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CPR review

CPR review. L Hodsdon 01/04/2009. Self Assessment of CPR review. Hindsight is 20/20 Knowing the algorithms does not imply the ability to implement them – i.e. ventilation rate (12-15??) Emotional tie in with a resuscitation attempt Last teaching’s resusc simulation fiasco

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CPR review

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  1. CPR review L Hodsdon 01/04/2009

  2. Self Assessment of CPR review • Hindsight is 20/20 • Knowing the algorithms does not imply the ability to implement them – i.e. ventilation rate (12-15??) • Emotional tie in with a resuscitation attempt • Last teaching’s resusc simulation fiasco • Conclusion: I would not be able to accurately assess any CPR attempt I’d been involved in.

  3. Self Assessment of CPR? • Rating of one owns team performance did not correlate with objective performance measures. • Few of the participants recalled delays, interruptions and other significant shortcomings when asked. • These results suggest that during CPR health-care workers do not realise deviations from algorithms and questions the value of narratives of medical emergencies. Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial. Hunziker et al (BCM EM 2009)

  4. Suboptimal CPR • Organisation failure • Lack of knowledge • Failure to appreciate clinical urgency • Lack of supervision • Failure to seek advice / training • Hospital Outreach Teams are not a substitute for good quality training of all hospital personnel

  5. Organisational Failure • Equipment / Staffing / Design – Boring! Boring! Boring! In RSA: God grant me the COURAGE to change the things I can, the SERENITY to accept those I cannot change and the WISDOM to know the difference.

  6. Organisational Failure • Resusc Team Organisation – we can make a difference. LEADERSHIP: • Despite an equal number of total utterances, ad-hoc teams made significantly less leadership utterances. • Structuring leadership of both team and task has been found to positively correlate with effective team performance during CPR.

  7. Organisational Failure - Leadership • Easy when 2 interns, more difficult when it’s the surgical reg & consultant: Few options: • “Force” the senior to assume leadership • Assume leadership (and consult the consultant) • Facilitative leadership (the power behind the throne) SOMEONE HAS TO TAKE COMMAND

  8. Organisational Failure • Resusc Team Organisation – we can make a difference. COMMUNICATION: • Clear directed instruction with confirmation • Open, but controlled forum for reflection (here the Ad hoc teams did better) • Non judgmental assessment of team preformance while performing CPR • Debriefing

  9. Failure to Appreciate Clinical Urgency • DNAR – reduce the number of futile resusc attempts • Lead by example • Don’t wait until the patient’s dead before instituting medical interventions • Don’t pretend you can’t hear • When “resusc” is called, make a determined move in the right direction • Don’t crucify “false alarms”

  10. Supervision • Be patient, all in good time! • When you become that consultant, remember what it felt like to be unsupervised, and give of your time to supervise others • Supervise your juniors and give them the opportunity to grow (don’t hog all the “exciting” interventions – stand next to them and be the support system) • “When I was an intern/registrar/etc we had to do ….” is NOT a good Ad Ed principle

  11. Goals • CPR can be satisfactorily but still not perfectly performed by highly trained professionals in the specialized health care environment of an emergency department. • A correct chest compression rate resulting in a mean of 96 compressions per minute and a hands-off ratio of 12.7% (mean 7.6sec) could be achieved. • Observations: • Deterioration in performance with resuscitation duration • Tendency to hyperventilate (mean 18/min) • Too much unnecessary no-flow time (ECG rhythm, pulse checks, and examination times)

  12. Bibliography • Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial. Hunziker et al; BCM EM 2009 • Quality of Cardiopulmonary Resuscitation Among Highly Trained Staff in an Emergency Department Setting Losert,H et al; Arch Intern Med. 2006 • Cardiopulmonary resuscitation – standards for clinical practice and training. London: Resuscitation Council (UK) 2004. Editorial: CD Deakin; BMJ volume 330 March 2005

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