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Day 2: Rod Little Prize Hall 1 14:00-15:30
013 Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland
  1. S Clarke1,
  2. R M Lyon2,
  3. D J Milligan3,
  4. G R Clegg2,4
  1. 1Medical School, The University of Edinburgh, Edinburgh, Scotland, UK
  2. 2Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
  3. 3National Headquarters, The Scottish Ambulance Service, Edinburgh, Scotland, UK
  4. 4Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK

Abstract

Objectives and Backgrounds Out-of-hospital cardiac arrest is a leading cause of mortality and neurological morbidity in the UK. Cardiopulmonary resuscitation is vital to maintaining cerebral and cardiac perfusion until return of spontaneous circulation. Recent studies have demonstrated the adverse physiological consequences of poor resuscitation technique and that quality of Cardiopulmonary resuscitation is a critical determinant of outcome. Analysis of the defibrillator transthoracic impedance (TTI) trace gives an objective measure of pre-hospital resuscitation quality. This study aims to analyse the impact of targeted resuscitation feedback and training on quality of pre-hospital resuscitation.

Methods Single centre, prospective cohort study over 13 months (1st December 2009–31st December 2010). Modems were fitted to the defibrillators on vehicles from Edinburgh City ambulance station (n=40). Resuscitation events were collected by telemetry and analysed. Outcome measures were: resuscitation time spent performing chest compressions, compression rate, hands-off time required to deliver a shock and use of automatic or manual defibrillator mode. Baseline data were gathered over a 3-month period. Monthly resuscitation classes and personalised written feedback following each resuscitation attempt were then introduced for 6 months. Resuscitation quality was again measured and compared to baseline data.

Results Analysis of 111 downloads showed hands-on-chest time improved significantly following feedback and targeted resuscitation training (73.0% vs 79.3%, p=0.007). Compression rate was unchanged (Abstract 013 figures 1 and 2). There was a significant reduction in median time-to-shock interval from 20.25 s (IQR 15.50–25.50 s) to 13.45 s (IQR 2.25–22.00 s) (p=0.006). Use of automatic rhythm recognition fell from 50% to 28.6% (p=0.03).

Abstract 013 Figure 1

Frequency histogram showing the distribution of compression rates around the “ideal” 90–110/min (2005 Guidelines: shaded area) during the baseline data collection period.

Abstract 013 Figure 2

Frequency histogram showing the distribution of compression rates around the “ideal” 90–110/min (2005 Guidelines: shaded area) following implementation of feedback and resuscitation training.

Conclusions TTI trace analysis following Out-of-hospital cardiac arrest allows objective evaluation of resuscitation quality. Targeted training and feedback improves the quality of pre-hospital resuscitation. Further studies are required to establish improvement in survival as a result of this approach.

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