Part 16: Education, Implementation, and Teams

Abstract

C ardiac arrest occurs in a wide variety of settings, from the unanticipated event in the out-of-hospital setting to anticipated arrests in the intensive care unit. Outcome from cardiac arrest is a function of many factors including the willingness of bystanders to perform cardiopulmonary resuscitation (CPR), the ability of rescuers to integrate knowledge and psychomotor skills, the quality of performance delivered by individual rescuers and teams, and the efficiency and effectiveness of post-cardiac arrest care.The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive, coordinated actions necessary to maximize survival from cardiac arrest. The use of evidence-based education and implementation strategies can optimize the links of that chain.Strengthening the Chain of Survival in the prehospital setting requires focus on prevention and immediate recognition of cardiac arrest, increasing the likelihood of high-quality bystander CPR and early defibrillation, and improving regional systems of care. In the hospital setting, organized efforts targeting early identification and prevention of deterioration in patients at risk can decrease the incidence of cardiac arrest. The challenge for resuscitation programs is twofold: to ensure that providers acquire and maintain the necessary knowledge, skills, and team behavior to maximize resuscitation outcome; and to assist response systems in developing, implementing, and sustaining an evidence-based Chain of Survival.Maximizing survival from cardiac arrest requires improvement in resuscitation education and the implementation of systems that support the delivery of high-quality resuscitation and postarrest care, including mechanisms to systematically evaluate resuscitation performance. Well-designed resuscitation education can encourage the delivery of high-quality CPR. In addition continuous quality improvement processes should close the feedback loop and narrow the gap between ideal and actual performance. Community-and hospitalbased resuscitation programs should systematically monitor cardiac arrests, the level of resuscitation care provided, and outcomes. The cycle of measurement, benchmarking, feedback, and change provides fundamental information necessary to optimize resuscitation care and maximize survival.This chapter reviews key educational issues that affect the quality of resuscitation performance and describes major implementation and team-related issues shown to improve outcomes. The information is organized into four major categories: willingness to perform CPR, educational design, improving resuscitation quality, and issues related to implementation and outcomes.While Willingness to PerformWithout immediate initiation of CPR, most victims of cardiac arrest will die. Bystander CPR can significantly improve survival rates from cardiac arrest, 3 but recent evidence indicates that only 15% to 30% of victims of out-of-hospital arrest receive CPR before EMS arrival. 4 Strategies to increase the incidence of bystander-ini...

Are Canadians more willing to provide chest-compression-only cardiopulmonary resuscitation (CPR)?—a nation-wide public survey

“…Popular strategies include the integration of effective dispatch-assisted telephone CPR instructions, 10-13 the implementation of CPR education in schools, 14 the organization of mass CPR training events, [15][16][17] targeted CPR training for family members of individuals with known cardiovascular disease, 18,19 and, recently, the promotion of a simplified chest-compression-only (CCO) CPR technique for bystanders. 20,21 However, these efforts have largely been unsuccessful, in that bystander CPR rates in OHCA remain unchanged. 22,23 Recently, international evidence-based guidelines have endorsed a simplified CCO approach for CPR.…”

“…22,23 Recently, international evidence-based guidelines have endorsed a simplified CCO approach for CPR. 20,21 The CCO-CPR approach emphasizes the importance of high-quality chest compressions and removes the requirement of mouth-to-mouth (MTM) ventilation. Studies have shown that CCO-CPR is associated with similar outcomes in adult OHCA when compared to traditional CPR.…”

What’s new in pediatric resuscitation? A practical update for the anesthesiologist

“…Resuscitation training improves performance 16,17 and self-efficacy of providers, 18 but psychomotor skills deteriorate rapidly 11 -the current two-year training interval for life support courses seems inadequate. 19 At a minimum, healthcare providers should maintain their resuscitation certification (basic life support for all and advanced courses for those who may need them), but they should also seek opportunities to practice and maintain their skills. Simulation, a field led by many anesthesiologists, is an ideal method by which to ''practice'' for these rare events.…”

“…La formation en réanimation améliore les résultats et la propre efficacité de ceux qui l'administrent, mais les habiletés psychomotrices déclinent rapidement: 11,[16][17][18] l'intervalle actuel de deux ans entre les cours de formation aux gestes de réanimation semble inadapté. 19 Au minimum, professionnels de la santé doivent maintenir leur certification en réanimation (soins de base pour tous et soins avancés pour ceux qui en ont besoin), mais ils doivent aussi rechercher des occasions de pratiquer et maintenir le niveau de leurs habiletés. La simulation, un domaine dans lequel de nombreux anesthésiologistes sont leaders, est une méthode idéale pour « s'entraîner » à faire face à ces événements rares.…”

Desenvolvimento e avaliação de curso on-line sobre suporte avançado de vida em parada cardiorrespiratória para enfermeiro

“…A implementação de projetos educacionais sobre a temática SAV em PCR do adulto é altamente relevante e a capacitação frequente em reanimação cardiopulmonar (RCP) baseada em evidências científicas e pautada em princípios educacionais é ressaltada nas diretrizes da AHA para otimizar a assistência de alta qualidade aos pacientes, e que esta influencie significativamente no sucesso da reanimação e no aumento da chance de sobrevivência (19,99) .…”