Abstract 222: Optimizing the Application of a Mechanical Chest Compression Device Within a High-Performance CPR Approach to Out-of-Hospital Cardiac Arrest Resuscitation

Abstract

Background: Minimizing the chest compression pause associated with application of a mechanical CPR (mCPR) device is a key component of optimal integration of mCPR into the overall resuscitation process. As part of a multi-agency implementation project, Anchorage Fire Department deployed LUCAS mCPR devices on BLS and ALS vehicles for initiation early in resuscitation efforts. A 2012 report from that project identified the pause interval for mCPR device application as a key opportunity for quality improvement (QI). In early 2013 we began a QI initiative to reduce device application time and optimize the overall CPR process, which included education on the importance of minimizing pauses, training on techniques for efficient device application, and a requirement for two manual CPR cycles prior to initiation of mCPR. To assess QI initiative effectiveness, we compared key CPR process metrics from before to during and after its implementation. Methods: We included all cases of EMS-treated out-of-hospital cardiac arrest during 2012 and 2013 in which mCPR was used and the defibrillator electronic record was available. Continuous ECG and impedance data were analyzed to measure chest compression fraction, duration of the pause from last manual to first mechanical compression, and duration of the longest overall pause in the resuscitation effort. Results: Compared to cases from 2012 (n=61), median (25th, 75th percentile) duration of the pause prior to first mCPR compression for cases from 2013 (n=71) decreased from 21 (15, 31) to 7 (4, 12) seconds (p<0.001), while median chest compression fraction increased from 0.90 (0.88, 0.93) to 0.95 (0.93, 0.96) (p<0.001). Median duration of the longest pause decreased from 25 (20, 35) to 13 (10, 20) seconds (p<0.001), while the proportion of cases where the longest pause was for mCPR device application decreased from 74% to 32% (p<0.001). Conclusions: Our QI initiative substantially reduced the duration of the pause prior to first mCPR compression. Combined with the simultaneous significant increase in compression fraction and significant decrease in duration of the longest pause, this finding strongly suggests a large improvement in mCPR device application efficiency within an overall high-performance CPR process.