Digital Supplement, Special Topics

November 2010 Supplement, Is Your EMS System on the Verge of Extinction?

A monograph sponsored by the CPR Improvement Working Group and published by Elsevier Public Safety. Cardiovascular disease is a leading cause of death in the U.S., and the quality of CPR delivered has a direct impact on ROSC. This monograph alerts health care professionals to the disparity between how they perceive their performance and their actual CPR performance; and the role that retraining, monitoring and feedback play in the delivery of quality CPR.

Quality Makes the Difference

“Knowing is not enough; we must apply. Willing is not enough; we must do.”
—Johann Wolfgang von Goethe

The impact of out-of-hospital cardiac arrest (OHCA) is enormous, taking the lives of nearly 300,000 people each year in the U.S.(1) Although survival rates vary widely, they are still generally low (less than 10%) in most areas of the country.(2) Yet many communities have significantly improved their survival rates.(3-5)

Perception vs. Reality

Most hospitals and EMS systems in the U.S. require providers to maintain current certification in basic or advanced life support, with recertification occurring every two years. Most EMS providers and many health care workers perform CPR routinely, but in many institutions, biennial recertification is the only time devoted to a formal evaluation of skill proficiency and quality of CPR performed. Recently, quantitative measures of CPR quality have been developed using real-time feedback; however, the health care market has been slow to adopt this technology.

The Science of CPR

Cardiopulmonary resuscitation (CPR) is celebrating its 50th anniversary this year. Although used for many years in conjunction with other resuscitation interventions, recent studies demonstrating the reality of its use in clinical settings and linking its quality to patient outcomes have revolutionized attitudes surrounding the importance of properly performed chest compressions. The key factors important to quality chest compressions include chest compression rate, depth and fraction, which will be described separately below.

Compression Depth

Retraining Pays Off

The steps for CPR are well known to caregivers and many bystanders. Some are so familiar with the orchestrated movements, they can perform them spontaneously when needed. But are those efforts effective?

The Experts Weigh In

The editors invited the contributors to this monograph and a few guests to answer some questions about the delivery of CPR. We’ve compiled their responses in the following pages.