Assessing the Quality of Real-World CPR

How true to cardiopulmonary resuscitation guidelines is CPR in the real world? Researchers addressed this question in two prospective studies: one of out-of-hospital CPR, the other of in-hospital CPR. Both studies were funded at least partly by a company that makes the special monitor/defibrillator that was used to assess chest-compression and ventilation rates.

In the out-of-hospital study, pressure sensors and accelerometers were used to assess the adequacy of CPR administered by paramedics or nurse anesthetists to 176 patients in Norway, Sweden, and the U.K. Although chest compressions were, on average, performed at the appropriate rate per minute, they were often too shallow (mean depth, 34 mm; vs. recommended depth, 38-51 mm) and were used in fewer than half of resuscitation events. Ventilation rates were generally appropriate. Return of spontaneous circulation (ROSC) was achieved in 61 cases (35%); 5 patients survived to hospital discharge with normal neurologic function.

In the in-hospital study, researchers used a similar technique to assess the adequacy of CPR in 67 patients with cardiac arrest, most in intensive care settings. Chest compressions, used in only 24% of resuscitation events, were too shallow (<38 mm) about 37% of the time and were often at an inadequate rate (e.g., <90/minute in about 1 in 4 cases, <80/minute in about 1 in 8 cases). Also, ventilation rates were often too high (>20/minute about 60% of the time). ROSC was achieved in 27 cases (40%); 7 patients survived to hospital discharge.

Comment: In these two small studies, the quality of CPR -- performed either outside or inside the hospital by trained personnel -- was inconsistent across patients and often did not meet CPR guidelines. Chest compressions, known to improve prognosis, were often not performed. The findings raise questions about the adequacy of CPR training and, as the editorialists note, about the simplicity and transparency of CPR protocol. These studies were unable to demonstrate whether providing guideline-adherent CPR actually improved outcomes.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology March 4, 2005

Source

Wik L et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005 Jan 19; 293:299-304.
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Abella BS et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005 Jan 19; 293:305-10.
[Original article][Medline abstract][Download citation]

Sanders AB and Ewy GA. Cardiopulmonary resuscitation in the real world: When will the guidelines get the message? JAMA 2005 Jan 19; 293:363-5.