Quality of Chest Compressions in Prehospital Care: Can it be done effectively

1. Quality of Chest Compressions in Prehospital Care: Can it be done effectively Baxter Larmon, PhD, MICP Professor Medicine and Emergency Medicine David Geffen School of Medicine at UCLA Director UCLA Center for Prehospital Care

2. No Conflicts to Declare

3. May 20th 2013

4. More than 150 published within the last year

5. I will focus on two UCLA projects • Los Angeles Quality Improvement project • On going • Study by UCLA Center for Prehospital Care • Currently submitted for publication and presented at ECC Scientific Assembly

6. CARDIAC ARRESTA TIME FOR CHANGEQuality Improvement Project Los Angeles County Dr. Dan Davis UCSD Center for Resuscitation Science Assistance by: William Koenig MD, Baxter Larmon, PhD, Susan Mori, RN, Todd LeGassick, MPH

7. QI Project • Partnership • UCSD • LA County DHS • UCLA Center for Prehospital Care • Zoll Corporation • Equipment and Education support ONLY • Started December 2010 • Five Fire Departments in LA County • 1 Department dropped out

8. QI Project • Pre – ART • Defib pads were modified, monitors had memory cards placed • No educational intervention • Providers were asked to contact a ART Coordinator when a cardiac arrest occurred • ART coordinator would gather data with 48 hours of arrest when possible

9. QI Project • Pre-ART • Standard Procedures • Post – ART • Same as above • Feedback on monitor turned on • Intervention / during regular CE • First Month 2 hour lecture • Next Month 1.5 skills • Data collected

11. Data Collection • Duration • Total time of arrest in minutes • Compression Depth within Target - % ofTarget >2 and < 3.5 inches • Compression Rate within Target • % Target 100 -120 compressions per minute • Time in Compressions • % of time that chest compression performed during entire arrest

12. Data Collection • Overall quality entire duration • % of time that both depth and rate are within target • Time to Shock • Time in minutes of stopping compression to deliver shock • Number of Shocks

13. Data Presentation • 109 cases Collected • 71 pre ART • 38 post ART • Convenient Sampling from 1 Fire Department • 3 Pre ART and 3 Post ART • All presented data was in a 3 month window Still collecting data

14. Pre ART

15. Pre ART 1 / Case # 62 Duration of Arrest = 20 Minutes 0 % in Depth Target Target = 2- 3.5 inches

16. Key Pre ART 1 / Case # 62 CPR Periods Target Zones Depth of Compression Rate of Compression Key CPR Periods Target Zones Duration of Arrest = 20 Minutes 1 % Target Rate Target Rate = 80 -120 minute

17. Pre ART 1 / Case # 62 Duration of Arrest = 20 Minutes 0 % in Target of both Rate and Depth

18. Pre ART 2 / Case # 65 Duration of Arrest = 26 Minutes 10 % in Target Depth Target = 2- 3.5 inches

19. Pre ART 2 / Case # 65 Duration of Arrest = 26 Minutes 11 % in Target Rate Target Rate = 80 -120 minute

20. Pre ART 2 / Case # 65 Duration of Arrest = 26 Minutes 1 % in Target of both Rate and Depth

21. Pre ART 3 / Case # 55 Duration of Arrest = 30 Minutes 2 % in Target Depth Target = 2- 3.5 inches

22. Pre ART 3 / Case # 55 Duration of Arrest = 30 Minutes 26 % in Target Rate Target Rate = 80 -120 minute

23. Pre ART 3 / Case # 55 Duration of Arrest = 30 Minutes 2 % in Target of both Rate and Depth

24. Pre ART 3 / Case # 55 Duration of Arrest = 30 Minutes Delay in compressions average 47 seconds in 5 shocks

25. Post ART

26. Post ART 1 / Case # 74 Duration of Arrest = 34 Minutes 92 % in Target Depth Target = 2- 3.5 inches

27. Post ART 1 / Case # 74 Duration of Arrest = 34 Minutes 81 % in Target Rate Target Rate = 80 -120 minute

28. Post ART 1 / Case # 74 Duration of Arrest = 34 Minutes 88 % in Target of both Rate and Depth

29. Post ART 2 / Case # 72 Duration of Arrest = 21Minutes 81 % in Target Depth Target = 2- 3.5 inches

30. Post ART 2 / Case # 72 Duration of Arrest = 21Minutes 99 % in Target Rate Target Rate = 80 -120 minute

31. Post ART 2 / Case # 72 Duration of Arrest = 21Minutes 81 % in Target of both Rate and Depth

32. Post ART 3 / Case # 71 Duration of Arrest = 43 Minutes 90 % in Target depth Target = 2- 3.5 inches

33. Post ART 3 / Case # 71 Duration of Arrest = 43 Minutes 90 % in Target Rate Target Rate = 80 -120 minute

34. Post ART 3 / Case # 71 Duration of Arrest = 43 Minutes 82 % in Target of both Rate and Depth

35. Post ART 3 / Case # 71 Duration of Arrest = 43 Minutes Delay in compressions average 3 seconds in 6 shocks

36. Comparison Pre and Post ART

37. Total Elapsed Time of Cardiac Arrest (minutes) Need Graph, % Pre ART Post ART

38. Comparison Pre and Post ARTCompression Depth in Target (%) Need Graph, % Pre ART Post ART

39. Comparison Pre and Post ARTCompression Rate in Target (%) Need Graph, % Pre ART Post ART

40. Comparison Pre and Post ARTOverall Chest Compression Quality Need Graph, % Pre ART Post ART

43. Hard To Teach An Old Dog A NEW Trick

44. Feedback Graph

45. Presented toAHA ECC

46. Method • 35 Paramedic students recently completing a AHA HCP BLS Course • Each subject randomly drew three cards • Each card allowed them to perform chest compressions for a 2 minute period of time in three different positions • Backboard on the ground • Backboard on the stretcher in the lowered position • Backboard on a stretcher in the raised position

47. Method continued • They were given a six minute rest between each attempt • Data was collected

49. Conclusion • Effective compressions must be done on the ground or on a stretcher in the lowered position • There is a degradation of chest compression over time

50. Currently studying this Summer • Quality of Chest Compressions on a moving gurney • Does body mass index effect the quality of chest compressions