To the Editor,The COVID-19 pandemic has created unique challenges for resuscitation teams responding to cardiac arrests. In response, the American Heart Association and European Resuscitation Council have released new guidance to help navigate these challenges. Specific mention was made to consider mechanical chest compression devices to reduce the number of providers needed during the resuscitation. 1,2 This guidance builds upon prior consensus on science and guidelines recommending against routine use of mechanical chest compression devices, outside of arrests where sustained high-quality manual compressions is impractical or a threat to provider safety. 3,4 In general, the quality of data regarding the safety/efficacy of mechanical chest compression devices for in-hospital arrest is low. 5 Explored here are our experiences with rapid implementation of the LUCAS 1 chest compression system at a tertiary care hospital during the COVID-19 pandemic.The LUCAS 1 device was introduced in April 2020. In total, 23 inperson training events were held and were attended by 126 nurses and 30 physicians. A video learning module was released to all potential code team responders and was completed by 555 individuals. Twenty-one in-hospital cardiac arrests (IHCA) occurred between April and June 2020. In June 2020, a survey exploring the attitudes and experiences with the device (see supplement data) was sent to nurse and physician code leaders identified via intra-arrest documentation. Ultimately, 44/76 (58%) participants responded, distributed roughly evenly between nurses (34%), code leaders (32%), and attending physicians (34%).Ultimately, 32 (73%) responders had been involved in an event where the LUCAS 1 device was deployed. On a five-point Likert scale ranging from 'Strongly Disagree' to 'Strongly Agree,' more than half of participants strongly agreed that the LUCAS 1 reduced the number of individuals needed in the room (56%), improved the quality of chest compressions (59%), and led to a more controlled resuscitation experience (59%). Of the surveys where the LUCAS 1 was deployed, 12 (37%) participants agreed/strongly agreed that the LUCAS 1 led to delays in patient care, while 12 (37%) participants disagreed/strongly disagreed that it resulted in delays. The largest barrier identified during use of the LUCAS 1 was concern for patient size and patient transfer onto the LUCAS 1 backboard. Of the 20 (45%) participants who were

Purpose: Traditional paper documentation of cardiopulmonary arrest (CPA) events is often inaccurate and incomplete. Electronic documentation supports appropriate process improvements and optimal patient care and contributes to greater accuracy in national databases from which national benchmarks are derived. The aim of this quality improvement initiative was to compare the timeliness and accuracy of paper-based versus electronic documentation of live CPA events. Methods: Nurses on four medical–surgical pilot units received training on the use of a handheld electronic device with a documentation app (Full Code Pro) to document live CPA events. The data were downloaded into an Excel file and compared for completeness and accuracy with the data downloaded from the LIFEPAK 15 defibrillator using CODE-STAT 10.0 software. Electronic documentation and traditional paper documentation of events from units where the intervention wasn't implemented (control units) were also compared with the CODE-STAT data. Results: There were 26 CPA events: six on the pilot units were documented using the electronic app, 12 on the pilot units were documented using the paper-based method (the latter were excluded from analysis), and eight on the control units were documented using the existing paper forms. Data accuracy was significantly greater in the electronic group compared with the paper-based group for recorded rhythm (100% versus 13%, P = 0.01) and end-tidal carbon dioxide (67% versus 0%, P = 0.02). The electronic method significantly outperformed the paper-based method in legibility (100% versus 13%, P < 0.01). Staff reported increased satisfaction with the electronic documentation method. Conclusion: Using electronic handheld devices to document live resuscitation events demonstrated the inaccuracies of paper-based documentation, supporting the findings of previous studies. Electronic documentation was superior to paper in overall documentation quality and allowed providers to identify and quickly document the initial rhythm of the event. A larger study using electronic documentation to capture more ventricular fibrillation and ventricular tachycardia arrests would show a greater accuracy of timing, which would have large positive effects on overall resuscitation quality.

Our city was significantly impacted by the initial COVID-19 outbreak in the United States. We describe how members of our Quality and Safety team were able to leverage skills in relational coordination and process improvement to respond to rapidly changing needs in a flexible and effective way.