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JAMA. 2005 Jan 19;293(3):305-10.

Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.

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1
Section of Emergency Medicine, University of Chicago Hospitals, Chicago, Ill 60637, USA.

Abstract

CONTEXT:

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.

OBJECTIVES:

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

DESIGN AND SETTING:

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.

MAIN OUTCOME MEASURE:

Adherence to American Heart Association and international CPR guidelines.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
15657323
DOI:
10.1001/jama.293.3.305
[Indexed for MEDLINE]
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