Missing
the “High” in High Performance CPR?
Alan
Perry
July
30, 2017
High
Performance CPR is a generic term associated with
various methods now used in the setting of cardiac arrest aimed at improving
the survival rate and long-term outcomes of victims beyond outcomes obtained by
standard AHA/ACLS guidelines. It is achieved by improving the quality and consistency
of CPR and maximizing the effect of efficacious actions taken during the
process.
High performance does
not occur by accident or by writing an SOP, It takes education, practice and
teamwork. It is a complicated process in which every team player must
understand the whole process, what their area of responsibility is and how to
best perform each task. It also takes leadership and communication. A gap in
any area will decrease performance and potentially have a negative effect on
the patient’s outcome.
Education on any high
performance variant of CPR will likely require your agency to develop its own
system with the approval and participation of your OMD(s). Since High Performance CPR is a skill every
operational member of your organization must have for the system to work. Initial
and on-going training programs should be put into place that convey the necessary
knowledge, skills and abilities.
Because it is a
team-based function it will also require regular practice and competency/skill
verification. In most systems, providers will not always be working with the
same crew members. Practical exercises across shifts/stations/battalions, with
members functioning in all roles they might normally fill, will produce greater
consistency of performance across the organization.
Teamwork can be difficult
to achieve when you are not always working with the same members. This is where
training to a standard and having all members of the team knowing the whole
process pays off. There can be little variation across
shifts/stations/battalions if you want everyone to work collaboratively in this
fast-paced and stressful situation.
Leadership is important
but not as much dependent on rank as where you find yourself. What is important
is that the person taking the lead be competent and communicate effectively
with other team members. This is no place to fuss over who’s going to lead,
make the call and fall into line. If this falls apart the whole process can
implode into utter confusion.
Communication is
probably the most important skill. It requires both effective delivery of
messages as well as good listening. A closed-loop communication model is best
so that critical procedures and information can be tracked accurately by both
the sender and receiver. This type of communication also helps keep the whole
team aware of where they are in the resuscitation process.
It has been proven that
effective CPR delivered early in a witnessed arrest and preceding
defibrillation of VF produces the greatest possible benefit for the patient. It
has also been proven that minimizing gaps in CPR created by analyzing rhythms,
charging defibrillators and switching compressors improves outcomes. This is an
excellent place to hone the communication and teamwork.
It should go something
like this:
Scribe/Timekeeper: Approaching 2 minutes CPR
ALS team leader: Prepare for rhythm check and
compressor switch.
(Charge defibrillator)
Switch compressors, clear the
patient.
(Examines rhythm, shocks if
VF/VT) 2 seconds max.
Resume compressions.
Scribe/Timekeeper: Records actions/defibrillation/rhythm.
Restarts CPR clock.
Looks simple right? Try this
with a crew you have not worked with before, or with providers who have not
practiced or don’t remember the process. It won’t be so simple.
Enjoy,
Alan
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