AUTHORS: Ortega, H; Mignogna, D; Paik, S; Aden, J. K.; Remy, L; Trevino, R; Matos, RI
BACKGROUND: Factors associated with high-quality cardiopulmonary resuscitation (CPR) should be explored when CPR quality remains the primary factor influencing return of spontaneous circulation and survival in cardiac arrest patients. Previous studies in the out of hospital setting have found older age and lack of fitness to be associated with reduced CPR quality
OBJECTIVE: We sought to evaluate factors influencing CPR performance in the in-hospital setting among non-intensive care nursing staff at a single institution to guide further educational interventions.
METHODS: 385 medical/surgical inpatient and outpatient nursing staff (RN, EMT, LVN, CNA) at a military treatment facility performed 2 minutes of CPR during semiannual high-stakes nursing skills validation, after which a partner operated the defibrillator, and then compressors switched for an addition 2 minutes of CPR. Real-time audiovisual CPR feedback was available from the defibrillators to the compressors. CPR quality metrics were extracted from Zoll R-series defibrillators using CodeNet, and a post-hoc analysis was performed on participant demographics: gender, BLS expiration date, and years in healthcare using Pearson Chi-Squared and Cochran Armitage trend tests.
RESULTS: 223 (57.9%) RNs, 77 (20%) EMTs, 63 (16.4%) LVNs, and 22 (5.7%) CNAs participated with a median depth and rate in guidelines target (rate 100-120 min-1 and depth > 2 inches) of 62.9% [IQR 38%, 81%]. Of the participants, 269 (69.9%) were female and median BLS training occurred within 11 months [IQR 6, 18]. 135 (35.1%) had < 5 years of experience, 161 (41.8%) had 5-20 years, and 87 (22.6%) had >20 years. While there was no difference between gender (p=0.6), staff role (p=0.3), or recency of BLS training (p=0.49), CPR quality in staff with more than 20 years of nursing experience was lower than staff with < 5 years of experience (43% vs. 61%, p=0.0335).
CONCLUSION: This study identified that while level of training and recency of CPR training was not a factor in CPR quality performance, length of experience in the field was negatively associated with CPR quality in this setting. Further studies are needed to explore why length of experience would negatively impact CPR quality and what aspects of CPR quality are most affected as this could guide code team roles and additional training initiatives.
DISCLOSURE: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, or the Department of Defense or the U.S. Government.