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Leo WZ, Chua D, Tan HC, Ho VK. Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study. Sci Rep 2023; 13:19852. [PMID: 37964016 PMCID: PMC10645752 DOI: 10.1038/s41598-023-46862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.
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Affiliation(s)
- Wen Zhe Leo
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Damien Chua
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Hui Cheng Tan
- Department of Clinical Governance, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
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2
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Carter M. Optimizing the management of inpatient cardiac arrest. JAAPA 2021; 34:20-25. [PMID: 33735135 DOI: 10.1097/01.jaa.0000735736.00078.d9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cardiac arrest is a common event in the inpatient setting, and although attempts have been made to simplify the approach to its management via systemwide training in CPR and Advanced Cardiac Life Support, significant challenges remain in implementing these guidelines in the management of cardiac arrest.
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Affiliation(s)
- Michael Carter
- Michael Carter practices in pulmonology and critical care in Tacoma, Wash., is an adjunct professor in the Department of Emergency Medical Services at Tacoma Community College, and holds a clinical faculty appointment with the University of Washington's MEDEX physician assistant training program. He also is an instructor for the Society of Critical Care Medicine's Fundamentals of Critical Care Support program. The author has disclosed no potential conflicts of interest, financial or otherwise
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Toews AJ, Martin DE, Chernomas WM. Clinical debriefing: A concept analysis. J Clin Nurs 2021; 30:1491-1501. [PMID: 33434382 DOI: 10.1111/jocn.15636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition. BACKGROUND Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting. DESIGN Concept analysis. METHODS Walker and Avant's eight-step approach to concept analysis. RESULTS The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing. CONCLUSION Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings. RELEVANCE TO CLINICAL PRACTICE A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development.
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Affiliation(s)
- Andrea J Toews
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Donna E Martin
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Wanda M Chernomas
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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Kim Y, Dym AA, Yang K, Fein DG, Bangar M, Ferenchick HRB, Keene A, Orsi D, Washington MA, Eisen LA. The Effect of Numbered Jerseys on Directed Commands, Teamwork, and Clinical Performance During Simulated Emergencies. J Healthc Qual 2021; 43:24-31. [PMID: 32502088 DOI: 10.1097/jhq.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Communication and teamwork are essential during inpatient emergencies such as cardiac arrest and rapid response (RR) codes. We investigated whether wearing numbered jerseys affect directed commands, teamwork, and performance during simulated codes. Eight teams of 6 residents participated in 64 simulations. Four teams were randomized to the experimental group wearing numbered jerseys, and four to the control group wearing work attire. The experimental group used more directed commands (49% vs. 31%, p < .001) and had higher teamwork score (25 vs. 18, p < .001) compared with control group. There was no difference in time to initiation of chest compression, bag-valve-mask ventilation, and correct medications. Time to defibrillation was longer in the experimental group (190 vs. 140 seconds, p = .035). Using numbered jerseys during simulations was associated with increased use of directed commands and better teamwork. Time to performance of clinical actions was similar except for longer time to defibrillation in the jersey group.
