12/03/2013. Conflict of interest. ERC 2010 Guidelines. Waar is nog winst te behalen in het reanimatieonderwijs?

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Colin Robbins
5 years ago
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vice chair Belgian Resuscitation Council 6 maart 2013 ERC 2010 Guidelines Role of chest compression depth during resuscitation

1 Conflict of interest Waar is nog winst te behalen in het reanimatieonderwijs? Unrestricted research grant from the Laerdal Foundation Nicolas MPOTOS Emergency Department, Ghent University Hospital, Belgium vice chair Belgian Resuscitation Council 6 maart 2013 ERC 2010 Guidelines Role of chest compression depth during resuscitation Compressions 5-6 cm deep Complete release Minimal interruptions Rate /min Ventilations Visible rise of the chest < 1 second No gastric insufflation Stiell I, et al. Crit Care Med

Effect of rate on compression depth Effect of rate on compression depth Fig. 1.

Black bars indicate <4 cm depth, white bars 4-5 cm depth, crossed bars >5 cm depth. Fig. 2.

Horizontal line indicates minimum compression depth (4 cm) according to ERC 2005 Guidelines.

compression rate when higher rates generate insufficient compression depth (145/min).

2 Effect of rate on compression depth Effect of rate on compression depth Fig. 1. Distribution of depth according to rate category. Black bars indicate <4 cm depth, white bars 4-5 cm depth, crossed bars >5 cm depth. Fig. 2. Relationship between chest compression rate and depth. Horizontal line indicates minimum compression depth (4 cm) according to ERC 2005 Guidelines. Vertical lines indicate compression rate with deepest compression depth (86/min), and compression rate when higher rates generate insufficient compression depth (145/min). Interrupted lines indicate 95% confidence intervals. Field RA, et al. Resuscitation 2012 Monsieurs KG, et al. Resuscitation 2012 We don t even follow the guidelines 48% of the time: no compressions Mean compression depth: 34 mm Wik et al, JAMA 2005 The Utstein formula of survival Suboptimal compression depth in almost 50% (2005 guidelines) In almost ALL (2010 guidelines) 2

Educational efficiency The way we teach CPR Different course formats

financial, organisational) Skill decay within 3 6 months Average

? Black box phenomenon The Utstein formula of survival Where and how can

ERC recommendations Problem with the trainee?

3 Educational efficiency The way we teach CPR Different course formats (IL, video, computer, e-learning) Considerable barriers (time, financial, organisational) Skill decay within 3 6 months Average retraining intervals: 18 months (Verplanke et al.)?? Black box phenomenon The Utstein formula of survival Where and how can we improve quality?? Where and how can we improve? ERC recommendations Problem with the trainee? All courses should be evaluated to ensure that they Within the training method? Instructor-led Video, computer-learning Within the training strategy? reliably achieve the program objectives. Regular assessments could detect people in need of retraining Single vs multiple training, assessment-based learning 3

4 What should we assess? How to assess? Define clear course objectives Feed up: where are we going? Instructor judgement alone is not sufficient Lynch B, et al To know = to measure Core CPR skills vs procedural skills Smallest set of skills most associated with survival American Heart Association Rationale for measuring and reporting the quality of CPR Kramer-Johanssen J, et al Automated assessment Mpotos N, et al Assessment criteria What is an acceptable competence level? Against a pre-defined level Wass V, et al. Lancet 2001 Knowledge gap Using a clear methodology Mäkinen M, et al. Eur J Emerg Med 2007 Reporting proportions of successful students vs improvements of (group) mean values 100 % skills mastery? 90, 80, 70 %?? Combined assessment score Mpotos N, et al. Resuscitation 2013 Principles of Mastery Learning Hattie J 2009 Effective compression ratio Greif R, et al. Resuscitation 2012 How to reach competence? Multiple short training sessions followed by assessment and feedback Feedback, feedforward Hattie J 2009 Debriefing Perkins GD, et al Where am I going? Feedup Training Multiple training sessions Sutton R, et al. 2011; Mpotos N, et al And where to next? Feedforward Automated test How am I going? Feedback Mpotos N, et al. Resuscitation

combined assessment score including: 70%

compressions with complete release (<5 mm)

and 70% ventilations with a volume between

followed by assessment and feedback : Lay

Use of real-time feedback Regular automated

5 Automated testing Debriefing (feedback summary)and feed forward 2 minutes test 70% combined assessment score including: 70% compressions with depth 50 mm and 70% compressions with complete release (<5 mm) and a compression rate between /min and 70% ventilations with a volume between ml Multiple short training sessions followed by assessment and feedback : Lay people Emergency nurses Mpotos N, et al. Resuscitation 2013 How to maintain competence? Use of real-time feedback Regular automated assessments Mean time 7 minutes Lower cost No instructor involvement Every 6 months? Use of real-time feedback devices 5

Use of immediate CPR performance feedback New training strategies Self-learning Time efficient

6 CPR process monitoring Cardiac arrest registries Feedback, debriefing on CPR procedures Bench marking? Use of immediate CPR performance feedback New training strategies Self-learning Time efficient course model Cost-effective CPR process monitoring Bench marking Course validation Regular competence assessment KRAKOW, October 25-26, 2013 The only way is (still) up! Thank you! 6

The Concept of Q-CPR. The need for Quality CPR

The Concept of Q-CPR. The need for Quality CPR The need for Quality CPR Push hard, push fast, allow full chest recoil after each compression, and minimise interruptions in chest compressions. 1 Victims of cardiac arrest need immediate CPR. This provides