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Video review process is a valuable tool to improve skills and identify
areas of performance improvement during cardiopulmonary resuscitation.
This study shows pulse check times and chest compression fraction
significantly improved with video review process
1. Introduction :
Cardiac arrests (CA) are the leading global cause of
mortality.1In the United States alone, more than 500,000 CAs occur each year.2Survival rates of CA remain dismal with less than 15% of patients
surviving to hospital discharge.3
Given the tremendous morbidity and mortality associated with CA, the
American Heart Association (AHA) promotes several important strategies
associated with improved outcomes. Chief amongst these strategies is
high quality cardiopulmonary resuscitation (CPR). Minute changes in CPR
quality, such as the percentage of chest compression fraction (CCF) and
duration of pulse checks, correlate with return of spontaneous
circulation (ROSC) and survival to hospital discharge. Several studies
emphasize the importance of decreasing interruptions during chest
compressions while maximizing CCF to improve patient outcomes.4–7
Despite these studies and interventions from the AHA, improving the
quality of CPR and outcomes of CA remains difficult. This difficulty may
arise from the often chaotic environment of the resuscitation bay and
inherently poor outcomes. Many have strived to improve cardiac arrest
outcomes through pre-hospital and in-hospital initiatives. Given its
association with increased survival, the AHA has focused significant
resources on improving rates of bystander
CPR.8Furthermore, emergency departments (ED) have minimized the impact of the
chaotic environment of resuscitations by improving communication and
decreasing the number of interruptions in
CPR.9,10
Video review is another tool to improve skills and identify areas of
performance
improvement.11Outside of cardiac arrest, video review has become a key practice in
trauma centers to evaluate adherence to Advanced Trauma Life Support
(ATLS)
protocols.12–14However, there is little literature on the effect of video review on CA
resuscitations in the
ED.11,15
Our goal was to utilize video review of resuscitation in CA patients to
drive quality improvement. We sought to improve our compliance with AHA
quality metrics. To accomplish these goals, we collected and analyzed
data for key resuscitation metrics.
2. Methods :
2.1 Data Collection
This was a prospective, observational study evaluating the care provided
by emergency medicine physicians, nurses, and technicians at a single,
urban, tertiary institution with 80,000 annual patient visits between
July 2017 and June 2020. The project was approved through the
Institutional Review Board (IRB#031819). A real-time video recording
system in three resuscitation bays collected data for review.
Researchers exported video within 72 hours of capture, after which the
video was automatically deleted. Each day, the electronic medical record
(EMR) was used to identify any patients who may qualify for the study
and footage was reviewed from that time. If a qualifying case was found,
the video was exported to an encrypted, password-protected flash drive
which was stored in a locked office. Data collection was performed by
reviewing the footage and corresponding medical record. Data points were
collected on each case in accordance with the Cardiac Arrest Registry to
Enhance Survival (CARES) .16 Videos underwent
review by two CoVeRT resident members to ensure accuracy and
consistency. For each case, at least one reviewer was a post-graduate
year 3 or 4 resident. Reviews were performed independently and a faculty
member reviewed the data to ensure accuracy and consistency in observed
values.