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Hunie M, Desse T, Fenta E, Teshome D, Gelaw M, Gashaw A. Availability of Emergency Drugs and Essential Equipment in Intensive Care Units in Hospitals of Ethiopia: A Multicenter Cross-Sectional Study. Open Access Emerg Med 2020; 12:435-440. [PMID: 33293877 PMCID: PMC7719042 DOI: 10.2147/oaem.s285695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Emergency drugs and essential equipment are important to successfully manage patients in the intensive care unit (ICUs). The absence of these emergency drugs and essential equipment might result in mortality and morbidity which is more compounded in resource-limited settings. This study aims to assess the availability of emergency drugs and essential equipment in ICUs in hospitals in Ethiopia. Materials and Methods A cross-sectional descriptive study design was employed in the intensive care unit of nine Amhara regional state hospitals in Ethiopia. This study was done from August 01, 2020, to September 01, 2020. The data were collected using a structured questionnaire, which were adopted from the Emergency Medicine Society of South Africa (EMSSA) guidelines. Tables and narration were used to describe results. Results There were deficiencies of essential emergency items particularly in the pediatrics domain, devices to confirm tracheal intubation and equipment for managing difficult intubation. Emergency drugs like adrenaline, salbutamol puff, atropine, aspirin, furosemide, hydrocortisone, insulin, lidocaine, and medical oxygen were available in all ICUs, whereas amiodarone, sodium bicarbonate, glucagon, ipratropium nebulization, thiamine were not available in all ICUs. Conclusions and Recommendations There were considerable deficiencies in emergency drugs and essential equipment. Based on our findings, we recommend to develop standardized checklists, regular audits, and healthcare personnel awareness program to improve checking, maintaining, restocking, and repairing the equipment in the emergency trolley.
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Affiliation(s)
- Metages Hunie
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tiruwork Desse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Diriba Teshome
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Moges Gelaw
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amanu Gashaw
- Department of Anesthesia, School of Medicine, College of Health Science, Hawassa University, Hawassa, Sidama, Ethiopia
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Douthit NT, McBride CM, Townsley EC. Increasing Internal Medicine Resident Confidence in Leading Inpatient Cardiopulmonary Resuscitations and Improving Patient Outcomes. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520923716. [PMID: 32518830 PMCID: PMC7252364 DOI: 10.1177/2382120520923716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Residents do not feel confident or competent in leading inpatient resuscitations. This is a crucial part of training future internists. Our objective was to develop a low-cost intervention to improve resident confidence in leading cardiopulmonary resuscitations and patient outcomes. METHODS A "code-conference" including a lecture on a high-yield topic, a low-fidelity simulation, and review of resident-led resuscitations was created at our institution for the 2017-2018 academic year. Patient outcomes were assessed using objective measures of return of spontaneous circulation (ROSC) and survival to discharge (sDC). Confidence was assessed via survey before and after the intervention, with a focus on beginning postgraduate year 2 (PGY-2) residents. RESULTS In 2017, 8 out of 8 (100%) PGY-2 residents responded, while in 2018, 8 out of 10 (80%) responded. Patient outcomes did not show a statistically significant improvement. There was a trend toward positive outcomes in the resident group alone. Return of spontaneous circulation increased from 63% to 79% (P = .08, total n = 97). Resident confidence was not improved in a statistically significant way, but there was a trend toward improvement and residents agreed it was an important part of their training. DISCUSSION There was no statistically significant improvement in code-blue outcomes; however, there was a positive trend with increased ROSC and stable sDC for resident-led resuscitations, despite hospital-wide decreases in both. Resident confidence also showed a positive trend with no statistical significant changes. It is possible to institute a low-cost high-yield intervention to improved resident confidence in leading code-blue resuscitations. It may also improve patient outcomes; however, further studies are needed to determine if it can improve patient survival outcomes.
