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Quality Improvement for Prehospital Cardiac Arrest Management

Quality Improvement for Prehospital Cardiac Arrest Management. Mark E. Pinchalk , MS, EMT-P Patient Care Coordinator City of Pittsburgh EMS. Aggressive EMS QI Programs. Evidence based care Employ best practices Standardization of Care Care Bundles Performance Feedback.

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Quality Improvement for Prehospital Cardiac Arrest Management

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  1. Quality Improvement for Prehospital Cardiac Arrest Management Mark E. Pinchalk, MS, EMT-P Patient Care Coordinator City of Pittsburgh EMS

  2. Aggressive EMS QI Programs • Evidence based care • Employ best practices • Standardization of Care • Care Bundles • Performance Feedback Performance Improvement Performance Feedback Research New care practices IMPROVED PATIENT OUTCOMES

  3. Prehospital Phases of Cardiac Arrest for Quality Improvement • Pre-arrival • Intra-arrest • Post-arrest

  4. Pre-Arrival • Recognition • 911 Access • Bystander CPR • Public Access AED availability & Use • EMS Response Times

  5. Pre-arrival: Bystander CPR Bystander CPR Rate 24.8 – 43.3% (29.3%)

  6. Intra-Arrest QI Interventions • Minimally Interrupted CPR Strategy • Early Defibrillation • Early Vascular Access • Early Medications • Appropriate Advanced Airway Management

  7. Coronary Perfusion Pressure and ROSC in Human Cardiac Arrest Paradis (1990) P < 0.001

  8. Adjusted OR of Survival 95% CI 0.87. 5.22 1.00, 5.08 1.20. 6.88 1.50, 7.26 Adjusted for: bystander CPR, age, gender, time from 911 call to arrive at scene, chest compression rate, public location

  9. Improving Perfusion • High CPR Fractions • > 80% • Minimal Interruptions • < 10 seconds • Vasopressors • Early

  10. Epinephrine and CPP(Rosenberg, 1996)

  11. 375E5 Program - Training • CQI Training Initiative • Started Pilot Training January 2008 • Two (2) hour program • Small unit training 2-4 personnel per session • Phased in regular bureau training cycles for all personnel Spring 2008

  12. 2 and 4 provider VF Cardiac Arrest Scenarios run for 5 minutes Pretest Performance Feedback Post Test CPR Fraction and pause times measured via qCPR ™ system in the Phillips Monitor 375E5 Program - Training

  13. 375E5 - 2 Rescuer Scenario

  14. 375E5 - 2 Rescuer Scenario

  15. Pretest: 20 seconds to begin CCC

  16. Pretest: 30 second pause in CCC for rhythm analysis and defibrillation

  17. Post-test: 10 seconds to assess and start CCC; 7 second pause for rhythm analysis and defibrillation

  18. Post-test: 6 second pause for 2nd defibrillation

  19. Pretest: Beginning of a 50 second pause in CCC for ETI

  20. Training Results: 2 rescuer scenario

  21. Training Results: 4 Rescuer Scenario

  22. Total CPR % over time

  23. 375E5 Patient Outcomes: Pulse on ED Arrival

  24. Time and Attempts to Secure Airway vs. ROSC P = 0.098 P = 0.245

  25. Outcomes 2010-11 vs 2011-12 ROSC: p = 0.219, OR = 1.140 (0.792 – 2.511) ROSC ED: p = 0.057, OR = 1.770(0.954 – 3.292)

  26. Post Cardiac Arrest Care

  27. Integrated Post Arrest Care

  28. Integrated Post Arrest Care

  29. Questions? Mark E Pinchalk, MS, EMT-P Patient Care Coordinator City of Pittsburgh EMS 412-622-6930 Mark.pinchalk@pittsburghpa.gov

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