Awadhare Pranali, Barot Karma, Frydson Ingrid, Balakumar Niveditha, Doerr Donna, Bhalala Utpal
Driscoll Children's Hospital, Corpus Christi, TX, USA.
Eastern Virginia Medical School, Norfolk, VA, USA.
Crit Care Res Pract. 2023 Mar 9;2023:6875754. doi: 10.1155/2023/6875754. eCollection 2023.
Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children's hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children.
We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO (EtCO), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate.
We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1-13) minutes and 3 minutes (1.25-10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1-5), respectively. We observed an improvement in compliance with the CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (=0.0009). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% (=0.016) and 100% vs. 63% (=<0.0001) events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle (=0.014).
Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.
已对各种质量改进（QI）干预措施在心肺复苏（CPR）质量方面进行了单独评估。我们旨在评估我院针对儿童心肺复苏质量的QI组合措施（实践培训和总结汇报）。我们假设该QI组合措施能提高住院儿童心肺复苏的质量。
我们于2017年8月启动了QI组合措施（实践培训和总结汇报）。我们进行了前后分析，比较了2013年7月至2017年5月（之前）和2018年1月至2020年12月（之后）期间的心肺复苏质量。我们从关键事件日志中收集了关于心肺复苏持续时间、胸外按压（CC）频率、通气频率（VR）、首剂肾上腺素给药时间、血压（BP）、呼气末二氧化碳（EtCO）以及心肺复苏期间生命体征监测的数据。我们进行了单因素分析，并以中位数四分位间距（IQR）和适当的百分比形式呈现数据。
我们分别比较了QI组合措施实施前后58次心肺复苏事件和41次心肺复苏事件的数据。QI组合措施实施前和后的心肺复苏持续时间中位数（IQR）分别为5（1 - 13）分钟和3分钟（1.25 - 10），首剂肾上腺素给药时间分别为2（1 - 2）分钟和2分钟（1 - 5）。我们观察到胸外按压频率（每分钟100 - 120次）的依从性从QI组合措施实施前的72%的事件提高到了实施后的100%（P = 0.0009）。同样，胸外按压中断率和过度通气率分别从QI组合措施实施前的100%降至50%（P = 0.016）和从100%降至63%（P = <0.0001）。我们还观察到血压监测情况从QI组合措施实施前的36%提高到了实施后的60%（P = 0.014）。
我们的QI组合措施（实践培训和总结汇报）与儿童高质量心肺复苏依从性的提高相关。