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Affiliation(s)
- Nathan T Douthit
- Department of Internal Medicine, Brookwood Baptist Health Medical Education, Birmingham, AL, USA
| | | | - Erin Coleman Townsley
- Internal Medicine Residency, Brookwood Baptist Health Medical Education, Birmingham, AL, USA
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Balian S, McGovern SK, Abella BS, Blewer AL, Leary M. Feasibility of an augmented reality cardiopulmonary resuscitation training system for health care providers. Heliyon 2019; 5:e02205. [PMID: 31406943 PMCID: PMC6684477 DOI: 10.1016/j.heliyon.2019.e02205] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/08/2019] [Accepted: 07/30/2019] [Indexed: 10/31/2022] Open
Abstract
AIM OF THE STUDY Augmented reality (AR) has the potential to offer a novel approach to CPR training that supplements conventional training methods with gamification and a more interactive learning experience. This is done through computer-generated imagery superimposed on users' view of the real environment to simulate interactive training scenarios. We sought to test the feasibility of an AR CPR training system (CPReality) for health care providers (HCPs). METHODS In this feasibility trial, a CPR training manikin was integrated with a commercial AR device (Microsoft HoloLens) to provide participants with real-time audio-visual feedback via a holographic overlay of blood flow to vital organs dependent on CC quality. In this system, higher quality CC visually improved virtual blood circulation. HCPs performed a 2-minute cycle of hands-only CPR using only the AR system, and CC parameters were recorded. Descriptive data on participants' demographics, CC quality, and satisfaction with the training environment were reported using quantitative and qualitative analysis. RESULTS Between 10/2018-11/2018, we enrolled a convenience sample of 51 HCPs. The median age of participants was 31 years (IQR 27-41), 71% (36/51) were female, and 67% (34/51) were registered nurses. CC rates (mean 126 ± 12.9 cpm), depths (median 53 mm, IQR 46-58), and percent with complete recoil (median 80%, IQR 12-100) were consistent with guideline recommendations for good quality CPR. Participants were predominantly satisfied with the system, with 82% perceiving the experience as realistic, 98% recognizing the visualizations as helpful for training, and 94% willing to use the application in future CPR training. CONCLUSIONS As AR is increasingly applied in the healthcare setting, integration in CPR training offers a novel and promising educational approach. In this convenience sample of trained HCPs, high quality CC delivery was feasible using the AR CPR training system which was received favorably by most participants.
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Affiliation(s)
- Steve Balian
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shaun K. McGovern
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S. Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Audrey L. Blewer
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Marion Leary
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
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Williams CA, Wedgwood KCA, Mohammadi H, Prouse K, Tomlinson OW, Tsaneva-Atanasova K. Cardiopulmonary responses to maximal aerobic exercise in patients with cystic fibrosis. PLoS One 2019; 14:e0211219. [PMID: 30759119 PMCID: PMC6373911 DOI: 10.1371/journal.pone.0211219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022] Open
Abstract
Cystic fibrosis (CF) is a debilitating chronic condition, which requires complex and expensive disease management. Exercise has now been recognised as a critical factor in improving health and quality of life in patients with CF. Hence, cardiopulmonary exercise testing (CPET) is used to determine aerobic fitness of young patients as part of the clinical management of CF. However, at present there is a lack of conclusive evidence for one limiting system of aerobic fitness for CF patients at individual patient level. Here, we perform detailed data analysis that allows us to identify important systems-level factors that affect aerobic fitness. We use patients’ data and principal component analysis to confirm the dependence of CPET performance on variables associated with ventilation and metabolic rates of oxygen consumption. We find that the time at which participants cross the gas exchange threshold (GET) is well correlated with their overall performance. Furthermore, we propose a predictive modelling framework that captures the relationship between ventilatory dynamics, lung capacity and function and performance in CPET within a group of children and adolescents with CF. Specifically, we show that using Gaussian processes (GP) we can predict GET at the individual patient level with reasonable accuracy given the small sample size of the available group of patients. We conclude by presenting an example and future perspectives for improving and extending the proposed framework. The modelling and analysis have the potential to pave the way to designing personalised exercise programmes that are tailored to specific individual needs relative to patient’s treatment therapies.
