CPR Report Cards: What’s Your Grade? Nicole Kupchik MN, RN, CCNS, CCRN, PCCN-CMC, CSC
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CPR Report Cards: What’s Your Grade?
Nicole KupchikMN, RN, CCNS, CCRN, PCCN-CMC, CSC
Our Moderator
Kimberly Kelly, BSN,RN,CCRN-CSC• Staff Nurse at Legacy Emanuel
Medical Center, Portland, OR§ Lead Responder: Code Blue/RRT§ Cardiovascular Intensive Care Unit§ AACN Critical Care Fall Symposium
Committee Member
Our Speaker
Nicole Kupchik MN, RN, CCNS, CCRN, PCCN-CMC§ Clinical Nurse Specialist§ Former Code Blue Committee Chair§ Currently consultant
National Resuscitation Presentations:§ American Heart Association (AHA)§ Emergency Cardiovascular Care Updates (ECCU)§ Society of Critical Care Medicine (SCCM)§ National Teaching Institute (NTI)§ Emergency Nurses Association (ENA)
Disclosures
Speaker’s Bureau: § Physio-Control, now part of Stryker § La Jolla Pharmaceuticals§ Cheetah Medical
Consultant: § Physio-Control, now part of Stryker § Baxter Healthcare
§ This educational activity is approved for 1 contact hour. .§ A link to obtain CE credits will be available at the conclusion of the webinarAccreditation Statements§ Saxe Healthcare Communications is accredited as a provider for continuing
education by the American Nurses’ Credentialing Center’s Commission on Accreditation. Provider approved by California Board of Nursing. Provider #14477 and the Florida Board of Nursing Provider # 50-17032
§ This program has been approved for 1.0 contact hours Continuing Respiratory Care Education (CRCE) credit by the American Association of Respiratory Care, 9425 N. MacArthur Blvd. Suite 100, Irving, TX 75063
§ Support for this educational activity provided by Physio-Control, now part of Stryker
Continuing Education for Nurses and Respiratory Therapists
CPR Report Cards: What’s Your Grade?
Nicole KupchikMN, RN, CCNS, CCRN, PCCN-CMC, CSC
Learning Objectives
§ Discuss the importance of high quality CPR during cardiac arrest
§ Describe the importance of post event feedback using CPR reports
§ Discuss common issues with CPR in resuscitation events
Poll # 1
Is your hospital measuring CPR quality and giving feedback to teams?1. Yes2. No3. Sometimes
Solutions to Optimize CPR Performance
§ Metronomes§ Real time feedback
devices§ Capnography§ CPR Coach§ Post Event Review
Ideal – Fix issues as they happen!
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
Post Event Review & Debriefing
§ Data automatically downloads from the defibrillator
§ Evaluate CPR quality§ Rate§ Depth§ Chest Compression
Fraction§ Time to defibrillation§ Peri-shock pauses§ Capnography trends§ Assisted ventilation rate
So, how does this work?
Wireless transmission
Software / Database
Feedback/Report Card to Code Blue teams
CPR Report Card
So, how does this work?
Impedance signal & waveformfrom defibrillation pads
What does a CPR
report card tell you?
Breakdown of the CPR Report Card
% of time on the chest giving compressions
Average CC Rate
Average ventilation rate
Initial Rhythm
Breakdown of the CPR Report Card
Capnography trends during entire event
Total compression count# Pauses over 10 seconds
Longest compression pause
Breakdown of the CPR Report Card
Minute by minute events:Each red dash = single chest compression
Each blue inverted triangle = ventilation
Poll # 2
What do you think is your biggest challenge in codes?1. Chest compression rates are too fast &/or depth is too
shallow2. Pauses in compressions or around defibrillation events3. Over-ventilation4. Forgetting to connect Capnography5. We don’t have issues with any of these! (Yay!)
Does debriefing post-event improve outcomes?
Pediatric patients 8 years or older119 cardiac arrest events:
60 Control; 59 InterventionProspective quality improvement interventional trialDebriefing: **Safe environment**§ Patient history§ Pre-arrest studies (radiographs, CT scans, labs)§ Quantitative resuscitation data§ Patient Outcome and SummaryWolfe et al. (2014) Critical Care Medicine. 42(7)
Four Targets: “Excellent CPR”
§ Depth ≥ 38 mm§ Rate ≥ 100/min§ CPR Fraction > 90%§ Leaning < 10%
Wolfe et al. (2014).Critical Care Medicine. 42(7)
P = 0.054 P = 0.036
Issues with the Chest Compression Rate
Rapid CC Rate!
