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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.