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Affiliation(s)
- Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
- * E-mail:
| | - Kyle C. A. Wedgwood
- Department of Mathematics and Living Systems Institute, University of Exeter, Exeter, United Kingdom
- Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom
| | - Hossein Mohammadi
- Department of Mathematics and Living Systems Institute, University of Exeter, Exeter, United Kingdom
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom
| | - Katie Prouse
- Department of Mathematics and Living Systems Institute, University of Exeter, Exeter, United Kingdom
| | - Owen W. Tomlinson
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Living Systems Institute, University of Exeter, Exeter, United Kingdom
- Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom
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Clark R, McLean C. The professional and personal debriefing needs of ward based nurses after involvement in a cardiac arrest: An explorative qualitative pilot study. Intensive Crit Care Nurs 2018; 47:78-84. [PMID: 29680586 DOI: 10.1016/j.iccn.2018.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/20/2017] [Accepted: 03/30/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current research demonstrates that debriefing staff post cardiac arrest in clinical practice is rare, with little evidence of effectiveness. OBJECTIVES The aim of this pilot study was to identify the needs of ward based nurses for debriefing after involvement in a cardiac arrest and to identify any barriers to participating in debriefing. METHODOLOGY An explorative qualitative study was undertaken with a purposive sample of seven nurses working on acute adult wards in a United Kingdom hospital. Data were collected by audio-recorded interviews and analysed using framework analysis. FINDINGS Two key themes emerged relating to the nurses debriefing needs post a cardiac arrest. Nurses expressed 'professional needs' to use the experience as an opportunity to learn and improve practice, and 'personal needs' for reassurance and validation. Nurses identified barriers to engaging in debriefing including lack of awareness and uncertainty about the role of a debrief, identifying time for debriefing and the lack of clear guidance from organisational protocols. CONCLUSION Nurses make a distinction between 'professional' and 'personal needs' which may be met through debriefing. Debriefing is an untapped opportunity, which has the potential to be capitalised on after every cardiac arrest in order to improve care of patients and nurses.
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Affiliation(s)
- Ruth Clark
- University Hospital Southampton, NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom.
| | - Chris McLean
- University of Southampton, Faculty of Health Sciences, Southampton, Hampshire SO17 1BJ, United Kingdom
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11
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Khpal M, Coxwell Matthewman M. Cardiac arrest: a missed learning opportunity. Postgrad Med J 2016; 92:608-10. [DOI: 10.1136/postgradmedj-2016-134117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/13/2016] [Indexed: 11/04/2022]
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13
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Automated testing combined with automated retraining to improve CPR skill level in emergency nurses. Nurse Educ Pract 2015; 15:212-7. [DOI: 10.1016/j.nepr.2014.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 11/08/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
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Abstract
Simulation in anesthesia is a field that has revolutionized the teaching outlook. The uncommon grave situations are no more unseen. The ability of these devices to test and give a taste of nerves to an anesthetist is actually preparing him for a safe future management when the need be. The role of simulation in testing a new device for its likely success in clinical world can be foreseen. Mastering a difficult skill no longer subjects a patient to danger. These advanced methods not only see how anesthetist responds to environment, but also how the OT environment reacts to him. The review highlights how technology will help us become technically sound clinicians for tomorrow.
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Affiliation(s)
- P M Singh
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
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A new method for feedback on the quality of chest compressions during cardiopulmonary resuscitation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:865967. [PMID: 25243189 PMCID: PMC4163344 DOI: 10.1155/2014/865967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/08/2014] [Indexed: 11/17/2022]
Abstract
Quality of cardiopulmonary resuscitation (CPR) improves through the use of CPR feedback devices. Most feedback devices integrate the acceleration twice to estimate compression depth. However, they use additional sensors or processing techniques to compensate for large displacement drifts caused by integration. This study introduces an accelerometer-based method that avoids integration by using spectral techniques on short duration acceleration intervals. We used a manikin placed on a hard surface, a sternal triaxial accelerometer, and a photoelectric distance sensor (gold standard). Twenty volunteers provided 60 s of continuous compressions to test various rates (80–140 min−1), depths (3–5 cm), and accelerometer misalignment conditions. A total of 320 records with 35312 compressions were analysed. The global root-mean-square errors in rate and depth were below 1.5 min−1 and 2 mm for analysis intervals between 2 and 5 s. For 3 s analysis intervals the 95% levels of agreement between the method and the gold standard were within −1.64–1.67 min−1 and −1.69–1.72 mm, respectively. Accurate feedback on chest compression rate and depth is feasible applying spectral techniques to the acceleration. The method avoids additional techniques to compensate for the integration displacement drift, improving accuracy, and simplifying current accelerometer-based devices.
