School of Medicine and Health Sciences Poster Presentations

Title

Improving Use of Ultrasound in Cardiopulmonary Resuscitation to Minimize Duration of Pulse Checks

Document Type

Poster

Abstract Category

Health Sciences

Keywords

Cardiopulmonary resuscitation, CPR, Ultrasound, ACLS

Publication Date

Spring 5-1-2019

Abstract

Background Bedside ultrasound has played an increased role in cardiopulmonary resuscitation (CPR) over the past several years. It is mainly utilized to detect spontaneous cardiac movement (SCM) and identify reversible causes of cardiac arrest including cardiac tamponade, pulmonary embolism, and pneumothorax. While using bedside ultrasound in CPR adds value, high-quality CPR emphasizes that the time spent during the resuscitation providing compressions should take priority, with a goal of limiting pulse checks to <10 seconds. Recent studies have suggested that the use of bedside ultrasound during CPR increases pulse check time and decreases the quality of CPR provided. Methods This prospective study investigated the effect of educational intervention on the length of pulse checks involving ultrasound use. Cardiac arrest resuscitations are currently video-recorded in a number of our resuscitation bays. Videos of resuscitations were independently evaluated by two reviewers for data points including use of ultrasound during pulsecheck, duration of pulse check, and patient outcome. Written feedback was given to providers about length of pulse checks and compression fraction ratio. In addition, selected cases were analyzed in multidisciplinary grand round presentations, providing qualitative and educational feedback on the resuscitation. Specific strategies were highlighted, including limiting pulse check time, emphasis on compressions, as well as the “record then review” method for pulse checks with ultrasound. The primary endpoint was the length of pulse checks with and without ultrasound use, while the secondary endpoint was patient outcome. Average pulse check times with and without ultrasound were also calculated longitudinally to evaluate the effect of our educational interventions. ** what is the stats we used?*** Results 47 cases were reviewed over 10 months, with a total of 166 pulse checks. The mean length of pulse checks without ultrasound was 12.7 ± 9.6 seconds (n=127/ 76.5%). The mean length of pulse checks that utilized ultrasound was 16.5 ± 11.0 seconds (n=39/ 23.5%). Pulse checks using ultrasound were significantly longer than those without ultrasound (p=0.0081). Pulse check times decreased globally over time with educational interventions both with and without use of ultrasound (p=0.0178), with an even greater significant decrease in pulse check time with ultrasound use (p=0.0074). Conclusion Previous studies have shown that ultrasound use prolongs pulse checks. Our data supports this conclusion, but importantly provides evidence that educational efforts targeting use of ultrasound during CPR can improve pulse check times. With educational intervention, our recorded pulse check times have decreased significantly overall, with marginally significant changes for pulse checks without ultrasound and with a greater significant ch

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Presented at Research Days 2019.

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Improving Use of Ultrasound in Cardiopulmonary Resuscitation to Minimize Duration of Pulse Checks

Background Bedside ultrasound has played an increased role in cardiopulmonary resuscitation (CPR) over the past several years. It is mainly utilized to detect spontaneous cardiac movement (SCM) and identify reversible causes of cardiac arrest including cardiac tamponade, pulmonary embolism, and pneumothorax. While using bedside ultrasound in CPR adds value, high-quality CPR emphasizes that the time spent during the resuscitation providing compressions should take priority, with a goal of limiting pulse checks to <10 seconds. Recent studies have suggested that the use of bedside ultrasound during CPR increases pulse check time and decreases the quality of CPR provided. Methods This prospective study investigated the effect of educational intervention on the length of pulse checks involving ultrasound use. Cardiac arrest resuscitations are currently video-recorded in a number of our resuscitation bays. Videos of resuscitations were independently evaluated by two reviewers for data points including use of ultrasound during>pulsecheck, duration of pulse check, and patient outcome. Written feedback was given to providers about length of pulse checks and compression fraction ratio. In addition, selected cases were analyzed in multidisciplinary grand round presentations, providing qualitative and educational feedback on the resuscitation. Specific strategies were highlighted, including limiting pulse check time, emphasis on compressions, as well as the “record then review” method for pulse checks with ultrasound. The primary endpoint was the length of pulse checks with and without ultrasound use, while the secondary endpoint was patient outcome. Average pulse check times with and without ultrasound were also calculated longitudinally to evaluate the effect of our educational interventions. ** what is the stats we used?*** Results 47 cases were reviewed over 10 months, with a total of 166 pulse checks. The mean length of pulse checks without ultrasound was 12.7 ± 9.6 seconds (n=127/ 76.5%). The mean length of pulse checks that utilized ultrasound was 16.5 ± 11.0 seconds (n=39/ 23.5%). Pulse checks using ultrasound were significantly longer than those without ultrasound (p=0.0081). Pulse check times decreased globally over time with educational interventions both with and without use of ultrasound (p=0.0178), with an even greater significant decrease in pulse check time with ultrasound use (p=0.0074). Conclusion Previous studies have shown that ultrasound use prolongs pulse checks. Our data supports this conclusion, but importantly provides evidence that educational efforts targeting use of ultrasound during CPR can improve pulse check times. With educational intervention, our recorded pulse check times have decreased significantly overall, with marginally significant changes for pulse checks without ultrasound and with a greater significant ch