Background: Minimizing pulse check times and maximizing compression ratio is arguably the only intervention other than defibrillation shown to improve outcomes in cardiac arrest. Major guidelines on resuscitation following cardiopulmonary arrest emphasize that chest compression fraction is a predictor of return of spontaneous circulation as well as survival to hospital admission. The objective of our study is to analyze the efficacy of a quality video review-based educational intervention in minimizing pulse check times and maximizing compression ratio for all out-of-hospital cardiac arrests at George Washington University Hospital.
Methods: Cardiac arrest resuscitations are recorded in real time via in-ceiling cameras in multiple critical care bays. Resuscitation videos are reviewed separately by two emergency medicine residents and pulse check times and compression ratio are measured. Through grand rounds presentations as well as individualized email feedback, individuals who participated in the resuscitation, as well as the entire department, receive qualitative and qualitative feedback on the resuscitations. This educational intervention was continuously implemented between December 2017 and October 2018. Spearman’s Correlation Coefficient, ρ, was analyzed to show the relationship between date, percentage compression time, and pulse check time.
Results: cases met inclusion criteria and had full data record for this pilot study. Inter-rater reliability among video reviewers was sufficiently concordant (ρ=0.9664, p-value<.0001). Over the course of our study, there was a statistically significant positive correlation between more recent dates and percent compression time (ρ=0.4277, p-value<.0001) and a statistically significant negative correlation between more recent dates and pulse check time (ρ= -0.7871, p-value<.0001).
Conclusion: Analysis of resuscitation videos has improved cardiopulmonary resuscitation in our emergency department. There was a statistically significant reduction of pulse check times after staff received individualized feedback as well as video-review lectures. Other emergency departments can also improve their cardiopulmonary resuscitation care in a meaningful way over the course of one year through video review and email feedback.