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Mpotos N, De Wever B, Cleymans N, Raemaekers J, Loeys T, Herregods L, Valcke M, Monsieurs KG. Repetitive sessions of formative self-testing to refresh CPR skills: a randomised non-inferiority trial. Resuscitation 2014; 85:1282-6. [PMID: 24983199 DOI: 10.1016/j.resuscitation.2014.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/26/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate whether repetitive sessions of formative self-testing (RFST) result in an equal cardiopulmonary resuscitation (CPR) skill level compared to repetitive sessions of formative self-testing with additional practice (RFSTAP). METHODS In a non-inferiority trial, 196 third-year medical students were randomised to an RFST or RFSTAP group. Testing and practising took place in a self-learning station equipped with a manikin connected to a computer. Each cycle of RFST consisted of a 2-min CPR test followed by feedback and feedforward. In the RFSTAP group, additional practice consisted of CPR exercises with a computer voice feedback. To be successful, a combined score consisting of ≥70% compressions with a depth of ≥50 mm and ≥70% compressions with complete release (<5 mm) and a compression rate of 100-120 min(-1) and ≥70% ventilations with a volume of 400-1000 ml had to be achieved within 6 weeks. Skill retention was measured after 6 months. The non-inferiority margin was predefined as a 10% difference in success rate. RESULTS After six weeks the success rate in both groups was 96%: 99/103 (RFST) and 89/93 (RFSTAP). After 6 months, the success rate in the competent students was 26/96 (27%) for RFST and 32/86 (37%) for RFSTAP (three students dropped out in each group). The difference in the success rate between RFSTAP and RFST was 10% and 90% (CI -2 to 23%), respectively. As the upper bound exceeded 10%, non-inferiority was inconclusive. For each CPR skill separately, RFST was non-inferior for ventilation and complete release, superior for compression depth and inferior for compression rate. CONCLUSIONS RFST and RFSTAP were equally effective to refresh skills within 6 weeks. After 6 months, non-inferiority was inconclusive for the combined score. Our results indicate the potential of RFST to refresh CPR skills.
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Affiliation(s)
- Nicolas Mpotos
- Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
| | - Bram De Wever
- Department of Educational Studies, Ghent University, H. Dunantlaan 2, B-9000 Ghent, Belgium
| | - Nick Cleymans
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Joris Raemaekers
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Tom Loeys
- Department of Data Analysis, Ghent University, H. Dunantlaan 1, B-9000 Ghent, Belgium
| | - Luc Herregods
- Department of Anaesthesiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Martin Valcke
- Department of Educational Studies, Ghent University, H. Dunantlaan 2, B-9000 Ghent, Belgium
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium; Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium
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Kristiansen AM, Svanholm JR, Karlgren K. Debriefing after in-hospital cardiopulmonary resuscitation—Does it work? A literature review. Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2013.08.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Efficiency of short individualised CPR self-learning sessions with automated assessment and feedback. Resuscitation 2013; 84:1267-73. [DOI: 10.1016/j.resuscitation.2013.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/29/2013] [Accepted: 02/26/2013] [Indexed: 11/19/2022]
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Couper K, Finn J. Real-time feedback during basic life support training: Does it prevent skill decay? Resuscitation 2013; 84:1005-6. [DOI: 10.1016/j.resuscitation.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 11/16/2022]
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An institutionwide approach to redesigning management of cardiopulmonary resuscitation. Jt Comm J Qual Patient Saf 2013; 39:157-66. [PMID: 23641535 DOI: 10.1016/s1553-7250(13)39022-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite widespread training in basic life support (BLS) and advanced cardiovascular life support (ACLS) among hospital personnel, the likelihood of survival from in-hospital cardiac arrests remains low. In 2006 a university-affiliated tertiary medical center initiated a cardiopulmonary (CPR) resuscitation redesign project. REDESIGNING THE HOSPITAL'S RESUSCITATION SYSTEM: The CPR Committee developed the interventions on the basis of a large-scale view of the process of delivering BLS and ACLS, identification of key decision nodes and actions, and compartmentalization of specific functions. It was proposed that arrest management follow a steady