Award Candidate Poster Presentation
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.
Catherine Allan, MD
Associate Program Director - Simulator Program
Boston Children's Hospital