ABSTRACT
Objective: To survey the times to critical actions (defibrillator and doctor presence, initiation of chest compression) of in-hospital simulated cardiopulmonary resuscitation (CPR). Methods: A 1-year retrospective simulated audit 2009 in a 2,400-bed university hospital in Thailand. Results: A total of 57 adult wards (around a third of all wards in the hospital), including intensive care units, critical wards, procedural units, general wards and out-patient units were audited. Overall, the median time of initiation of chest compression and defibrillator presence among CPR teams were 1.27 (0.35-7.19) and 1.16 (0.00-26.00) minutes, respectively. The median time of the first doctor presence was 3.45 (0.00-15.15) minutes. However, there were significant differences in time to defibrillator and doctor presence among wards. The longer time of these critical managements were recorded in non-monitored areas (general wards and out-patient units) (p = 0.004 and 0.007, respectively). Conclusion: In our CPR simulated survey, delayed initiation of critical managements commonly occurred in non-monitored areas. Better management should be concerned for favorable outcomes.
ABSTRACT
Background and objectives: Chest compression (CC) performance is one of the most important parts in saving the lives of victims with cardiac arrest. The primary objective was to determine the retention of CC performance among last-year medical students (externs). Methods: All externs were recorded for their CC performance at the end of their BLS (BLS not yet defined) workshop by the use of a CPR training manikin. The retention of BLS performance was evaluated by CC score (CCS) which is the percentages of correct CC during their internal medicine rotation. Detailed errors of chest compression performance including rate of compression, compression to ventilation ratio, incomplete release, too little, too much, and wrong hand position were also recorded. Results: 223 externs had baseline data for a chest compression score (CCS1) and 118 with follow-up data (CCS2). The interval between CCS1 and CCS2 was 198 (range 119-266) days. CCS during the training course (CCS1) and CCS during the test (CCS2) were 89 (range 84-94) and 81 (range 68- 89) respectively. CCS2 was significantly lower than CCS1 (p < 0.001). The percentages of externs who passed 80% decreased from 90.5% to 51.4% (p <0.001). The independent predictors for a high CCS2 included male gender, grade point average, experience in CPR observation or participation - especially recent experience. The area of errors in CC included compression rate, compression: ventilation ratio, too little and too deep compressions. Conclusion: CC performance significantly decreases after CPR training. Assessment of predictors for retention of CC performance and the area of errors may help to strengthen the CPR training program in the future.