Challenge 10

Optimal Resuscitation

Optimal Resuscitation often occurs in emergency medicine, trauma surgery, and intensive care medicine when a healthcare professional is able to intervene in a way that corrects breathing or a declining heartbeat; in doing so, the patient is revived or taken away from the pathway to death.

Each Actionable Patient Safety Solutions (APSS) includes an Executive Summary Checklist, Performance Gap, Leadership Plan, Practice Plan, Technology Plan and Metrics. Please click Download below to view the full document. A preview of the Executive Summary is offered below.

Executive Summary Checklist

Reducing preventable deaths requires a multi-disciplinary, multi-specialty collaborative team. In order to implement a program that will optimize resuscitation an implementation plan to complete the following actionable steps should be followed:

  • An institutional resuscitation outcome program should target preventable deaths for a particular hospital or healthcare organization.
  • A multi-disciplinary institutional group, the Resuscitation Outcomes Steering Committee (ROSC), should be designated as primarily responsible for the resuscitation program.
  • A formal mechanism for input data (Afferents) should be identified. This should include both external sources of information, such as guidelines and scientific literature, as well as internal (institutional) data.
  • The institutional ROSC should have input into the Efferent actions in response to Afferent data and perceived institutional resuscitation needs.
  • An effective resuscitation program will engage individual providers and enhance their personal sense of ownership and accountability. Ultimately, this program should become the primary vehicle to reduce preventable deaths and ensure an institutional culture of safety.
  • Outcome data should be presented to the hospital medical executive board monthly.
  • An organized approach to data collection and performance improvement should target various etiologies of cardiopulmonary arrest with regard to reducing arrest incidence, increasing arrest survival and improving end-of-life discussions with patients and families.
  • Institutional resuscitation protocols should consider available evidence, technology, and performance improvement data.
  • Provider training should ensure optimal resuscitation performance and be specific to provider type and clinical unit.
  • Cardiopulmonary arrest resuscitation should emphasize optimal chest compressions and controlled ventilations as recommended by the AHA in their ACLS protocol.
  • Post-resuscitative care should focus on optimizing supportive critical care and consideration of targeted temperature management and early coronary revascularization.
  • End-of-life discussions should provide patients and families with compassionate but realistic expectations regarding goals of therapy and various therapeutic options.
  • Cardiopulmonary arrest prevention should emphasize early recognition of the deteriorating patient by technology that can present an early warning system.
    • Perfusion technologies include sphygmomanometry, ECG, capnometry, clinical assessment (mental status, capillary refill, pulse quality, extremity temperature), pulse oximetry including related perfusion indices, laboratory measures of acidosis (pH, base deficit, lactate, anion gap), and newer modalities (near-infrared spectroscopy, orthogonal polarization, heart-rate variability).
    • Oxygenation technologies include pulse oximetry, blood gas analysis, near-infrared spectroscopy, and clinical assessment.
    • Ventilation technologies include respiratory volumetrics (tidal volume, respiratory rate), blood gas analysis, capnometry, capnography, apnea monitoring, and clinical assessment.

Statistics

CPR only provides 10 – 30% of normal blood flow to the heart and 30 – 40% of normal blood flow to the brain when performed according to guidelines, therefore CPR must be delivered at the highest quality possible.1
1.

Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., De Caen, A. R., Bhanji, F., … & Aufderheide, T. P. (2013). Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital a consensus statement from the American Heart Association. Circulation, 128(4), 417-435.