Week 2 of the Coursera course, Course Review: Cardiac Arrest, Hypothermia, and Resuscitation Science Week 1 #MOOC, focused on CPR. With frequent references to clinical research and AHA guidelines Dr. Abella discussed that CPR quality is the key variable to survival with lay and professional rescuers.
Lay Person CPR Training
Little is known about the number of lay people training in CPR, where they live, and their willingness to provide CPR. Although millions of people attend CPR every year many of those people are healthcare professionals fulfilling a training requirement. High quality CPR from a bystander is associated with increased survival.
Minimize Interruption of Compressions
Dr. Abella had a great visual of patient blood pressure during continuous compressions and interrupted compressions. When chest compressions are stopped it takes several compressions to return the blood pressure to adequate level for perfusion.
Healthcare Provider CPR
As many of us know from our own anecdotal observations there is wide variability in the quality of CPR provided by our EMS and emergency department colleagues. Dr. Abella affirmed this with several studies that showed variation in compression fraction (time spent doing CPR) and compression rates.
Dr. Abella shared an interesting chart about a research study that looked at the affect of CPR quality feedback devices and resuscitation team debriefings. ROSC was better when the person performing chest compressions in real time received immediate feedback about rate and depth from the AED. There was an additional impact on survival for resuscitation teams that also participated in structured post cardiac arrest debriefs. I have not personally used a feedback device but have found debrief “code reviews” very helpful and insightful.
Top Quote from Week 2
“Educational interventions” to prehospital providers improve patient survival to hospital discharge.
High Quality Chest Compressions
As a reminder high quality chest compressions are:
- Delivered at a rate of 90-110 per minute
- Minimally interrupted for a pre-shock pause
- Correct depth of at least 2″
- Uniform rate and depth over time
In addition there was discussion about the importance of only delivering 8-10 breaths per minute. Hyperventilation kills.
This course doesn’t have any reading assignments (yet?). It would be helpful if a PDF was available for each journal publication Dr. Abella references in the video lectures.
To my knowledge there are not any assignments or projects for this course. In the 3rd week two video Dr. Abella asks us if we know about the quality of CPR in our community but it is not clear if that is an assignment or simply encouragement to learn about the level of out of hospital CPR quality. Was it clear to you?