Improvements in the quality of advanced life support and patient outcome after implementation of a standardized real-life post-resuscitation feedback system

Resuscitation. 2017 Nov;120:38-44. doi: 10.1016/j.resuscitation.2017.08.235. Epub 2017 Aug 31.

Abstract

Background: Educational aspects in the training of advanced life support (ALS) represent a key role in critical care management of patients with out-of-hospital cardiac arrest (OHCA) and received special attention in guidelines of various international societies. While a positive association of feedback on ALS performance in training conditions is well established, data on the impact of a real-life post-resuscitation feedback on both ALS quality and outcome remain scarce and inconclusive. We aimed to elucidate the impact of a standardized post-resuscitation feedback on quality of ALS and improvements in patient outcome, in a real-life out-of-hospital setting.

Methods: We prospectively enrolled and analyzed 2209 patients presenting with OHCA receiving resuscitation attempts by the municipal emergency medical service (EMS) of Vienna over a two-year period. A standardized post-resuscitation feedback protocol was delivered to the respective EMS-team to elucidate its impact on the quality of ALS.

Results: We observed that both chest compression rates and ratios were in accordance to recommendations of recent guidelines. While interruptions of chest compressions longer than 30s declined during the observation period (-6.5%) rates of the recommended chest compressions during defibrillator-charging periods increased (+8.9%). Since the percentage of ROSC and 30-day survival remained balanced, the frequencies of both survival until hospital discharge (+6.3%) and favorable neurological outcome (+16%) in survivors significantly increased during the observation period.

Conclusion: Improvements in the quality of advanced life support as well the patient outcome were observed after the implementation of a standardized post-resuscitation feedback protocol.

Keywords: Advanced life support; Feedback; Out-of-hospital cardiac arrest; Outcome.

MeSH terms

  • Advanced Cardiac Life Support / education*
  • Advanced Cardiac Life Support / methods
  • Aged
  • Emergency Medical Services / standards*
  • Feedback
  • Female
  • Heart Massage
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / mortality*
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Outcome Assessment, Health Care
  • Program Evaluation
  • Prospective Studies
  • Quality Improvement
  • Time-to-Treatment