title: Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland.
abstract: BACKGROUND
  Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and serious neurological morbidity in Europe. Recent studies have demonstrated the adverse physiological consequences of poor resuscitation technique and have shown that quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome from OHCA. Telemetry of the defibrillator transthoracic impedance (TTI) trace can objectively measure quality of pre-hospital resuscitation. This study aims to analyse the impact of targeted resuscitation feedback and training on quality of pre-hospital resuscitation.
  
  
  METHODS
  Prospective, single centre, cohort study over 13 months (1st December 2009-31st December 2010). Baseline pre-hospital resuscitation data was gathered over a 3-month period. Modems (n=40) were fitted to defibrillators on ambulance vehicles. Following a resuscitation attempt, the event was sent via telemetry and the TTI trace analysed. Outcome measures were time spent performing chest compressions, compression rate, the interval required to deliver a defibrillator shock and use of automatic or manual cardiac rhythm analysis. Targeted resuscitation classes were introduced and all ambulance crews received feedback following a resuscitation attempt. Pre-hospital resuscitation quality pre and post intervention were compared.
  
  
  RESULTS
  111 resuscitation traces were analysed. Mean hands-on-chest time improved significantly following feedback and targeted resuscitation training (73.0% vs 79.3%, p=0.007). There was no significant change in compression rate during the study period. There was a significant reduction in median time-to-shock interval from 20.25s (IQR 15.50-25.50s) to 13.45 s (IQR 2.25-22.00 s) (p=0.006). Automatic rhythm recognition fell from 50% to 28.6% (p=0.03) following intervention.
  
  
  CONCLUSIONS
  Telemetry and analysis of the TTI trace following OHCA allows objective evaluation of the quality of pre-hospital resuscitation. Targeted resuscitation training and ambulance feedback improves the quality of pre-hospital resuscitation. Further studies are required to establish possible survival benefit from this technique.
authors.affiliation: Emergency Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK. richardlyon@doctors.org.uk
authors.forename: R M
authors.initials: RM
authors.lastname: Lyon
authors.forename: S
authors.initials: S
authors.lastname: Clarke
authors.forename: D
authors.initials: D
authors.lastname: Milligan
authors.forename: G R
authors.initials: GR
authors.lastname: Clegg
mesh_terms: D000368:Aged; D004501:Education, Medical / Q000379:methods*; D004632:Emergency Medical Services / Q000592:standards*; D005246:Feedback; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012151:Resuscitation / Q000193:education / Q000592:standards*; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate