Quick Take: How to improve CPR survival rates

Dr. Sabina Braithwaite and Dr. Paul Hinchey co-presented the effectiveness of different interventions for improving cardiac arrest patient outcomes at EMS Today in Baltimore, Md. They also discussed the pit crew model or choreographed model of CPR which requires ems providers to focus on what matters, assign positions to specific personnel, give each position a task, and ensure the process works for the department.

Overview: Why does cardiac arrest improvement matter?

Although cardiac arrest is only 1 percent of EMS calls, 70 percent of cardiac arrests happen outside of the hospital. EMS providers need to be the experts at cardiac arrest resuscitation. The lessons learned and research on EMS interventions for cardiac arrest drive in-hospital improvements.

Memorable quotes

"It is really hard to overstate the importance of compressions to improving CPR."

— Dr. Hinchey

"Do whatever you think needs to be done for the airway as long as you don’t stop compressions"

— Dr. Braithwaite

Key takeaways to improve cardiac arrest survival

• Early bystander CPR, high quality compressions, and proper rate of compressions really matter.
• Early use of an AED with a really short peri-shock pause
• Deliver fewer ventilations to the patient more slowly. Consider compression-only CPR with passive ventilation.
• De-emphasize endotracheal intubation. The most important thing is compressions.
• Epinephrine improves likelihood of ROSC, but has no impact on neurologically intact survival.
• Use EtCO2 as soon as possible and throughout the resuscitation.
• Design checklists and diagrammed assignments to choreograph resuscitation. 

For EMS systems and individual paramedics to improve cardiac arrest outcomes several tasks need to be consistently performed very well. As a final measure, Braithwaite and Hinchey recommend follow-up of the resuscitation event with an annotation and feedback to all of the providers that responded to it.