduced the duration of the pause prior to first mechanical compression. Combined with the simultaneous significant increase in compression fraction and significant decrease in duration of the longest pause, this finding strongly suggests a large improvement in mechanical CPR device application efficiency within an overall high-performance CPR process.

Keywords: Cardiac arrest resuscitation; Chest compression fraction; High performance CPR; Mechanical chest compression; OHCA.

MeSH terms

Cardiopulmonary Resuscitation / instrumentation*
Cardiopulmonary Resuscitation / standards*
Emergency Medical Services / standards*
Equipment Design
Humans
Out-of-Hospital Cardiac Arrest / therapy*
Quality Improvement*
Thorax
Time Factors