ROSC
Same case – ROSC, then re-arrest
Intra-Arrest Review
Compression fraction
Goal: at least 80%!
2 months after giving feedback to teams
§ ED patient with STEMI
§ PEA arrest§ Compression
fraction?§ What do you
think about the rate?
Poll # 3
What grade would you give on the 2-month changes?1. A+2. B+3. C+4. Detention
Issues with Chest Compression Depth
CC Rate 141
Minute by minute breakdown
Issues with Chest Compression Pauses
Case #1 Pre-shock Pause Issues
38 second pre-shock pause
Case #2 2 months later…
8 second pulse check
Case #3 Minimized pre & post shock pauses
Poll # 4
What grade would you give on the 6-month changes? 1. A+2. B+3. C+4. Detention!
Mechanical CPR with a Shock - #1
Pre-Shock Pause with Mechanical CPR - #2
Report Card - #3
Mechanical CPR – Don’t forget to shock!
Shock #1Minimal pause
Shock #231 sec pause
Shock #329 sec pause,
then shock
Too much timein between
pauses
Capnography Without & With Pulse
Pulseless – Capno 20 mm Hg with CPR
Conversion to an organized rhythm – Capno over 50 mm Hg
STEMI – Vfib ArrestChest Compressions: 1 of 3
Patient goes into Ventricular Fibrillation
20 seconds until CC started
Chest Compressions – Shock 200J,Organized Rhythm – then Vfib: 2 of 3
Vfib – Defib 300J – 8 CCBack into Vfib: 3 of 3
60-Minute Case… Minutes 1 - 26
Minutes 27 - 53
Patient remains in VF at minute 34, 43 & 46 – no shock
Minutes 54 - 59
How many shocks should have been delivered for a 60
min VF case?
AT LEAST 30!
Vfib – Compressions? Shock?
Poll # 5
What grade would you give this Vfib arrest case? 1. A+2. B+3. C+4. Detention!
Poll # 6
What grade would you give this 41 minute Vfib arrest case? 1. A+2. B+3. C+4. Detention
Issues with Over-Ventilation
Over-Ventilation is Common
In conclusion
§ Improvements in CPR quality and performance can be improved with feedback
§ Post event review can assist in targeting system issues to focus training
You won’t improve what you don’t measure!
Our Moderator
Kimberly Kelly
§ This activity has approved this program for 1.0 contact hour of CRCE and CNE by the AARC and California Board of Nursing and the Florida Board of Nursing
§ Go to http://www.saxetesting.com/sl§ You will need to register on the test site. Complete the evaluation form.§ Upon successful submission, you will be able to print your certificate of
completion.Accreditation Statements § American Association for Respiratory Care, 9425 N. MacArthur Blvd., Suite
100, Irving, TX 75063.§ Provider (Saxe Communications) is approved by the California Board of
Registered Nursing. Provider # 14477 and Florida Board of Nursing. Provider # 50-17032
§ Support for this educational activity provided by Physio-Control, now part of Stryker
Continuing Education for Nurses and Respiratory Therapists
Archive Version
§ An archive/on-demand version will be available on www.savinglivesnow.org
§ An email will be sent to all registrants when it is available
§ The on-demand version will be accredited for nurses and respiratory therapists
Next Webinar in Resuscitation Series
June 6th§ Mechanical CPR: Innovations in Cardiac Arrest
Questions
Kimberly Kelly Nicole Kupchik
Thank you for attending this webinar
Survey§ Immediately upon the conclusion of this webinar, you will be
presented with an online Survey. Please keep your web browser open. We appreciate your feedback
CE Certificate of Completion§ In 1 hour following the conclusion of this webinar, you will receive
an email with instructions and this link to obtain your CE credits: saxetesting.com/sl
On-Demand Version§ In a few days, an email will be sent to all registrants when the On-
demand recording of this webinar is available
Thank You
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