progression in a two-layer scheme from BLS to ACLS. Handouts describing team structure and specific roles were given to all code team providers and house staff at the start of their month-long rotations. To further increase role clarity and team organization, daily morning and evening meetings of the arrest team were instituted. Site-specific BLS training, on-site ACLS refresher training, and defibrillator training were initiated. Project elements also included use of unannounced mock codes to provide system oversight; preparation and distribution of cognitive aids (printed algorithms, dosing guides, and other checklists to ensure compliance with ACLS protocols), identification of patients who may be unstable or a source of concern, event review and analysis of arrests and other critical events, and a CPR website. CONCLUSION A mature hospital-based resuscitation system should include definition of arrest trends and resuscitation needs, development of local methods for approaching the arresting patient, an emphasis on prevention, establishment of training programs tailored to meet specific hospital needs, system examination and oversight, and administrative processes that maximize interaction between all components.
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Are the 2010 guidelines on cardiopulmonary resuscitation lost in translation? A call for increased focus on implementation science. Resuscitation 2013; 84:422-5. [DOI: 10.1016/j.resuscitation.2012.08.336] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/12/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022]
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Monsieurs K, Mpotos N. Motion detection technology to measure chest compressions on a manikin: Does it work and does it improve quality? Resuscitation 2013; 84:411-2. [DOI: 10.1016/j.resuscitation.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/25/2022]
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Wallmüller C, Sterz F, Testori C, Schober A, Stratil P, Hörburger D, Stöckl M, Weiser C, Kricanac D, Zimpfer D, Deckert Z, Holzer M. Emergency cardio-pulmonary bypass in cardiac arrest: Seventeen years of experience. Resuscitation 2013; 84:326-30. [DOI: 10.1016/j.resuscitation.2012.05.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/08/2012] [Accepted: 05/11/2012] [Indexed: 11/16/2022]
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Gruber J, Stumpf D, Zapletal B, Neuhold S, Fischer H. Real-time feedback systems in CPR. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McInnes AD, Sutton RM, Nishisaki A, Niles D, Leffelman J, Boyle L, Maltese MR, Berg RA, Nadkarni VM. Ability of code leaders to recall CPR quality errors during the resuscitation of older children and adolescents. Resuscitation 2012; 83:1462-6. [PMID: 22634433 DOI: 10.1016/j.resuscitation.2012.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
AIM Performance of high quality CPR is associated with improved resuscitation outcomes. This study investigates code leader ability to recall CPR error during post-event interviews when CPR recording/audiovisual feedback-enabled defibrillators are deployed. PATIENTS AND METHODS Physician code leaders were interviewed within 24h of 44 in-hospital pediatric cardiac arrests to assess their ability to recall if CPR error occurred during the event. Actual CPR quality was assessed using quantitative recording/feedback-enabled defibrillators. CPR error was defined as an overall average event chest compression (CC) rate <95/min, depth < 38 mm, ventilation rate >10/min, or any interruptions in CPR >10s. We hypothesized that code leaders would recall error when it actually occurred ≥ 75% of the time when assisted by audiovisual alerts from a CPR recording feedback-enabled defibrillators (analysis by χ(2)). RESULTS 810 min from 44 cardiac arrest events yielded 40 complete data sets (actual and interview); ventilation data was available in 24. Actual CPR error was present in 3/40 events for rate, 4/40 for depth, 32/40 for interruptions >10s, and 17/24 for ventilation frequency. In post-event interviews, code leaders recalled these errors in 0/3 (0%) for rate, 0/4 (0%) for depth, and 19/32 (59%) for interruptions >10s. Code leaders recalled these CPR quality errors less than 75% of the time for rate (p=0.06), for depth (p<0.01), and for CPR interruption (p=0.04). Quantification of errors not recalled: missed rate error median=94 CC/min (IQR 93-95), missed depth error median=36 mm (IQR 35.5-36.5), missed CPR interruption >10s median=18s (IQR 14.4-28.9). Code leaders did recall the presence of excessive ventilation in 16/17 (94%) of events (p=0.07). CONCLUSION Despite assistance by CPR recording/feedback-enabled defibrillators, pediatric code leaders fail to recall important CPR quality errors for CC rate, depth, and interruptions during post-cardiac arrest interviews.
