Improved Cardiopulmonary Resuscitation Performance With CODE ACES 2 : A Resuscitation Quality Bundle

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Over 6000 children have an in‐hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives.

Methods and Results

A prospective observational study of quality of chest compressions ( CC) during pediatric in‐hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle. Objectives were to: 1) implement a debriefing program, 2) identify impediments to delivering high quality CC, 3) develop a resuscitation quality bundle, and 4) measure the impact of the resuscitation quality bundle on compliance with American Heart Association ( AHA) Pediatric Advanced Life Support CC guidelines over time. Logistic regression was used to assess the relationship between compliance and year of event, adjusting for age and weight. Over 3 years, 317 consecutive cardiac arrests were debriefed, 38% (119/317) had CC data captured via defibrillator‐based accelerometer pads, data capture increasing over time: (2013:13% [12/92] versus 2014:43% [44/102] versus 2015:51% [63/123], P<0.001). There were 2135 1‐minute cardiopulmonary resuscitation (CPR) epoch data available for analysis, (2013:152 versus 2014:922 versus 2015:1061, P<0.001). Performance mitigating themes were identified and evolved into the resuscitation quality bundle entitled CPR Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES ²). The adjusted marginal probability of a CC epoch meeting the criteria for excellent CPR (compliant for rate, depth, and chest compression fraction) in 2015, after CPR Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation was developed and implemented, was 44.3% (35.3–53.3) versus 19.9%(6.9–32.9) in 2013; (odds ratio 3.2 [95% confidence interval:1.3–8.1], P=0.01).

Conclusions

CODE ACES ² was associated with progressively increased compliance with AHA CPR guidelines during in‐hospital cardiac arrest.

Related collections

Most cited references 30

Record: found
Abstract: found
Article: not found

Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.

Benjamin Abella, Jason Alvarado, Helge Myklebust … (2005)

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. To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. 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. Adherence to American Heart Association and international CPR guidelines. 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. 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.

0 comments Cited 190 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

What type of leadership behaviors are functional in teams? A meta-analysis

Eduardo Salas, Stanley Halpin, Cameron Klein … (2006)

0 comments Cited 167 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Debriefing with good judgment: combining rigorous feedback with genuine inquiry.

Jenny Rudolph, Robert Simon, Peter Rivard … (2007)

Drawing on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through reflective practice, we develop a model of "debriefing with good judgment." The model specifies a rigorous reflection process that helps trainees surface and resolve pressing clinical and behavioral dilemmas raised by the simulation. Based on the authors' own experience using this approach in approximately 2000 debriefings, it was found that the "debriefing with good judgment" approach often sparks self-reflection and behavior change in trainees.

0 comments Cited 167 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Elizabeth A. Hunt: ehunt@jhmi.edu

Journal

Journal ID (nlm-ta): J Am Heart Assoc

Journal ID (iso-abbrev): J Am Heart Assoc

Journal ID (doi): 10.1002/(ISSN)2047-9980

Journal ID (publisher-id): JAH3

Journal ID (hwp): ahaoa

Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2047-9980

Publication date (Electronic): 07 December 2018

Publication date Collection: 18 December 2018

Volume: 7

Issue: 24 ( doiID: 10.1002/jah3.2018.7.issue-24 )

Electronic Location Identifier: e009860

Affiliations

[ ¹ ] Department of Anesthesiology and Critical Care Medicine Johns Hopkins Hospital Baltimore MD

[ ² ] Department of Pediatrics Johns Hopkins Hospital Baltimore MD

[ ³ ] Division of Health Sciences Informatics Johns Hopkins Hospital Baltimore MD

[ ⁴ ] Johns Hopkins Medicine Simulation Center Johns Hopkins Hospital Baltimore MD

[ ⁵ ] Division of Pediatric Emergency Medicine Johns Hopkins Hospital Baltimore MD

[ ⁶ ] Department of Pharmacy Johns Hopkins Hospital Baltimore MD

[ ⁷ ] Department of Occupational Health Johns Hopkins Hospital Baltimore MD

[ ⁸ ] Department of Nursing Johns Hopkins Hospital Baltimore MD

[ ⁹ ] Division of Respiratory Services Johns Hopkins Hospital Baltimore MD

[ ¹⁰ ] Armstrong Institute for Patient Safety and Quality Johns Hopkins Hospital Baltimore MD

[ ¹¹ ] Department of Pediatrics Division of Critical Care Medicine Johns Hopkins All Children's Hospital Petersburg FL

[ ¹² ] Department of Anesthesiology and Critical Care Medicine Stanford University Stanford CA

[ ¹³ ] Healthcare Analytics Unit Children's Hospital of Philadelphia Philadelphia PA

Author notes

[*] [* ] Correspondence to: Elizabeth A. Hunt, MD, MPH, PhD, Johns Hopkins Charlotte Bloomberg Children's Center, 1800 Orleans Street, Suite 6321, Baltimore, MD 21287. E‐mail: ehunt@ 123456jhmi.edu

Article

Publisher ID: JAH33703

DOI: 10.1161/JAHA.118.009860

PMC ID: 6405605

PubMed ID: 30561251

SO-VID: f53dcc48-c020-470b-967f-ca2faeea8771

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

History

Date received : 21 May 2018

Date accepted : 25 September 2018

Page count

Figures: 3, Tables: 4, Pages: 16, Words: 11580

Custom metadata

source-schema-version-number 2.0

component-id jah33703

cover-date 18 December 2018

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.4 mode:remove_FC converted:18.12.2018

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: cardiopulmonary arrest,cardiopulmonary resuscitation (cpr),emergency cardiac care,pediatrics,quality and outcomes,quality improvement,sudden cardiac death,cardiopulmonary resuscitation and emergency cardiac care

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: cardiopulmonary arrest, cardiopulmonary resuscitation (cpr), emergency cardiac care, pediatrics, quality and outcomes, quality improvement, sudden cardiac death, cardiopulmonary resuscitation and emergency cardiac care