Couper, Keith, Kimani, Peter K., Abella, Benjamin S., Chilwan, Mehboob, Cooke, Matthew, Davies, Robin P., Field, Richard A., Smith, F. Gao (Fang Gao), Quinton, Sarah, Stallard, Nigel, Woolley, Sarah and Perkins, Gavin D. (2015) The system-wide effect of real-time audiovisual feedback and postevent debriefing for in-hospital cardiac arrest. Critical Care Medicine, 43 (11). pp. 2321-2331. doi:10.1097/CCM.0000000000001202 ISSN 0090-3493.

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Abstract

Objective:
To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest.

Design:
A two-phase, multicentre prospective cohort study.

Setting:
Three UK hospitals, all part of one National Health Service Acute Trust.

Patients:
One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013.

Interventions:
During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2.

Measurements and Main Results:
The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31–1.22; p = 0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35–1.21; p = 0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06–3.30; p = 0.03) and process-focused outcomes.

Conclusions:
Implementation of real-time audiovisual feedback with or without postevent debriefing did not lead to a measured improvement in patient or process-focused outcomes at individual hospital sites. However, there was an unexplained system-wide improvement in return of spontaneous circulation and process-focused outcomes during the second phase of the study.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > ( - July 2016) Health Education Hub Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	CPR (First aid) -- Methodology, CPR (First aid) -- Study and teaching, Cardiac arrest -- Treatment
Journal or Publication Title:	Critical Care Medicine
Publisher:	Lippincott Williams & Wilkins
ISSN:	0090-3493
Official Date:	November 2015
Dates:	Date Event November 2015 Published
Volume:	43
Number:	11
Number of Pages:	11
Page Range:	pp. 2321-2331
DOI:	10.1097/CCM.0000000000001202
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	31 December 2015
Date of first compliant Open Access:	31 December 2015
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	PB-PG-1207–14246 (NIHR)

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