Katie McDermott, APRN, BSN, MSN, RN
Critical Care Pediatric Nurse Practitioner
Childrens Hospital of Wisconsin
Milwaukee, Wisconsin
Disclosure information not submitted.
Kari Rajzer- Wakeham, MSN, , CCRN
Pediatric Nurse Practioner-Critical Care
Medical College of Wisconsin, United States
Disclosure information not submitted.
Jennifer Andres, MBA, BSN, RN
Quality and Outcomes Manager
Children's Wisconsin
Milwaukee, Wisconsin, United States
Disclosure information not submitted.
Christine Schindler, PhD, CPNP
APP Director, Pediatric Critical Care
n/a
Muskego, Wisconsin
Disclosure information not submitted.
Title: A Good Coach Can Change a Game, A Great Coach Can Change a Life: Impact of Quality CPR Coaching
Introduction: Use of a feedback device (i.e. ZollTM) and a quality cardiopulmonary resuscitation (qCPR) coach are associated with improved compliance to the American Heart Association (AHA) CPR metrics in simulated arrests. The qCPR Coach is a supplementary resuscitation team member who provides real-time, verbal feedback of chest compression performance directly to the chest compressors during cardiac arrest.
Methods: A qCPR Coach training curriculum was implemented using Rapid Cycle Deliberate Practice simulation method focused on rapid acquisition of skills to improve performance in low-volume, high-risk events. Curriculum was evaluated based on three outcome measures: (1) frequency of qCPR coach presence; (2) application of ZollTM pads; and (3) quality of CPR delivery via internal and external patient metrics in real code events. Patient data from in-unit arrests were collected via retrospective review. Internal metrics included arterial diastolic blood pressure (aDBP) and end-tidal carbon dioxide (ETCO2) and external metrics included chest compression rate, depth, and chest compression fraction (CCF). Inclusion criteria were any in-unit arrest longer than one minute that occurred either one year pre- or one year post-intervention. Data metrics were analyzed using descriptive statistics and compared pre- and post-intervention.
Results: Data from a total of 54 arrests were analyzed, with 29 pre- and 25 post-intervention arrests. Presence of a qCPR Coach had statistical significance (p=0.02) with increased frequency from 48.3% pre- to 80.0% post-intervention. Remaining variable frequencies: ZollTM pad application unchanged 62.1% to 60.0%; CCF >60% increased 88.9% to 93.3%; CCF >80% increased 61.1% to 66.7%; ETCO2 >15mmHg increased 52.9% to 65.0%; and aDBP >goal increased 40.0% to 62.5% pre- and post-intervention respectively.
Conclusions: Though not statistically significant, the outcomes were clinically significant in that the frequencies of AHA compliant CPR improved. This suggests a larger sample size may be needed to reach statistical significance. This work reinforces previously published reports that qCPR Coach presence on code teams is associated with both enhanced compliance to and measurable improvements of AHA CPR metrics, which are associated with improved survival outcomes.