Resuscitation skills must be improved

The Arrhythmia Alliance estimates that sudden cardiac arrest (SCA) claims the lives of 250 people every single day in the UK. With earlier recognition of the deteriorating patient and effective cardiopulmonary resuscitation (CPR), this figure could be reduced. Yet poor technique and inadequate knowledge of basic CPR guidelines continues to hamper progress. According to the British Heart Foundation, immediate CPR more than doubles a person’s chances of survival.1 If effective CPR is not provided immediately, a sudden cardiac arrest victim’s chance of survival falls 14% for every minute of delay until defibrillation.2 However, research shows that the quality of CPR also has a direct impact on a victim’s chance of survival.3 Given that most of these patients receive CPR from a healthcare professional, training on how to deliver proper CPR and improving skill performance during the delivery of CPR are critical to saving lives. The Resuscitation Council (UK) is responsible for issuing CPR guidelines in the UK. These are updated every five years to help improve training and performance of CPR, which in turn will improve survival rates. The UK guidelines are based on those issued by the European Resuscitation Council, which are in turn derived from research and in association with the International Liaison Committee on Resuscitation (ILCOR). The most recent 2005 CPR guidelines put more emphasis on compressions than rescue breaths, recommending 30 chest compressions for every two breaths given to cardiac arrest victims.

Poor performance

Unfortunately, recent studies report that compliance to these guidelines and CPR performance, by healthcare professionals, are poor. Despite the importance of effective technique on outcomes, a study published in the Journal of the American Medical Association, showed that CPR performed both outside and inside the hospital setting often does not meet standard guidelines. The 2005 study, led by Benjamin Abella, MD, of the Hospital of the University of Pennsylvania, revealed very poor CPR quality in the in-hospital setting, referencing too few and shallow chest compressions and too many ventilations per minute.4 Another study, led by Dr Lars Wik, showed that healthcare professionals are also not adhering to established CPR guidelines in out-of-hospital situations. The study found that during the administration of CPR, there were no chest compressions delivered nearly half of the time and, when delivered, just around one-third adhered to recommended CPR guidelines.5 Additionally, a study examining depth and uniformity of compressions found that too-shallow chest compressions are common during the delivery of CPR to cardiac arrest patients in both in-hospital and out-of-hospital settings. Subsequent research has indicated that increasing compression depth is associated with increased defibrillation success and survival rates.6 Interruptions can also impede CPR performance and be detrimental to patient survival. A study, led by Dana Edelson, MD, of the University of Chicago Hospital, concluded that longer interruptions and shallow chest compressions result in defibrillation failure.7 Therefore, approaches to minimise or eliminate interruptions and optimise compression depth may significantly improve resuscitation success.