ReviewUniform reporting of measured quality of cardiopulmonary resuscitation (CPR)☆
Introduction
The importance of CPR during resuscitation from cardiac arrest has been highlighted by a number of recent clinical investigations.1, 2, 3 Additional work has shown that poor quality CPR is common during both in-hospital and out-of-hospital resuscitation4, 5, 6, 7, 8, 9 and suboptimal quality of CPR is associated with worse outcomes in both animals10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 and humans.4, 7, 8, 24
In the 2005 revision of international resuscitation consensus guidelines, CPR quality was emphasised and both the monitoring and collection of CPR quality variables was broadly recommended without specifying how these goals should be satisfied. 25, 26, 27
While the Utstein templates for cardiac arrest reporting have facilitated comparisons of many aspects of resuscitation care, they have not included aspects of CPR quality.28, 29, 30 Currently, the measurement and reporting of CPR quality data are not standardised, significantly limiting the potential scope of benefit. Recording of CPR quality would be useful to all emergency care providers as part of quality improvement systems, and failure to confirm the clinical benefits of encouraging trials during resuscitation in animals highlights the need for standardised reports of CPR quality as a possible confounding factor.
The capability to measure CPR quality is being incorporated into defibrillators and stand-alone devices from different manufacturers and for a variety of users. It is therefore important to develop consensus on how best to collect and report these data in a fashion that is both standardised and independent of specific measurement tools. In this paper we review data on CPR quality and propose practical guidelines for its reporting. Furthermore, we advocate widespread collection and reporting of such data, including core data that should be included in resuscitation research reports, as an addition to the presently available Utstein guidelines.29, 30 Finally, we discuss the current possibilities for studies on aspects of the quality of CPR itself.
Section snippets
Methods
This paper is the result of an international collaborative research meeting on the quality of CPR held in Stavanger, Norway in May 2006 with participants from three research groups that have studied CPR quality in both in-hospital and out-of-hospital settings using a variety of measurement tools. In addition, all participants have experience from laboratory investigations of CPR quality with animal models of cardiac arrest.
Each co-author reviewed the current literature and drafted a section of
Compression depth
Chest compression depth is one of the more challenging CPR variables to measure and modify since it cannot be extrapolated from motion artifact on the ECG or modified with a simple timer or metronome. Our research groups have found that shallow chest compressions are common during actual cardiac arrests in both the in-hospital and out-of-hospital settings.5, 6 While deeper chest compressions have been shown to correlate with increased cardiac output in both canine and porcine models of cardiac
Discussion
Our international collaborative group has presented recommendations for uniform reporting of CPR quality based on our research experiences, recent technological advances, and international guidelines. This is the first attempt to standardise reporting of CPR quality and extends previous efforts to establish a common nomenclature in clinical CPR research.28, 29, 30
The main purposes of quality reporting fall into three categories and we have elaborated recommendations for each. For the purpose of
Conclusion
Based on our collective research experiences and a consensus-building process, this international collaborative group has presented a rationale for measuring and reporting quality of CPR. This paper represents a first effort to make reporting of CPR quality more uniform. The main purposes are to aid debriefing and quality improvement as well as to facilitate valid comparisons in future clinical trials. We have proposed generic definitions of different aspects of CPR quality and have discussed
Conflict of interest
All authors have received funding and technical support for studies of CPR quality from Laerdal Medical, Stavanger, Norway and Philips Medical Systems, Andover, MA, USA. Drs. Edelson and Abella have received honoraria from Laerdal Medical and Philips Medical Systems, and Dr. Abella has received honoraria from Zoll Medical Corporation Chelmsford, MA, USA. Philips Medical Systems and Zoll Medical Corporation markets defibrillators capable of both recording of, and feedback on, CPR quality.
Acknowledgments
The authors wish to thank their colleagues who have shared their experience in CPR quality evaluation and provided valuable comments in the writing and editing process; Petter Andreas Steen and Lars Wik (Oslo), Fritz Sterz (Vienna), Terry Vanden Hoek (Chicago), and Lance Becker (Philadelphia). The organisational efforts of Helge Myklebust (Research and Development, Laerdal Medical, Stavanger, Norway) are appreciated. We also thank Salem Kim and Barbara Litzinger for assistance with manuscript
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.01.024.