Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department.
OBJECTIVE
Determine if implementing cardiac arrest teams trained with a 'pit-crew' protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation.


METHODS
A phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.


RESULTS
After implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10-0.19, p<0.005), and from 0.24 to 0.18 (decrease=0.06, 95% CI 0.01-0.11, p=0.02) for the next 5min. The mean time taken to apply Autopulse™ decreased from 208.8s to 141.6s (decrease=67.2, 95% CI, 22.3-112.1, p<0.005). The mean CPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9-46.9, p<0.005) and the mean total NFR for the first 10min decreased from 0.33 to 0.23 (decrease=0.10, 95% CI 0.07-0.14, p<0.005).


CONCLUSIONS
Implementation of cardiac arrest teams was associated with a reduction in NFR in the first 10min of resuscitation. Training cardiac arrest teams in a 'pit-crew' protocol may improve the quality of CPR at the ED.
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. marcus.ong.e.h@sgh.com.sg
Marcus Eng Hock
ME
Ong
Joy Li Juan
JL
Quah
Annitha
A
Annathurai
Noorkiah Mohamed
NM
Noor
Zhi Xiong
ZX
Koh
Kenneth Boon Kiat
KB
Tan
Sohil
S
Pothiawala
Ah Ho
AH
Poh
Chye Khiaw
CK
Loy
Stephanie
S
Fook-Chong
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000295:instrumentation*; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012984:Software