title: Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan S. Road, Taipei 100, Taiwan, ROC.
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.forename: Wen-Jone
authors.initials: WJ
authors.lastname: Chen
authors.forename: Shyr-Ying
authors.initials: SY
authors.lastname: Chen
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Lin
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Tsai
authors.forename: Wei-Tien
authors.initials: WT
authors.lastname: Chang
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
authors.forename: Chin-Yuan
authors.initials: CY
authors.lastname: Tsan
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
mesh_terms: 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