Survival in cardiac arrest is associated with rapid initiation of high-quality cardiopulmonary resuscitation (CPR) and advanced life support. To improve ROSC rates and survival, we identified the need to reduce response times and implement coordinated resuscitation by dedicated cardiac arrest teams (CATs). We aimed to improve ROSC rates by 10% within 6 months, and subsequent survival to hospital discharge. We used the Model for Improvement to implement a ward-based cardiac arrest quality improvement (QI) initiative across 3 Plan-Do-Study-Act (PDSA) cycles. QI interventions focused on instituting dedicated CATs and resuscitation equipment, staff training, communications, audit framework, performance feedback, as well as a cardiac arrest documentation form. The primary outcome was the rate of ROSC, and the secondary outcome was survival to hospital discharge. Process measures were call center processing times, CAT response times and CAT nurses’ knowledge and confidence regarding CPR. Balancing measures were the number of non-cardiac arrest activations and the number of cardiac arrest activations in patients with existing do-not-resuscitate orders. After adjustments for possible confounders in the multivariate analysis, there was a significant improvement in ROSC rate post-intervention as compared to the pre-intervention period (OR 2.05 [1.04–4.05], p = 0.04). Median (IQR) call center processing times decreased from 1.8 (1.6–2.0) pre-intervention to 1.4 (1.4–1.6) minutes post-intervention (p = 0.03). Median (IQR) CAT response times decreased from 5.1 (4.5–7.0) pre-intervention to 3.6 (3.4–4.3) minutes post-intervention (p < 0.001). After adjustments for possible confounders in the multivariate analysis, there was no significant improvement in survival to hospital discharge post-intervention as compared to the pre-intervention period (OR 0.71 [0.25–2.06], p = 0.53). Implementation of a ward-based cardiac arrest QI initiative resulted in an improvement in ROSC rates, median call center and CAT response times.

中文翻译：

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改善院内心脏骤停病房的响应时间和生存率：一项质量改进举措

心脏骤停时的生存与快速启动高质量心肺复苏 (CPR) 和高级生命支持有关。为了提高 ROSC 率和生存率，我们确定需要减少响应时间并由专门的心脏骤停小组 (CAT) 实施协调复苏。我们的目标是在 6 个月内将 ROSC 率提高 10%，并提高出院后的生存率。我们使用改进模型在 3 个计划-实施-研究-行动 (PDSA) 周期中实施基于病房的心脏骤停质量改进 (QI) 计划。 QI 干预措施的重点是建立专用 CAT 和复苏设备、员工培训、沟通、审计框架、绩效反馈以及心脏骤停文件表格。主要结局是 ROSC 率，次要结局是出院生存率。流程衡量指标包括呼叫中心处理时间、CAT 响应时间以及 CAT 护士对 CPR 的了解和信心。平衡措施是非心脏骤停激活的数量和现有不复苏命令的患者心脏骤停激活的数量。在对多变量分析中可能的混杂因素进行调整后，与干预前相比，干预后的 ROSC 率显着改善（OR 2.05 [1.04–4.05]，p = 0.04）。呼叫中心处理时间中位数 (IQR) 从干预前的 1.8 (1.6–2.0) 分钟减少到干预后的 1.4 (1.4–1.6) 分钟 (p = 0.03)。中位 (IQR) CAT 反应时间从干预前的 5.1 (4.5–7.0) 分钟减少到干预后的 3.6 (3.4–4.3) 分钟 (p < 0.001)。在对多变量分析中可能的混杂因素进行调整后，与干预前相比，干预后出院生存率没有显着改善（OR 0.71 [0.25–2.06]，p = 0.53）。基于病房的心脏骤停 QI 计划的实施改善了 ROSC 率、呼叫中心中位数和 CAT 响应时间。