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

Survival from cardiac arrest is critically dependent on high-quality cardiopulmonary resuscitation. Despite evidence-based guidelines, achieving optimal cardiopulmonary resuscitation quality remains a significant challenge in the emergency department. The emergency department demonstrated persistent suboptimal adherence to evidence-based chest compression quality metrics during cardiac arrest resuscitations, with marked deviation from American Heart Association guidelines during high-acuity events. This theory-practice gap was reflected in the chest compression fraction of 65% among nontraumatic cardiac arrest adult patients compared with the national benchmark of 80%, indicating a substantial opportunity for performance improvement and enhanced patient outcomes.

A quasi-experimental quality improvement initiative was implemented in a Taiwanese emergency department over 8 months (March to October 2024). Using a pre-post intervention design, the project enrolled 30 adult patients presenting with nontraumatic cardiac arrest (n = 20 before the intervention; n = 10 after the intervention). Primary outcome measures included chest compression fraction, compression rate, compression depth, and end-tidal carbon dioxide concentrations. Secondary outcome measures included time to establishment of intravenous access and time to initial rhythm analysis. A multimodal intervention was implemented, including (1) a standardized resuscitation workflow with visual role mapping to improve team coordination, (2) monthly high-fidelity simulation training to enhance technical skills, and (3) real-time quality cardiopulmonary resuscitation and end-tidal carbon dioxide monitoring for direct performance feedback.

Statistically significant improvements were observed across all outcome measures. Chest compression fraction increased from 65.2% to 81.3%, compression rate improved from 94.5 to 109.2/min, compression depth for adults increased from 47.2 to 52.1 mm, and mean end-tidal carbon dioxide rose from 8.1 to 14.4 mm Hg. Time to intravenous access and rhythm analysis decreased by 27.8% and 33.0%. Staff surveys indicated high intervention acceptance, with 96.7% of respondents reporting improved technique and 100% reporting enhanced role clarity.

A multimodal quality improvement intervention successfully enhanced cardiopulmonary resuscitation quality metrics, achieving guideline-concordant compression parameters and increasing end-tidal carbon dioxide values, with corresponding improvement in chest compression fraction from 65% to 81%. Concurrent reductions in time to critical interventions and strong staff endorsement suggest that this approach effectively addresses barriers to optimal resuscitation performance, including role ambiguity and skill variability, with potential for broader implementation in ED settings.