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Affiliation(s)
- Andrew D McInnes
- The Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
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Atkins DL, Berger S. Improving outcomes from out-of-hospital cardiac arrest in young children and adolescents. Pediatr Cardiol 2012; 33:474-83. [PMID: 21842254 DOI: 10.1007/s00246-011-0084-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 07/28/2011] [Indexed: 12/01/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is an unusual but devastating occurrence in a young person. Years of life-lost are substantial and long-term health care costs of survivors can be high. However, there have been noteworthy improvements in cardiopulmonary resuscitation (CPR) standards, out-of hospital care, and postcardiac arrest therapies that have resulted in a several-fold improvement in resuscitation outcomes. Recent interest and research in resuscitation of children has the promise of generating improvements in the outcomes of these patients. Integrated and coordinated care in the out-of-hospital and hospital settings are required. This article will review the epidemiology of OHCA, the 2010 CPR guidelines, and developments in public access defibrillation for children.
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Affiliation(s)
- Dianne L Atkins
- Carver College of Medicine, University of Iowa Children's Hospital, Iowa City, IA 52242, USA.
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Boller M, Boller EM, Oodegard S, Otto CM. Small animal cardiopulmonary resuscitation requires a continuum of care: proposal for a chain of survival for veterinary patients. J Am Vet Med Assoc 2012; 240:540-54. [DOI: 10.2460/javma.240.5.540] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tschan F, Vetterli M, Semmer NK, Hunziker S, Marsch SC. Activities during interruptions in cardiopulmonary resuscitation: A simulator study. Resuscitation 2011; 82:1419-23. [DOI: 10.1016/j.resuscitation.2011.06.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 06/15/2011] [Accepted: 06/21/2011] [Indexed: 11/24/2022]
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Fisher N, Eisen LA, Bayya JV, Dulu A, Bernstein PS, Merkatz IR, Goffman D. Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training. Am J Obstet Gynecol 2011; 205:239.e1-5. [PMID: 22071051 DOI: 10.1016/j.ajog.2011.06.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/02/2011] [Accepted: 06/03/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the impact of simulation-based maternal cardiac arrest training on performance, knowledge, and confidence among Maternal-Fetal Medicine staff. STUDY DESIGN Maternal-Fetal Medicine staff (n = 19) participated in a maternal arrest simulation program. Based on evaluation of performance during initial simulations, an intervention was designed including: basic life support course, advanced cardiac life support pregnancy modification lecture, and simulation practice. Postintervention evaluative simulations were performed. All simulations included a knowledge test, confidence survey, and debriefing. A checklist with 9 pregnancy modification (maternal) and 16 critical care (25 total) tasks was used for scoring. RESULTS Postintervention scores reflected statistically significant improvement. Maternal-Fetal Medicine staff demonstrated statistically significant improvement in timely initiation of cardiopulmonary resuscitation (120 vs 32 seconds, P = .042) and cesarean delivery (240 vs 159 seconds, P = .017). CONCLUSION Prompt cardiopulmonary resuscitation initiation and pregnancy modifications application are critical in maternal and fetal survival during cardiac arrest. Simulation is a useful tool for Maternal-Fetal Medicine staff to improve skills, knowledge, and confidence in the management of this catastrophic event.
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Sweeney A, Stephany A, Whicker S, Bookman J, Turner DA. Senior pediatric residents as teachers for an innovative multidisciplinary mock code curriculum. J Grad Med Educ 2011; 3:188-95. [PMID: 22655141 PMCID: PMC3184896 DOI: 10.4300/jgme-d-10-00212.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/31/2010] [Accepted: 01/01/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resuscitation education for pediatric residents may be limited due to the low frequency of actual codes in children. Mock codes represent an opportunity to increase trainee education in acute resuscitations, and we designed a unique multidisciplinary mock code curriculum that uses senior pediatric residents as teachers. METHODS A novel mock code curriculum was designed and integrated into an existing night-float rotation. Our 2-tiered curriculum not only focuses on improving teaching proficiency for resident educators (REs) but also includes separate goals to augment simulation-based resuscitation education for resident participants (RPs) and the multidisciplinary staff. RESULTS Seventy-six residents (17 REs, 59 RPs) and more than 75 nurses have participated in the curriculum. After participation, 100% of residents felt that this curriculum would improve the quality of actual resuscitations, and 94% of RPs reported receiving valuable feedback. Comfort with teaching and feedback increased for REs (P < .05), and comfort in resuscitation and crisis resource management improved for RPs (P < .05). The nursing staff also felt that communication, teamwork, and collaboration improved due to implementation of this curriculum. CONCLUSIONS A unique mock code curriculum can improve resident comfort with teaching, peer facilitation, feedback, and resuscitation. Curricular interventions of this nature may also be able to improve the balance between service and education within a residency training program. As we move toward a competency based training model within graduate medical education, further investigation is needed to link educational modifications of this nature to clinical outcomes and actual resident performance.
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Reyes JA, Somers GR, Taylor GP, Chiasson DA. Increased incidence of CPR-related rib fractures in infants--is it related to changes in CPR technique? Resuscitation 2011; 82:545-8. [PMID: 21353734 DOI: 10.1016/j.resuscitation.2010.12.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 11/15/2010] [Accepted: 12/27/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE A recent increase in the number of infants presenting at autopsy with rib fractures associated with cardio-pulmonary resuscitation (CPR) precipitated a study to determine whether such a phenomenon was related to recent revision of paediatric resuscitation guidelines. METHODS We conducted a review of autopsy reports from 1997 to 2008 on 571 infants who had CPR performed prior to death. RESULTS Analysis of the study population revealed CPR-related rib fractures in 19 infants (3.3%), 14 of whom died in the 2006-2008 period. The difference in annual frequency of CPR-related fractures between the periods before and after revision of paediatric CPR guidelines was statistically highly significant. CONCLUSIONS The findings indicate that CPR-associated rib fractures have become more frequent in infants since changes in CPR techniques were introduced in 2005. This has important implications for both clinicians and pathologists in their assessment of rib fractures in this patient population.
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Affiliation(s)
- J A Reyes
- Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Boller M. Celebrating the 50th anniversary of cardiopulmonary resuscitation: from animals to humans…and back? J Vet Emerg Crit Care (San Antonio) 2010; 20:553-7. [PMID: 21166976 DOI: 10.1111/j.1476-4431.2010.00593.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Percarpio KB, Harris FS, Hatfield BA, Dunlap B, Diekroger WE, Nichols PD, Mazzia LM, Mills PD, Neily JB. Code Debriefing from the Department of Veterans Affairs (VA) Medical Team Training Program Improves the Cardiopulmonary Resuscitation Code Process. Jt Comm J Qual Patient Saf 2010; 36:424-9, 385. [DOI: 10.1016/s1553-7250(10)36062-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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