Panel: CPR performance is progressing, but more needs to be done

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Dana Edelson, MD, and Vinay Nadkarni, MD

The results of the first-ever, multinational attitudinal survey concerning the performance of CPR by healthcare professionals showed that a mere 25 percent of healthcare professionals actually perform CPR in accordance with the American Heart Association (AHA) guidelines. Following the results' presentation, an expert panel discussed the ramifications of the survey, as well as potential solutions to improve the overall delivery of CPR.

The results were presented concurrently at the AHA 2009 Scientific Sessions. The panel of CPR experts included Robert O’Connor, MD, from the University of Virginia Medical Center; Dana Edelson, MD, from the University of Chicago Hospital; and Vinay Nadkarni, MD, from the University of Pennsylvania Hospital.

The survey of 1,023 respondents (454 U.S. healthcare professionals and 569 healthcare professionals from the U.K., France and Germany)—completed by the CPR Improvement Working Group—reported discrepancies between perceptions of CPR performance and statistics.

Following is part of the panelists' discussion, which included the current state of CPR, the discrepancies uncovered by the survey when it comes to perception and reality of how healthcare professionals perform CPR and ways to improve the quality of CPR performance through training, debriefings and feedback devices.

Q: Are we making progress when it comes to improving CPR performance among healthcare professionals?

Edelson: Over the past four years, we’ve implemented multiple programs in my institution to try to improve CPR quality. We’ve instituted instantaneous feedback, along with debriefing, and saw improvement in CPR quality. Now, CPR quality, in terms of compression depth and rate and ventilation rate, is significantly better. We get a pulse back in almost 60 percent of cases, which is a 50 percent improvement in pulse rate prior to implementing these programs.

Q: Can training result in chest compressions that are closer to the ideal rate?

Edelson: If you train people to deliver the proper rate of compressions, it can be done. Almost 100 percent of people deliver the proper depth post-training.

There were a couple of scientific papers that came out a few years ago that found EMS chest compressions were not being delivered about 50 percent of the time, even when they accounted for legitimate reasons to have the responder’s hands off of the chest. The assumption was that CPR performance is better in the hospital. However, in a mannequin simulation, when the providers tried to adhere to the guidelines, they spent more time off the chest than on the chest.

As important as CPR is to survival, defibrillation is also important because longer interruptions between CPR and defibrillation decrease survival rates. The good thing is that the survey showed that 93 percent of the respondents understood that the amount of hands-off time is something that should be minimized.

Q: Regarding the survey findings, is it the reality that a lot of centers are not using feedback? If so, what can you suggest for training?

O’Connor: I think you’re shedding light on the gap between perception and performance, which is a very common phenomenon. This is another example of where, when one has a tool to measure what one is doing, one becomes aware of the problem and now has the ability to change.

In my hospital, we have the same perception/reality gap phenomenon. When we first measured and used several measuring devices to track depth rate and interruptions of chest compressions, we thought we were doing a very good job.

However, we found that even people who did it well, had about a 77 percent compliance with guidelines. When they turned on the feedback and listened to the debriefings, the performance improved to 88 percent compliance. There is hope that we can improve, but it seems that we need some help to be able to figure out just how to comply with the guidelines.

Q: How do you handle debriefing and ongoing training with your team in the hospital?

Edelson: Resuscitation is surprisingly complicated. There are so many moving pieces, so many things that need to happen at the same time and quickly because somebody’s life depends on it.

We know for example with chest compressions, that if responders do CPR for a while and if you ask them at what point they got tired and the compression got shallow, they say about seven minutes into the simulation. However, we can tell – in terms of their actual