The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.
BACKGROUND
Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest.


METHODS
The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors.


METHODS
All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites.


CONCLUSIONS
This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing.


BACKGROUND
ISRCTN56583860.
Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS, UK. g.d.perkins@warwick.ac.uk
Gavin D
GD
Perkins
Robin P
RP
Davies
Sarah
S
Quinton
Sarah
S
Woolley
Fang
F
Gao
Ben
B
Abella
Nigel
N
Stallard
Matthew W
MW
Cooke
D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D016009:Chi-Square Distribution; D004638:Emergency Treatment / Q000592:standards*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D058996:Quality Improvement; D012107:Research Design; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom