Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association

• Published in: Circulation (New York, N.Y.) Vol. 128; no. 4; pp. 417 - 435
• Main Authors: Meaney, Peter A, Bobrow, Bentley J, Mancini, Mary E, Christenson, Jim, de Caen, Allan R, Bhanji, Farhan, Abella, Benjamin S, Kleinman, Monica E, Edelson, Dana P, Berg, Robert A, Aufderheide, Tom P, Menon, Venu, Leary, Marion
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the American College of Cardiology Foundation and the American Heart Association, Inc 23-07-2013; Lippincott Williams & Wilkins
• Subjects: American Heart Association; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiopulmonary Resuscitation - standards; Consensus; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Heart Arrest - mortality; Heart Arrest - therapy; Hospitalization; Humans; Medical sciences; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; United States; United States; North America; America; Heart; Human; Intensive cardiocirculatory care; Cardiocirculatory arrest; Prognosis; American; CPR; Cardiovascular disease; cardiac arrest; Consensus; AHA Scientific Statements; Improvement; Association; CPR quality; outcomes; Quality; Evolution; resuscitation; Circulatory system; Hospital; Cardiology
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIR.0b013e31829d8654

The '2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care' increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPRminimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuermetrics of CPR performance; monitoring, feedback, and integration of the patient’s response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.