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Real-Time CPR Quality Metrics

Third Annual EMS Research Summit. Real-Time CPR Quality Metrics. Background. All monitors used locally can collect data during the performance of CPR Hands-on time Compression rates and ratio Compression depth and other compression information

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Real-Time CPR Quality Metrics

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  1. Third Annual EMS Research Summit Real-Time CPRQuality Metrics

  2. Background • All monitors used locally can collect data during the performance of CPR • Hands-on time • Compression rates and ratio • Compression depth and other compression information • CPR pauses (e.g., before and after defibrillation, etc.) • Data from these files are useful for crews, agencies, and research.

  3. Local Cardiac Monitor/Defibrillators Three device manufacturers used in the region: • Philips Electronics • Zoll Medical • Medtronic Physio-Control Philips Zoll Medtronic Medtronic

  4. Philips Q-CPR™ Average Compression Rate (per min.) & Depth Compressions Events Timeline Rhythm

  5. Zoll RescueNet™ Chest Compression Depth Compression Rate ECG CPR

  6. Physio-Control Code-Stat™ Events & Assorted Vital Signs Statistics (1-minute intervals) Compressions ROSC Rhythm Compressions

  7. Research Utility Monitor files generate data that can provide: • Individual case information • Research protocol implementation • Time data • Aggregate information • CPR quality across multiple cases • Identification of trends • Information to enhance other available data • Initial rhythm • Outcome data • Medication timing and impact

  8. Previous Research Several studies have recently used data from monitor files: • Large randomized clinical trials • PRIMED • Observational studies • Chest Compression Fraction in VF/VT • Quality of CPR—nationwide feasibility study in Denmark • Randomized studies of feedback • Real-time feedback study—ROC • Feedback study—Germany

  9. Previous Research continued… • Multicenter observational study of 506 CPR files (largest of its kind to date) • Investigated the association of chest compression fraction (CCF)* with survival in patients presenting in VF/VT • Evaluated CCF during the period prior to first shock • Conclusions: • More time spent performing chest compressions in the early phase of resuscitation substantially affects survival • Some questions are unanswered, and further studies are necessary Chest Compression Fraction Determines Survival in Patients with Out-of-Hospital VF • *Proportion of time spent delivering chest compressions.

  10. Agency Value Monitor files, when reviewed with the chart, can aid in: • Chart (incident report) writing • Cardiac arrest management QI/QA • CPR quality review • Protocol compliance • Reasons/Context for pauses in CPR • Best practices for cardiac arrest treatment • Objective measures of time • Agency-specific performance

  11. Code-Stat™ Case Report QI Feedback to Field Providers Overall Performance Initial Rhythm Compressions &Other Events(analysis, shocks, ROSC, etc.)

  12. Zoll CPR Summary Analysis QI Feedback to Field Providers Compression Depth (inches) Time On/Off Chest Compression Rate

  13. Philips Q-CPR Report Card QI Feedback to Field Providers Average Compression Rate Average Compression Depth Compression Depth (% adequate)

  14. Conclusions Cardiac monitor file data: • Is useful for objective case review • Can enhance treatment • Can help clarify the timing and effectiveness of protocol changes • Is critical to advancing the science of cardiac arrest care

  15. Questions?

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