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Poor Adherence to CPR Guidelines in Out-of-Hospital Cardiac Arrest
Providers certified in advanced cardiovascular life support frequently failed to give chest compressions appropriately.
Cardiopulmonary resuscitation (CPR) guidelines are derived from animal and human studies. These authors assessed adherence to the 2000 International Guidelines by paramedics and nurse anesthetists who administered CPR to patients with out-of-hospital cardiac arrest between March 2002 and October 2003 in three western European cities.
CPR providers were certified in advanced cardiovascular life support and had taken a refresher course immediately before the study started; all providers were aware of the study. The depth and frequency of chest compressions (CCs) were measured by an electronic sternal pad, and ventilatory frequency was measured by changes in thoracic impedance. During 176 resuscitation episodes, CC was not given 38% of the time when indicated. CCs were delivered at a mean frequency of 121/minute (recommended rate, 100/minute) and at a mean depth of 34 mm; only 28% of CCs obtained the recommended depth (38-51 mm). The mean ventilatory rate was 11/minute (recommended rate, 12-16/minute).
Comment: Chest compressions are considered the most important component of CPR. These providers had just completed a refresher course and were aware that their performance was being assessed; yet they failed to give CCs nearly 40% of the time when indicated, and the depth of CCs did not meet standards more than 70% of the time. Automated devices that provide real-time audio feedback might enhance CPR performance.
— John A. Marx, MD, FACEP
Published in Journal Watch Emergency Medicine March 2, 2005
Citation(s):
Wik L et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005 Jan 19; 293:299-304.
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