title: Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.
abstract: OBJECTIVE
  To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality.
  
  
  METHODS
  CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing.
  
  
  RESULTS
  A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p < 0.001), with the percentage of CC ≥ 51 mm increasing from 30.6% in P1 to 87.4% in P2 (p < 0.001). CC release velocity increased from 314 ± 25 mm/s in P1 to 442 ± 20 mm/s in P2 (p < 0.001). No significant differences were identified in CC fraction (84.3% P1 vs. 88.4% P2, p = 0.1), CC rate (125 ± 3 cpm P1 vs. 125 ± 3 cpm P2, p = 0.7), or pre-shock pause (9.7s P1 vs. 5.9s P2, p = 0.5), though CC fraction and pre-shock pause were within guideline recommendations.
  
  
  CONCLUSIONS
  Implementation of the bundle of scenario-based training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department.
authors.affiliation: Maricopa Medical Center, Department of Emergency Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008, United States. Electronic address: ck55crowe@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Crowe
authors.affiliation: Bureau of Emergency Medical Services and Trauma System, Arizona Department of Health Services, 150 N. 18th Ave., Suite 540, Phoenix, AZ 85007, United States; Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Bentley.Bobrow@azdhs.gov.
authors.forename: Bentley J
authors.initials: BJ
authors.lastname: Bobrow
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Vadeboncoeur.tyler@mayo.edu.
authors.forename: Tyler F
authors.initials: TF
authors.lastname: Vadeboncoeur
authors.affiliation: Maricopa Medical Center, Department of Emergency Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008, United States. Electronic address: cdameffmd@gmail.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Dameff
authors.affiliation: Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Ustolz@aemrc.arizona.edu.
authors.forename: Uwe
authors.initials: U
authors.lastname: Stolz
authors.affiliation: ZOLL Medical, 269 Mill Rd, Chelmsford, MA 01824, United States. Electronic address: Asilver@zoll.com.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Silver
authors.affiliation: Lutheran Medical Center, 8300 West 38th Avenue, Wheat Ridge, CO 80033, United States. Electronic address: jr_roosa@yahoo.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Roosa
authors.affiliation: Maricopa Medical Center, Department of Emergency Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008, United States. Electronic address: riannepage@gmail.com.
authors.forename: Rianne
authors.initials: R
authors.lastname: Page
authors.affiliation: Maricopa Medical Center, Department of Emergency Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008, United States. Electronic address: frank.lovecchio@bannerhealth.com.
authors.forename: Frank
authors.initials: F
authors.lastname: LoVecchio
authors.affiliation: Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Dan@aemrc.arizona.edu.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Spaite
mesh_terms: D000368:Aged; D001130:Arizona; D001296:Audiovisual Aids; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*; D013192:Staff Development / Q000379:methods*; D013647:Task Performance and Analysis
keywords: CPR; CPR feedback; CPR quality; Cardiac arrest; Emergency medicine; Resuscitation