High Quality CPR
Training and dedication to quality improvement goals regarding the provision of excellent BLS care are essential for establishing a baseline from which survival can continue to be improved.
When excellent basic care is provided by all systems, the wide variations in survival that now exist may be reduced. This will allow a clearer baseline from which the survival impact of additional therapies can be evaluated in the future. Ensuring that high quality CPR is provided in an EMS system can be approached in a number of ways.
Ongoing evaluation of CPR metrics from SCA cases can provide a quality check on interruptions to compressions, pause times around defibrillation and other CPR metrics. Implementation of regular training scenarios using manikins that provide feedback on the rate and depth of compressions can be used to improve skills and reduce pause times. Each system should establish a method for ensuring that high quality CPR is provided as a basic requisite. The Appendix contains a sample review form for CPR Metrics.
While drugs and devices have a place in resuscitation, there is no substitute for excellent basic care.17 High quality CPR and early defibrillation are the best tools EMS owns, and the important role of the first responder in delivering this important treatment must be recognized. Until survival becomes less variable across the nation, trials involving adjuncts to CPR must cafefully be evaluated.
EMS Use of Devices
The AHA has published a statement addressing the use of CPR devices which can be read in its entirety in the highlights document available at heart.org.
The American Heart Association has published Highlights of the 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care, which includes statements addressing the use of CPR devices. The statements can be read in their entirety in the highlights document available at static.heart.org/eccguidelines/guidelines-highlights. html. Regarding the use of CPR devices, the summay statement from the AHA 2010 Guidelines Part 7. CPR Techniques and Devices states ?To date, no adjunct has consistently been shown to be superior to standard conventional (manual) CPR for out-of-hospital basic life support, and no device other than a defibrillator has consistently improved long-term survival from out-of-hospital cardiac arrest. .A variety of CPR techniques and devices may improve hemodynamics or short-term survival when used by well-trained providers in selected patients. All of these techniques and devices have the potential to delay chest compressions and defibrillation. In order to prevent delays and maximize efficiency, initial training, ongoing monitoring, and retraining programs should be offered to providers on a frequent and ongoing basis?.