improving survival: a special presentation for aha training centers and instructors

OUR ROLE IN IMPROVING RECOGNITION, RESPONSE, CARE

AND OUTCOMES1

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Learning Objectives

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Despite Decades of Effort…

Approach to Improving OutcomesMany Systems Ideal System

No Data Data Collected

No Plan Quality Improvement Plan

Fragmented Efforts Holistic Approach

Partially Implemented Guidelines

Fully Implemented Guidelines

A Systems Approach

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Issues:CPR Component Challenges to Improving Quality

Recognition Failure to recognize gasping as sign, unreliable Pulse Detection

Initiation of CPR Low Bystander CPR response Rate, Incorrect Dispatch instructions

Compression Rate Slow compression Rate

Compression Depth Shallow compression Depth

Chest Wall Recoil Rescuer Leaning on Chest

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Issues: cont’dCPR Component Challenges to Improving Quality

Compression Interruptions Excessive interruptions for pulse check, Ventilations, defibrillation, intubation, IV access, other

Ventilations Ineffective ventilations, prolonged interruptions in compressions , excessive ventilations (esp with airway)

Defibrillation Prolonged time to defibrillate avail, prolonged interruptions in chest compressions pre- and post shocks

Team Performance Delayed rotation, leading to rescuer fatigue and decay in compression quality, poor communication among rescuers leading to unnecessary interruptions in compressions

What is Guideline Implementation?

Guideline Implementation

IMPROVED SURVIVAL

Tale of Two Communities

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Tools and Resources

Call to Action

Link 1: Immediate Recognition and Activation

• Failure to recognize gasping as sign • Unreliable pulse detection• Failure to recognize early warning signs of ACS • Delayed 9-1-1 activation

Tools and Resources

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Call to ActionECC Instructors can access existing print, radio,

and video Public Service Announcements to use in their own communities and increase

awareness, response and 9-1-1 Activation.

Link 2: Early CPR

• Low bystander CPR response rates• Incorrect dispatch instructions

>>Play audio file<<

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Tools and Resources

Call to Action

Instructors should use tools such as

Hands-Only CPR, self instructional and

certification programs designed to support

community education.

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Link 3: Rapid Defibrillation

• Delayed time to defibrillator use• Delayed interruptions in chest compressions

pre- and post-shocks

Tools and Resources

Response to Cardiac Arrest and Selected Life-ThreateningMedical Emergencies

Call to ActionInstructors should use tools

such as the AED Implementation Guide and

Scientific Statements designed to support

rapid defibrillation.

Link 4: Effective ACLS

Compression rate – Slow compression rate

Compression depth – Shallow compression depth

Chest wall recoil – Rescuer leaning on the chest

Link 4: Effective ACLS

• Compression interruptions• Excessive interruptions for:

Rhythm/pulse checks-Ventilations-DefibrillationIntubation-Intravenous Access

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Feedback and Debriefing

• Provider focused• Assist in improving

performance• Improved adherence

to guidelines• Higher rate of ROSC

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Tools and Resources

Maintenance of Competency

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CPR Fractions

Call to Action

Healthcare providers should practice

resuscitation skills and team performance,

incorporating strategies such as measuring of

CPR fractions and debriefing as methods for

improving quality and outcomes.

Link 5: Post-Cardiac Arrest Care

• Therapeutic Hyperthermia• Post ROSC 12-lead ECG• Transport to Cardiac Arrest Center

Tools and Resources

Call to Action

EMS providers and agencies are integral to the

advancement post resuscitation care and

evolving systems of care. The importance of

your role at all levels of design and

implementation is innumerable.

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The goal of Get With The Guidelines-Resuscitation is to help hospital teams save more lives threatened by cardiopulmonary emergencies through consistent

application of the most up-to-date scientific guidelines for in-hospital resuscitation.

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Summary

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Questions and Answers

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