improving survival: a special presentation for aha training centers and instructors
DESCRIPTION
The Emergency Cardiovascular Care Committee and AHA staff acknowledges and shares in the your goal of improving patient outcomes through the development and delivery of the highest quality resuscitation care available. We appreciate your collaboration, input, and interaction with us. New treatments have improved the possibility of survival from cardiovascular emergencies, cardiac arrest, and stroke. These new treatments offer the hope of improved quality of life for people who suffer these events. Thank you for your commitment to the art and science of resuscitation. Through your actions, we are helping to increase the probability of prompt citizen initiated CPR, and educating countless rescuers and clinicians to improve the quality of CPR. Only with you can our quest for improving outcomes and lifesaving mission continue.TRANSCRIPT
OUR ROLE IN IMPROVING RECOGNITION, RESPONSE, CARE
AND OUTCOMES1
2
Learning Objectives
4
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
7
8
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
9
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
12
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
>>insert banner from http://www.heart.org/HEARTORG/News/PublicServiceAnnouncements/Public-Service-Announcements_UCM_312002_SubHomePage.jsp# <<
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<<
21
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.
23
24
25
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
31
Feedback and Debriefing
• Provider focused• Assist in improving
performance• Improved adherence
to guidelines• Higher rate of ROSC
32
Tools and Resources
Maintenance of Competency
34
35
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.
40
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.
41
Summary
42
Questions and Answers
44
45