Journal
CRITICAL CARE MEDICINE
Volume 43, Issue 11, Pages 2321-2331Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000001202
Keywords
cardiac arrest; cardiopulmonary resuscitation; debriefing; feedback; guideline adherence; quality improvement
Categories
Funding
- National Institute for Health Research (NIHR) under the Research for Patient Benefit programme [PB-PG-1207-14246]
- Resuscitation Council (UK) Research Fellowship
- C.R. Bard
- National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI)
- Phillips Healthcare
- Stryker medical
- Doris Duke foundation
- Intensive Care Foundation
- NIHR
- National Institute for Health Research [CL-2011-09-001, PB-PG-1207-14246] Funding Source: researchfish
- National Institutes of Health Research (NIHR) [PB-PG-1207-14246] Funding Source: National Institutes of Health Research (NIHR)
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Objective: To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest. Design: A two-phase, multicentre prospective cohort study. Setting: Three UK hospitals, all part of one National Health Service Acute Trust. Patients: One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013. Interventions: During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2. Measurements and Main Results: The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31-1.22; p = 0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35-1.21; p = 0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06-3.30; p = 0.03) and process-focused outcomes. Conclusions: Implementation of real-time audiovisual feedback with or without postevent debriefing did not lead to a measured improvement in patient or process-focused outcomes at individual hospital sites. However, there was an unexplained system-wide improvement in return of spontaneous circulation and process-focused outcomes during the second phase of the study.
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