CPR performance does not follow guidelines

New research indicates that CPR performed outside the hospital and in the hospital often does not meet or adhere to standard guidelines, according to 2 studies in the January 19 issue of JAMA.

The importance of CPR (cardiopulmonary resuscitation) for survival of cardiac arrest patients has been demonstrated, according to background information in the article. There are indications that the quality of CPR performance influences the outcome. When tested on mannequins, CPR quality performed by lay rescuers and health care professionals tends to deteriorate significantly within a few months after training, but little is known about the quality of actual clinical performance of CPR on patients.

CPR guidelines recommend target values for chest compressions, ventilations, and CPR-free intervals allowed for rhythm analysis and defibrillation. There is little information on adherence to these guidelines during advanced cardiac life support during out-of-hospital cardiac arrest.

In the first study, Lars Wik, M.D., Ph.D., of Ulleval University Hospital, Oslo, Norway and colleagues examined the performance of paramedics and nurse anesthetists during out-of-hospital advanced cardiac life support (ACLS) by continuously monitoring all chest compressions and ventilations during resuscitation episodes using online defibrillators. The study included 176 adult patients with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden, London, and Akershus, Norway, between March 2002 and October 2003. The defibrillators were modified to measure chest compressions and ventilations, in addition to standard event and electrocardiographic recordings.

The primary outcome measure was adherence to international guidelines for CPR. Target values for compression rate were 100 to 120/min; for depth, 38 to 52 mm; and for ventilation rate, 2 ventilations for every 15 compressions before intubation and 10/min to 12/min after intub

Contact: Lars Wik, M.D., Ph.D.
JAMA and Archives Journals

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