While overall cardiac deaths have dropped in recent decades, sudden cardiac deaths have not seen a similar decrease. Of the 200,000 people who have a sudden cardiac arrest in the hospital, only 24% survive.
The term “use it or lose it” applies to many skills, and competency in cardiopulmonary resuscitation (CPR) is no exception. While studies show skills can decay within 3 to 6 months of training, certification in Basic Life Support is only required every 2 years.
When skills diminish among healthcare professionals, the results can be deadly. Now, the American Heart Association (AHA) is trying to change that by promoting more frequent, convenient training.
The AHA and Laerdal Medical last week called for a “paradigm shift” in the way hospital staff stay current with CPR skills. Through the use of in-hospital learning stations complete with mannequins, the Resuscitation Quality Improvement (RQI) program seeks to eliminate 50,000 preventable deaths from cardiac arrest each year by 2025.
After AHA did studies on how quickly CPR skills were lost, there was the question: “How can we disrupt this and do it better?” John Meiners, chief of Mission-Aligned Businesses at AHA, said in an interview with The American Journal of Managed Care® (AJMC®). “We had to do it more frequently, offering low-dose, high-frequency training.”
However, there was no desire to take staff off the treatment floor. Technology offered the solution: RQI promotes use of a portable cart outfitted with adult- and infant-sized mannequins, as well as a computer. Staff can receive short, online lessons and practice CPR right where they work, Meiners said, and the station can move around the hospital to serve many locations, making it cost-effective.
In a statement, AHA said the technology from Laerdal would reduce costs by eliminating the need for trainers and by keeping staff on-site instead of sending them off the hospital floor. Health systems can measure sustained competency by tracking staff members’ RQI scores, which are given during the short trainings.
The mannequins are designed to allow staff to master CPR elements, including compression depth and recoil, according to the AHA statement.
“Our vision is to get to zero preventable deaths,” Meiners said. “The hospital should be the safest place.”
Right now, about 200,000 adult cardiac arrests happen in hospitals, but only 24% of these patients survive. (Overall, 325,000 people die in the United States each year from sudden cardiac arrest, including episodes in and out of the hospital.)
“Getting to zero preventable deaths from cardiac arrest is certainly about saving lives and reducing disability,” Meiners said.
According to Tore Laedal, chairman and CEO of Laerdal Medical, about 400 US hospitals have implemented the RQI program and 300,000 providers have improved their CPR skills.
“Technology has advanced to focus on healthcare provider competency, which can lead to transforming the quality and standard of care,” Laerdal said in the AHA statement. “The key to success is hospital adoption and implementation of the low-dose, high-frequency paradigm.”
Fear of change can always be a barrier to innovation, Meiners said, but once the core early adopters see success, more hospitals will start implementing it.
During an event in Dallas, Texas, AHA recognized early implementation of RQI in Seton Heatlhcare of Austin, Texas; Texas Health Resources and the University of Texas Southwestern Medical Center, both in Dallas; The Ohio State University Wexner Medical Center in Columbus, Ohio; the University of Alabama-Birmingham Medical Center in Birmingham; and the University of Rochester Medical Center in Rochester, New York.
The need to reduce sudden cardiac deaths has been recognized for some time. In 2013, a paper in the American Heart Journal found that despite an overall decline in cardiac-related deaths, sudden cardiac arrests remained just as deadly. The authors wrote that studies of prevention and treatment for sudden cardiac arrests, including the use of drugs, implantable devices, and external defibrillators, as well as CPR, “have brought to light substantial underutilization, variations in care, and disparities.”
The article called for the development of performance measures to prevent and treat sudden cardiac arrest. In 2016, the lead author of the article, Sana Al-Khatib, MD, FACC, announced the American College of Cardiology report that called for the development of 10 new measures for preventing sudden cardiac death. They covered areas such as screening, education, and training in automated external defibrillators for family members of at-risk patients, use of guideline-directed medical therapy and implanting cardioverter defibrillators in certain heart failure patients. The items in the 2016 report, however, addressed prehospital care, not measures for how to avoid deaths for patients already in the hospital.
Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN, the chief nursing officer for Texas Health Presbyterian Hospital in Dallas, said in an email to AJMC® that health systems already have emergency medical services liaisons to promote education and coordination among first responders, who offer critical prehospital care for those who experience sudden cardiac arrest. The RQI program will call for that approach to occur with educational organizations, such as schools of health, that train providers.
“Setting a new standard of high-frequency, low-dose training for CPR across the continuum of care—from prehospital, acute care, to post-acute—that is inclusive of educational organizations can be an accelerator for saving 50,000 lives and getting to zero," said Edmonson.