Award Candidate Poster Presentation

Poster

Closing the Gap: Optimizing Performance to Reduce Interruptions in CPR

Tuesday, May 15
09:45 - 10:45
Location: Saturn 1&2

Background: : Performance during CPR is associated with survival. An important measure of high performance is the minimization of interruptions in chest compressions(1,2). The American Heart Association recommends avoiding long pauses and targeting a chest compression fraction > 80%(3). The nature of interruptions and how they manifest during dynamic and stressful events is complex and not sufficiently understood; literature is limited(4).

Research Question: : We hypothesize that interruption times are excessively long and negatively impact CCF.

Methodology: : We conducted a retrospective study using video review of a convenience sample of in-situ simulated cardiopulmonary arrests taking place in the Johns Hopkins Children’s Center between September 2013 and June 2017. These simulations were clinically realistic in terms of environment, team composition, and patient traits.

We developed and used a framework to characterize interruptions by timing, duration, frequency, cause, and whether its initiation was autonomous (by the compressor), directed by someone in the room, or protocol-driven. We defined two previously unreported variables: ITE as the difference between actual duration and the guideline-indicated duration for an interruption of that cause, and CCFP as the chest compression fraction with ITE excluded from each individual interruption.

We measured each interruption’s start and stop time and classified its cause, (e.g. for intubation), and initiation. From these data we generated an excess interruption duration value for each observation. Descriptive statistics were generated for interruption-level and event-level variables including, ITE, CCF, and CCFP. Differences between median CCF and CCFP were assessed using Wilcoxon rank sum, and comparisons before and after the first five minutes of proportion of interruptions by initiation were assessed using the X2 test statistic.

Results: : 766 interruptions occurred over 22 events. Event duration was 463s (398-553), with 34.8 interruptions per event. Interruption duration was 3s (2-4) and IET duration was 1s (0-2). CCF was 75.97% (67.71-80.73) and CCFP was 83.38% (80.35-87.35).
Comparing CCF to CCFP found an absolute percent difference of 7.4% (CCF:75.97% vs. CCFp: 83.38%; p< 0.001). A significant difference proportion of interruption by initiation category in the first 5 minutes was discovered (Directed:80.0% vs, Autonomous: 50.7%; p=0.004).

Discussion/Conclusions: : This study lays the groundwork for studying inefficiency during CPR associated with chest compression interruptions. We created a framework for more fully characterizing the multidimensional nature of these interruptions. These findings indicate that significant interruption time is avoidable. This negatively impacts CCF, an important surrogate for perfusion. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.





Sara I. Jones, BA, EMT-B*

Medical Student
Johns Hopkins University School of Medicine

Sara Jones, BA, is a second year medical student at the Johns Hopkins University School of Medicine. Certified as an EMT for 6 years, she has a longstanding interest in resuscitation. In her first year of medical school, she was exposed to simulation as a tool to answer complex research questions in this area. Since then, she has enjoyed her initial foray into simulation research alongside the guidance of the Johns Hopkins Medicine Simulation Center team. She looks forward to continuing working alongside such accomplished mentors on simulation studies that can help elucidate ways to improve post-cardiac arrest outcomes.

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Elizabeth Hunt, MD, MPH, PhD

Associate Professor
Johns Hopkins University School of Medicine

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Andrew Stella, MS, MA

Multimedia Manager
Johns Hopkins Medicine Simulation Center

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Jordan Duval-Arnould, MPH, DrPH

Assistant Professor
Johns Hopkins University School of Medicine

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Catherine Allan, MD

Associate Program Director - Simulator Program
Boston Children's Hospital
Boston, Massachusetts

Catherine Allan, MD is the Associate Program Director of the Simulator Program and Medical Director of the Cardiac Intensive Care Unit at Boston Children’s Hospital. Over the last 10 years she has helped to develop a robust, interdisciplinary program in ECMO Simulation at Boston Children’s Hospital. Dr. Allan has translated this model to other insitutions on both a National and International level to help these programs build new clinical ECMO Programs. She has published on the use of ECMO Simulation Skills Training and on clinical outcomes following ECMO support in the congenital heart disease population and has presented on ECMO simulation at multiple National and International Meetings.

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