A failed attempt to improve quality of out-of-hospital CPR through performance evaluation

Prehosp Emerg Care. 2007 Oct-Dec;11(4):427-33. doi: 10.1080/10903120701536628.


Introduction: Quality of CPR performed by professionals has been reported to be substandard even with automated corrective feedback. Our hypothesis was that providing CPR performance evaluation (CPR-PE) to three ambulance services would facilitate local education and implementation of CPR guidelines and, consequently, improve CPR quality.

Methods: Quality of CPR in 85 consecutive cases of adult out-of-hospital cardiac arrests after CPR-PE was compared to 39 cases prior to CPR-PE. Real-time automated verbal and visual feedback on CPR performance was given in all cases. No general implementation strategy was provided because the sites were expected to use the CPR-PEs in development of local strategies. Because the strategies were expected to vary, the sites were analyzed separately.

Results: No significant improvement was seen in quality of CPR after CPR-PE. No chest compressions were given 40% of the time before versus 41% after CPR-PE. The median (95% confidence interval) percentage of chest compressions within the recommended depth range (38-51 mm) was 35% (27-57) before versus 51% (42-60) after CPR-PE (p = 0.12). In site-specific analysis, chest compressions within guideline depth increased from 31% to 61% after CPR-PE (p = 0.05) in one site.

Conclusions: Overall our attempt to improve CPR-quality was unsuccessful. Quality improvement likely requires a full range of implementation strategies to change current attitudes and practices.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / standards*
  • Emergency Medical Services*
  • Female
  • Heart Arrest / therapy*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality Assurance, Health Care / methods*