1 Tools to Improve CPR Quality National Teaching Institute San Diego, CA Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff Nurse Tuesday 12:15 pm EXED220 Thursday 9:30 am EXED220 Objectives • Discuss current issues with CPR quality • Discuss the role of Waveform Capnography in cardiac arrest • Describe ways to incorporate CPR assist devices into resuscitation events
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Tools to Improve CPR Quality€¦ · Man vs. Machine? • Simulated CA in pigs—coronary blood flow1 • CPP 20-25 mmHg LUCAS vs. 5-10 mmHg manual EtCO2 25.5 mmHg LUCAS vs. 16.5
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An increased chest compression fraction is independently predictive of better survival in patients who experience a pre-hospital ventricular fibrillation/tachycardia cardiac
arrest.
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Christenson et al. Circulation (2009)
Metronomes
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Compression rate“Push fast, push hard”
Too Slow(Before 2010)
Too Fast(current)
100 – 120 /min
Real-time Advantage Goals
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Disco Lives!!!• 5 Medical students & 10
MDs• With beat avg. 103 /minute• 5 weeks later repeated
Use a metronome!!!
Auditory cue that takes the guess work away
Chest compressions with metronome
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How do you accurately measure compression depth?
Real Time Feedback Devices
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Accelerometer CPR Depth
Perkins et al. Resuscitation 2009;80:79-82
The Mattress Issue:• Mattress compression = 35 – 40% of total
compression depth• Accelerometer feedback devices fail to account for
mattress compression• Use of a backboard fails to compensate for
• CPP 20-25 mmHg LUCAS vs. 5-10 mmHg manual▫ EtCO2 25.5 mmHg LUCAS vs. 16.5
mmHg manual
• EtCO2 measurement in humans2
▫ EtCO2 values higher compared to humans
▫ 126 OHCA patients ▫ Average 24.5 mmHg
vs. 20.4 mmHg
Man vs. Machine?
1. Liao Q, et al. Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs. BMC Cardiovascular Disorders. 2010;10:532. Axelsson C, Karlsson T, Axdelsson A, et al. Mechanical active compression decompression cardiopulmonary resuscitation (ACD-CPR) versus manual
CPR according to pressure of end tidal carbon dioxide (PETCO2) during CPR in out-of-hospital cardiac arrest (OHCA). Resuscitation. 2009:80(10):1099-1103.
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• Provides effective, consistent and uninterrupted compressions during: ▫ Intra-departmental transport ▫ Defibrillation▫ Advanced procedures
Mechanical Chest Compression Devices
In conclusion:
• Provide good quality compressions• Minimize interruptions in compressions• Practice! Utilize feedback on CC performance• Consider utilization of a mechanical
compression device!
• You can’t (won’t) improve what you don’t measure!!!