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Improving Outcomes for In-Hospital Cardiac Arrest

Alex KlacmanBy Alex Klacman, PhD(c), MSN/Ed., RN-BC, CCRN

February is American Heart Month! One American dies every 38 seconds from cardiovascular disease. The ultimate expression of cardiovascular disease is cardiac arrest. Each year, approximately 192,000 adults hospitalized in the United States suffer an in-hospital cardiac arrest (IHCA; Merchant et al., 2011). Sadly, nearly 141,000 of these patients will die from the cardiac arrest.

Researchers have been interested in examining why nearly 73% of patients who suffer an IHCA die (Benjamin et al., 2018). It is theorized that poor-quality cardiopulmonary resuscitation (CPR) delivered by healthcare providers may be partly responsible. The current two-year basic life support retraining intervals are not adequate for CPR providers to obtain and maintain competence in high-quality CPR skill performance. All healthcare providers must demonstrate competence in the skills that they perform, and this concept should be no different for the skills required to successfully resuscitate cardiac arrest victims. Researchers have shown that CPR skills decay in as little as three months, thus waiting longer than three months to refresh skills could directly impact a provider’s ability to perform CPR. This timeframe could lead to preventable harm to the patient.

The question then becomes how we can train CPR providers on a more frequent and ongoing basis. The resources needed to retrain CPR providers every three months would be too substantial to sustain over time. That’s where the American Heart Association and Laerdal Medical’s Resuscitation Quality Improvement (RQI)® Program becomes important. In 2014, I became the first person globally to implement this program at a large hospital in Dallas, TX.

The RQI Program utilizes CPR skills stations equipped with an adult and infant mannequin and a computer system that is located on the clinical unit. Every three months, CPR providers log into the computer system and complete a series of skills that take less than 10 minutes to execute. These skill sessions consist of 60 compressions and then followed by one minute of bag-mask ventilation. In other quarter in the program, there is a two-person CPR activity where the computer acts as a virtual second provider. During these skill sessions, CPR providers receive real-time audio and visual feedback that coaches the provider to high-quality CPR skill performance. For every quarter that the provider performs at a minimum acceptable level, the provider receives 90 days on their CPR card. This allows for perpetual CPR certification and could eliminate the need for classroom-based CPR training.

We recently completed a retrospective cohort study on whether providers enrolled in the RQI Program were able to obtain and/or maintain adequate CPR skill performance over time. In the soon to be published study, we used linear mixed-effects modeling to determine that across nine components of CPR, there was either improvement in skills over time or maintenance of CPR performance over time. In addition to improved competence, we saved over $395,000 each year through implementation of the program. While saving money is one aim, we also needed to ensure that we are improving outcomes for patients who suffer cardiac arrest. We conducted a retrospective chart audit on survival from cardiac arrest before and after implementation of the program. Not surprisingly, we saw statistically significant improvements in outcomes from cardiac arrest following implementation of the program!

Care of cardiac arrest patients and improving CPR performance at the point-of-care requires innovative solutions. Whether using the RQI Program, mock codes, or bedside refresher skills with a CPR mannequin, organizations must implement ongoing skill refreshers. Doing so will lead to improved CPR skills and better outcomes from cardiac arrest. Through intentions like the RQI Program, healthcare providers can improve survival rates of cardiac arrest victims.

Happy Heart Month!

Original Publish Date: February 2019


Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng,
     S.,...Munter, P. (2018). Heart disease and stroke statistics- 2018 update: A report from the
     American Heart Association. Circulation, 137, e67-e492.      doi:10.1161/CIR.0000000000000558 

Merchant, R. M., Yang, L., Becker, L. B., Berg, R. A., Nadkarni, V., & Nichol, G.,...Groenveld,
     P. W. (2011). Incidence of treated cardiac arrest in-hospitalized patients in the United States. Critical Care Medicine, 39, 2401-       2406. doi:10.1097/CCM.0b013e3182257459

Additional Resources Related to this Article

American Heart Association (AHA)
Resuscitation Quality Improvement (RQI)®
YouTube Video Discussing RQI

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