Free accessResearch articleFirst published online 2015-1
Evaluation of the Effect of a Clinical Pathway on the Quality of Simulated Pre-Hospital Cardiopulmonary Resuscitation: Primary Experience from a Chinese Pre-Hospital Care Centre
The aim of this study was to assess the quality of simulated cardiopulmonary resuscitation (CPR) in local pre-hospital care teams and the improvement achieved by using clinical pathways.
Methods
A prospective observation study. The 2010 American Heart Association Guidelines for CPR, the personnel characteristics of ambulance staff, China's legal system requirements, and the available medical resources were used to design a clinical pathway for pre-hospital care of cardiac arrest. Case simulations were used to evaluate the quality of CPR before and after implementation of the clinical pathway.
Results
The number of teams which successfully implemented electrocardiogram monitoring, endotracheal intubation and intravenous access before training were 8 (17.8%), 5 (11.1%) and 6 (13.3%) respectively. These increased to 45 (100%), 43 (95.6%) and 43 (95.6%), respectively, after training. The number of teams with successful implementation of artificial ventilation, airway management and insertion of oropharyngeal airway before training were 43 (95.6%), 38 (84.4%) and 12 (26.7%) respectively. These increased to 45 (100%), 42 (93.3%) and 43 (95.6%), respectively, after training. Nine (20%) teams decided CPR onsite before training and 35 (77.8%) after training. The average rate of chest compressions before and after training was 120.3 ± 17.9 and 123.2 ± 17.1 compressions per minute, respectively (p>0.05).
Conclusion
Training using established clinical pathway significantly improves the quality of CPR and increases the use of ALS techniques. CPR training requires ongoing validation and optimisation to maintain effectiveness. (Hong Kong j.emerg.med. 2015;22:14-22)
NicholG., ThomasE., CallawayC.W., HedgesJ., PowellJ.L., AufderheideT.P.Regional variation in out-of-hospital cardiac arrest incidence and outcome.JAMA2008; 300(12): 1423–31.
2.
McNallyB., RobbR., MehtaM., ValderramaA.L., YoonP.W., SassonC.Out-of-hospital cardiac arrest surveillance - Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005-December 31, 2010.MMWR Surveill Summ2011; 60(8): 1–19.
3.
IwamiT., HiraideA., NakanishiN., HayashiY., NishiuchiT., UejimaT.Outcome and characteristics of out-of-hospital cardiac arrest according to location of arrest: A report from a large-scale, population-based study in Osaka, Japan.Resuscitation2006; 69(2): 221–8.
4.
HayashiY., HiraideA., MoritaH., ShinyaH., NishiuchiT., YukiokaH.Three year longitudinal study for out-of-hospital cardiac arrest in Osaka Prefecture.Resuscitation2004; 63(2): 161–6.
5.
RogerV.L., GoA.S., Lloyd-JonesD.M., AdamsR.J., BerryJ.D., BrownT.M.Heart disease and stroke statistics - 2011 update: a report from the American Heart Association.Circulation2011; 123(4): e18–e209.
6.
ValenzuelaT.D., KernK.B., ClarkL.L., BergR.A., BergM.D., BergD.D.Interruptions of chest compressions during emergency medical systems resuscitation.Circulation2005; 112(9): 1259–65.
7.
PerkinsG.D., BoyleW., BridgestockH., DaviesS., OliverZ., BradburnS.Quality of CPR during advanced resuscitation training.Resuscitation2008; 77(1): 69–74.
8.
HuntE.A., VeraK., Diener-WestM., HaggertyJ.A., NelsonK.L., ShaffnerD.H.Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests.Resuscitation2009; 80(7): 819–25.
9.
EftestolT., SundeK., SteenP.A.Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest.Circulation2002; 105(19): 2270–3.
10.
WikL., Kramer-JohansenJ., MyklebustH., SørebøH., SvenssonL., FellowsB.Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.JAMA2005; 293(3): 299–304.
11.
AbellaB.S., AlvaradoJ.P., MyklebustH., EdelsonD.P., BarryA., O'HearnN.Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.JAMA2005; 293(3): 305–10.
12.
ThomasE.J., TaggartB., CrandellS., LaskyR.E., WilliamsA.L., LoveL.J.Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial.J Perinatol2007; 27(7): 409–14.
13.
EdelsonD.P., LitzingerB., AroraV., WalshD., KimS., LauderdaleD.S.Improving in-hospital cardiac arrest process and outcomes with performance debriefing.Arch Intern Med2008; 168(10): 1063–9.
14.
AndersenP.O., JensenM.K., LippertA., OstergaardD., KlausenT.W.Development of a formative assessment tool for measurement of performance in multiprofessional resuscitation teams.Resuscitation2010; 81(6): 703–11.
15.
