Improving Chest Compression Quality in Cardiac Arrest: A Multimodal Intervention Project in the Emergency Department

Area of Science:

• Emergency Medicine
• Cardiology
• Quality Improvement Science

Background:

• High-quality cardiopulmonary resuscitation (CPR) is crucial for cardiac arrest survival, yet achieving guideline adherence in emergency departments (EDs) is challenging.
• A significant gap exists between recommended chest compression fraction (80%) and actual performance (65%) in EDs, impacting patient outcomes.

Purpose of the Study:

• To implement and evaluate a multimodal quality improvement initiative to enhance CPR quality in an ED setting.
• To address the theory-practice gap in CPR performance and improve patient outcomes during nontraumatic cardiac arrest events.

Main Methods:

• A quasi-experimental, pre-post intervention design was used over 8 months in a Taiwanese ED.
• The multimodal intervention included a standardized resuscitation workflow, monthly high-fidelity simulation training, and real-time CPR feedback.
• The study enrolled 30 adult patients with nontraumatic cardiac arrest (20 pre-intervention, 10 post-intervention).

Main Results:

• Statistically significant improvements were observed in chest compression fraction (65.2% to 81.3%), compression rate, compression depth, and end-tidal carbon dioxide.
• Time to intravenous access and rhythm analysis decreased by 27.8% and 33.0%, respectively.
• Staff surveys showed high acceptance, with 96.7% reporting improved technique and 100% reporting enhanced role clarity.

Conclusions:

• A multimodal quality improvement intervention effectively enhanced CPR quality metrics to guideline-concordant levels.
• The intervention successfully addressed barriers like role ambiguity and skill variability, leading to improved chest compression fraction and reduced time to critical interventions.
• This approach shows potential for broader implementation in ED settings to optimize resuscitation performance and patient outcomes.