title: Introduction of performance coaching during cardiopulmonary resuscitation improves compression depth and time to defibrillation in out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Quality cardiopulmonary resuscitation (CPR) and timely defibrillation are associated with increasing survival to hospital discharge from out-of-hospital cardiac arrest (OHCA). The objective of this study was to demonstrate that performance coaching during an OHCA would improve compression depth and time to defibrillation (TTD).
  
  
  METHODS
  This study was conducted in a single emergency medical services (EMS) agency and utilized data collected from 815 patients treated between 1/1/2012 and 12/31/2013. The intervention used multiple Plan-Do-Study-Act (PDSA) cycles to train fire captains to translate performance data into active direction. Testing began in simulation with small-scale expansions prior to system-wide implementation. Performance metrics included average (reported as a percentage) and actual compression depth (reported in millimeters), and TTD (an average in seconds). Analysis was conducted using Xbar and S control charts with standard assessment of special cause for performance data. A statistical shift was seen in means and standard deviations for both depth metrics.
  
  
  RESULTS
  Average depth of compressions improved from 69.8% (SD=28.0%) to 80.4 (SD=21.8%). Depth of compressions delivered increased from 43.6mm (SD=8.2mm) to 47.2mm (SD=8.1mm). Analysis of the S charts indicates a statistical shift in process variation for TTD.
  
  
  CONCLUSIONS
  Early results indicate that utilization of a CPR coach during OHCA improves compression depth and TTD. Further data are needed to assess sustainability.
authors.affiliation: Mecklenburg EMS Agency, Charlotte, NC, United States.
authors.forename: Allison E
authors.initials: AE
authors.lastname: Infinger
authors.affiliation: Mecklenburg EMS Agency, Charlotte, NC, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Vandeventer
authors.affiliation: Mecklenburg EMS Agency, Charlotte, NC, United States. Electronic address: jonst@medic911.com.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Studnek
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004554:Electric Countershock / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011312:Pressure; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cardio-pulmonary resuscitation; Emergency medical service; Out-of-hospital cardiac arrests; Quality improvements