HunzikerS., TschanF., SemmerN.K., ZobristR., SpychigerM., BreuerM.Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial.BMC Emerg Med2009; 9: 3.
16.
ThomasE.J., SextonJ.B., LaskyR.E., HelmreichR.L., CrandellD.S., TysonJ.Teamwork and quality during neonatal care in the delivery room.J Perinatol2006; 26(3): 163–9.
17.
Chinese doctors are under threat.Lancet2010; 376(9742): 657.
18.
YuD., LiT.Doctor stabbed to death two days after warning in The Lancet.Lancet2011; 377(9766): 639.
19.
KimJ.A., VogelD., GuimondG., HostlerD., WangH.E., MenegazziJ.J.A randomized, controlled comparison of cardiopulmonary resuscitation performed on the floor and on a moving ambulance stretcher.Prehosp Emerg Care2006; 10(1): 68–70.
20.
OdegaardS., OlasveengenT., SteenP.A., Kramer-JohansenJ.The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest.Resuscitation2009; 80(8): 843–8.
21.
KrarupN.H., TerkelsenC.J., JohnsenS.P., ClemmensenP., OlivecronaG.K., HansenT.M.Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions - a nationwide prospective feasibility study.Resuscitation2011; 82(3): 263–9.
22.
PearsonS.D., Goulart-FisherD., LeeT.H.Critical pathways as a strategy for improving care: problems and potential.Ann Intern Med1995; 123(12): 941–8.
23.
EveryN.R., HochmanJ., BeckerR., KopeckyS., CannonC.P.Critical pathways: a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association.Circulation2000; 101(4): 461–5.
24.
LemmensL., vanZ.R., VanhaechtK., KerkkampH.Systematic review: indicators to evaluate effectiveness of clinical pathways for gastrointestinal surgery.J Eval Clin Pract2008; 14(5): 880–7.
25.
SaintS., HoferT.P., RoseJ.S., KaufmanS.R., McMahonL.F.JrUse of critical pathways to improve efficiency: a cautionary tale.Am J Manag Care2003; 9(11): 758–65.
26.
WayneD.B., McGaghieW.C.Use of simulation-based medical education to improve patient care quality.Resuscitation2010; 81(11): 1455–6.
27.
RudolphJ.W., SimonR., DufresneR.L., RaemerD.B.There's no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment.Simul Healthc2006; 1(1): 49–55.
28.
OlasveengenT.M., WikL., Kramer-JohansenJ., SundeK., PytteM., SteenP.A.Is CPR quality improving? A retrospective study of out-of-hospital cardiac arrest.Resuscitation2007; 75(2): 260–6.
29.
LeongB.S., ChuaG.S.Quality of resuscitation in hospitals.Singapore Med J2011; 52(8): 616–9.
30.
StoneC.K., ThomasS.H.Can correct closed-chest compressions be performed during prehospital transport.Prehosp Disaster Med1995; 10(2): 121–3.
31.
SundeK., WikL., SteenP.A.Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model.Resuscitation1997; 34(3): 235–42.
32.
OlasveengenT.M., WikL., SteenP.A.Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest.Resuscitation2008; 76(2): 185–90.
33.
NolanJ.P., SoarJ., ZidemanD.A., BiarentD., BossaertL.L., DeakinC.European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.Resuscitation2010; 81(10): 1219–76.
34.
JiangC., ZhaoY., ChenZ., ChenS., YangX.Improving cardiopulmonary resuscitation in the emergency department by real-time video recording and regular feedback learning.Resuscitation2010; 81(12): 1664–9.
35.
BruckeM., HelmM., SchwartzA., LamplL.Two rescuer resuscitation-mission impossible? A pilot study using a manikin setting.Resuscitation2007; 74(2): 317–24.
36.
Fernandez CastelaoE., RussoS.G., CremerS., StrackM., KaminskiL., EichC.Positive impact of crisis resource management training on no-flow time and team member verbalisation s durin g simulated cardiopulmonary resuscitation: a randomised controlled trial.Resuscitation2011; 82(10): 1338–43.
37.
OlasveengenT.M., Lund-KordahlI., SteenP.A., SundeK.Out-of hospital advanced life support with or without a physician: effects on quality of CPR and outcome.Resuscitation2009; 80(11): 1248–52.
38.
KirvesH., SkrifvarsM.B., VahakuopusM., EkstromK., MartikainenM., CastrenM.Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients.Eur J Emerg Med2007; 14(2): 75–81.
39.
StiellI.G., NicholG., LerouxB.G., ReaT.D., OrnatoJ.P., PowellJ.Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest.N Engl J Med2011; 365(9): 787–97.
40.
DeakinC.D., NolanJ.P., SoarJ., SundeK., KosterR.W., SmithG.B.European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support.Resuscitation2010; 81(10): 1305–52.
