Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts.
OBJECTIVE
Quality assurance to optimize clinical resuscitation performance is important. The aims of the present study were to identify the deficiencies in the clinical practice of resuscitation by motion analysis of video-recorded cardiopulmonary resuscitation (CPR), and to evaluate the effectiveness of quality improvement strategies based on audio-prompt methods.


METHODS
A two-stage prospective trial was conducted. The first stage (observation group) was designed to identify any major clinical nonconformity to current resuscitation guidelines by videotaped CPR sessions. The second stage (intervention group) was designed to evaluate the effectiveness of audio prompts in ameliorating the problems identified at the first stage. The demographic data of patients and CPR variables between the two groups were analysed.


RESULTS
A total of 30 resuscitation attempts were recorded during study period: 17 patients were in the observation group and 13 patients in the intervention group. Inadequate number of chest compressions per minute, lack of re-oxygenation during prolonged intubation attempts and unnecessary hands-off periods were identified as the three most important deficiencies in CPR practice. Compared to the observation group, the intervention group showed a significant improvement in the hands-off period per minute during CPR (12.7 +/- 5.3 s versus 16.9+/-7.9 s, P < 0.05), the total hands-off time during CPR (164 +/- 94 s versus 273 +/- 153 s, P < 0.05), the proportion of intubation attempts taking under 20 s (56.3% versus 10%, P < 0.05).


CONCLUSIONS
Audio-prompts can improve the adherence to current CPR guidelines in the clinical setting significantly. The quality improvement measures described in this study are helpful in translating CPR knowledge into clinical practice.
Chiang
Wen-Chu
WC
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan S. Road, Taipei 100, Taiwan, ROC.
Chen
Wen-Jone
WJ
Chen
Shyr-Ying
SY
Ko
Patrick Chow-In
PC
Lin
Chih-Hao
CH
Tsai
Min-Shan
MS
Chang
Wei-Tien
WT
Chen
Shyr-Chyr
SC
Tsan
Chin-Yuan
CY
Ma
Matthew Huei-Ming
MH
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D047548:Defibrillators; D005392:First Aid; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D013637:Tape Recording; D014741:Video Recording