Third Annual EMS RESEARCH SUMMITThird Annual EMS RESEARCH SUMMIT

• All monitors used locally can collect data All monitors used locally can collect data during the performance of CPRduring the performance of CPR Hands-on timeHands-on time Compression rates and ratioCompression rates and ratio Compression depth and other compression informationCompression depth and other compression information CPR pauses (e.g., before and after defibrillation, etc.)CPR pauses (e.g., before and after defibrillation, etc.)

• Data from these files are useful for crews, Data from these files are useful for crews, agencies, and research.agencies, and research.

• All monitors used locally can collect data All monitors used locally can collect data during the performance of CPRduring the performance of CPR Hands-on timeHands-on time Compression rates and ratioCompression rates and ratio Compression depth and other compression informationCompression depth and other compression information CPR pauses (e.g., before and after defibrillation, etc.)CPR pauses (e.g., before and after defibrillation, etc.)

• Data from these files are useful for crews, Data from these files are useful for crews, agencies, and research.agencies, and research.

• Philips ElectronicsPhilips Electronics• Philips ElectronicsPhilips Electronics

Three device manufacturers used in the region:

Philips Zoll Medtronic Medtronic

•Zoll MedicalZoll Medical

•Medtronic Physio-ControlMedtronic Physio-Control

Philips Q-CPR™Compressions

RhythmEvents Timeline

Average Compression Rate (per min.) & Depth

Zoll RescueNet™

CPR

ECG

Chest Compression Depth

Compression Rate

Physio-Control Code-Stat™

Compressions

Rhythm

Compressions

Events & Assorted Vital Signs

ROSC

Statistics(1-minute intervals)

• Individual case informationIndividual case information Research protocol implementationResearch protocol implementation Time dataTime data

• Aggregate informationAggregate information CPR quality across multiple casesCPR quality across multiple cases Identification of trendsIdentification of trends

• Information to enhance other available dataInformation to enhance other available data Initial rhythmInitial rhythm Outcome dataOutcome data Medication timing and impactMedication timing and impact

• Individual case informationIndividual case information Research protocol implementationResearch protocol implementation Time dataTime data

• Aggregate informationAggregate information CPR quality across multiple casesCPR quality across multiple cases Identification of trendsIdentification of trends

• Information to enhance other available dataInformation to enhance other available data Initial rhythmInitial rhythm Outcome dataOutcome data Medication timing and impactMedication timing and impact

Monitor files generate data that can provide:

• Large randomized clinical trialsLarge randomized clinical trials PRIMEDPRIMED

• Observational studiesObservational studies Chest Compression Fraction in VF/VTChest Compression Fraction in VF/VT Quality of CPR—nationwide feasibility study in DenmarkQuality of CPR—nationwide feasibility study in Denmark

• Randomized studies of feedbackRandomized studies of feedback Real-time feedback study—ROCReal-time feedback study—ROC Feedback study—GermanyFeedback study—Germany

• Large randomized clinical trialsLarge randomized clinical trials PRIMEDPRIMED

• Observational studiesObservational studies Chest Compression Fraction in VF/VTChest Compression Fraction in VF/VT Quality of CPR—nationwide feasibility study in DenmarkQuality of CPR—nationwide feasibility study in Denmark

• Randomized studies of feedbackRandomized studies of feedback Real-time feedback study—ROCReal-time feedback study—ROC Feedback study—GermanyFeedback study—Germany

Several studies have recently used data from monitor files:

• Multicenter observational study of Multicenter observational study of 506506 CPR files (largest of its kind to date)CPR files (largest of its kind to date)

• Investigated the association of Investigated the association of chest chest compression fraction compression fraction (CCF)* (CCF)* with survival with survival in patients presenting in VF/VTin patients presenting in VF/VT

• Evaluated CCF during the period prior to Evaluated CCF during the period prior to first shockfirst shock

• Conclusions: Conclusions: More time spent performing chest More time spent performing chest

compressions in the early phase of compressions in the early phase of resuscitation substantially affects survivalresuscitation substantially affects survival

Some questions are unanswered, and Some questions are unanswered, and further studies are necessaryfurther studies are necessary

*Proportion of time spent delivering chest compressions.*Proportion of time spent delivering chest compressions.

Chest Compression Fraction Determines Survival in Patients

with Out-of-Hospital VF

• Chart (incident report) writingChart (incident report) writing• Cardiac arrest management QI/QACardiac arrest management QI/QA• CPR quality reviewCPR quality review• Protocol complianceProtocol compliance• Reasons/Context for pauses in CPRReasons/Context for pauses in CPR• Best practices for cardiac arrest treatmentBest practices for cardiac arrest treatment• Objective measures of timeObjective measures of time• Agency-specific performanceAgency-specific performance

• Chart (incident report) writingChart (incident report) writing• Cardiac arrest management QI/QACardiac arrest management QI/QA• CPR quality reviewCPR quality review• Protocol complianceProtocol compliance• Reasons/Context for pauses in CPRReasons/Context for pauses in CPR• Best practices for cardiac arrest treatmentBest practices for cardiac arrest treatment• Objective measures of timeObjective measures of time• Agency-specific performanceAgency-specific performance

Monitor files, when reviewed with the chart, can aid in:

Code-Stat™ Case ReportQI Feedback to Field Providers

Overall Performance

Initial Rhythm

Compressions &Other Events(analysis, shocks, ROSC, etc.)

Compression Depth (inches)

Zoll CPR Summary Analysis

Time On/Off Chest

Compression Rate

QI Feedback to Field Providers

Average Compression Depth

Philips Q-CPR Report Card

Average Compression Rate

Compression Depth (% adequate)

QI Feedback to Field Providers

• Is useful for objective case reviewIs useful for objective case review

• Can enhance treatmentCan enhance treatment

• Can help clarify the timing and effectiveness Can help clarify the timing and effectiveness of protocol changesof protocol changes

• Is critical to advancing the science of Is critical to advancing the science of cardiac arrest carecardiac arrest care

• Is useful for objective case reviewIs useful for objective case review

• Can enhance treatmentCan enhance treatment

• Can help clarify the timing and effectiveness Can help clarify the timing and effectiveness of protocol changesof protocol changes

• Is critical to advancing the science of Is critical to advancing the science of cardiac arrest carecardiac arrest care

Cardiac monitor file data: