PURPOSE: 2005 AHA ACLS guidelines emphasize that adequate chest compressions are a key component to CPR. We investigated whether code team performance in this area could be improved using SBT with CPS.
METHODS: Study site was an urban hospital that has 120 medicine residents. From July 2005 through April 2006, every four weeks, code teams were trained using SBT with CPS. Each team consisted of 8 medicine residents, four of whom were interns assigned to perform chest compressions. The first seven teams used standard defibrillator paddles and received no specific task orientated training to improve chest compressions; we assumed that interns would have good technique. The last four teams employed transcutaneous pacing/defibrillating pads, which permit hands off defibrillation as they are wired directly to the defibrillator, instead of paddles. They also received intensive task orientated training on chest compressions. Each group was taken through 2 standardized CPR scenarios. The digital video record allowed us to measure the total duration of chest compressions, as well as their interruption for defibrillation and pulse check.
RESULTS: The standard education/paddle (SEP) groups performed chest compressions for 59% of total arrest time (131/207 seconds). The intensive education/ pacing pads (IEP) groups performed chest compressions for 77.5% of total arrest time (200/257 seconds) (p=0.008). The SEP group averaged 13 seconds of interrupted chest compressions during defibrillation sequence versus 6.5 seconds in the IEP group (p=0.06). There were no differences between the two groups in the amount of time chest compressions were halted to check for a pulse.
CONCLUSION: The use of transcutaneous pads for defibrillation combined with intensive task orientated training of interns in chest compression technique resulted in improvement in a critical component of CPR.
CLINICAL IMPLICATIONS: Adequate chest compressions are critical to improve patient outcome following a cardiac arrest. Our results indicate that SBT may be used to improve code team performance. They also suggest that task orientated training before SBT with CPS is effective and that the process allows improvement of equipment design.
DISCLOSURE: Crescens Pellecchia, None.