Factors Affecting Cardiopul-monary Resuscitation Hands-off Time in an Emergency Room

ABSTRACT

PURPOSE: The importance of minimizing hands-off time (HOT) during the performance of cardiopulmonary resuscitation (CPR) is emphasized in the new guidelines. This study analyzes the proportion and effects of each HOT result as observed in an Emergency room (ER). METHODS: We prospectively reviewed 45 video records of CPR performed in an ER resuscitation room from October 2007 to September 2008. We measured the total CPR time, the time to first chest compression (initial assessment time; IAT) and the time required to perform each step of the CPR procedure including pulse check and switchig compressors, echocardiography, efibrillation, X-ray, endotracheal intubation, central venous catheter insertion and needle thoracostomy. RESULTS: The median values recorded included the following total CPR time was 15.7 min (Interquartile range 7.51~27.8 min), fractions of HOT (HOTF) in CPR was 11.0% (Interquartile range 6.9~15.1%), the ratio of IAT in total HOT was 16.8% (Interquartile range 6.4~34%), pulse check and switching compressors in total HOT were 64.4% (Interquartile range 52~78%), echocardiography was 13.5% (Interquartile range 7.7~21.2%), defibrillation was 18.1% (Interquartile range 8.9~24.6%), endotracheal intubation was 12.2% (Interquartile range 4.2~17.2%) and X-ray was 15.1% (Interquartile range 12.7~21.0%). We found that the duration of CPR didn't increase HOTF (HOTF within 15 min of the total CPR time is 7.2% and after 15 min HOFT was counted 6.3%). CONCLUSION: During the year of in-hospital CPR data we observed, the pulse check and switch compressor procedure followed the CPR guideline, but the echocardiography, defibrillation and endotracheal intubation resulted in increased HOT. In order to reduce HOT during the performance of CPR, it is necessary to follow the guideline of each step of the procedure.