Association between barriers of resuscitation and chest compression quality metrics during in-hospital cardiac arrest resuscitation attempts

Abstract

Objective: To investigate the association between barriers reported by cardiac arrest team members and chest compression quality during in-hospital cardiac arrest (IHCA) cardiopulmonary resuscitation (CPR) attempts.

Methods: This is a mixed-methods prospective cohort study. We sent post-event debriefing surveys to cardiac arrest team members following resuscitation attempts across four hospitals from 2017 to 2022. Likert-scale ratings and qualitative analysis of free-text comments were used to categorize events as having barriers present. We investigated the association between barriers and key chest compression quality metrics measured from defibrillators. The association was further examined for three predefined barrier categories: CPR quality, teamwork and communication.

Results: We included 313 IHCAs with complete defibrillator and survey data, of which 133 (42.5%) events had barriers reported. The odds ratio (OR) of having a CCF ≥80% was 0.55 (95% CI: 0.35-0.89) when barriers were reported. IHCAs with any reported barriers had an increase in the longest pause duration of 3.21 s (95% CI: -1.91 to 8.38) compared to IHCAs without reported barriers, while the OR for guideline-compliant compression rate was 1.02 (95% CI: 0.64-1.62). Communication barriers, but not teamwork and CPR quality barriers, were associated with lower odds of guideline-compliant chest compression rates (OR = 0.53; 95% CI: 0.29-0.95).

Conclusion: Barriers were frequently reported during IHCA and were associated with a significantly lower odds for a CCF ≥80% but not significantly associated with the longest pause duration and guideline-compliant chest compression rates. The category of communication barriers appeared to be the main driver of associations with chest compression quality metrics.

Keywords: Barriers; CPR quality; Cardiac arrest team; Cardiopulmonary resuscitation; Chest compression fraction; Chest compression pauses; Chest compression quality; IHCA; In-hospital cardiac arrest; Leadership; Non-technical skills.