CLINICAL AUDIT on CARDIOPULMONARY RESUSCITATION
AIM:
To assess and improve the quality and effectiveness of Cardiopulmonary Resuscitation
(CPR) practices within a hospital.
OBJECTIVE :
To achieve the aim of this project, the following specific objectives have been outlined:
1. Evaluate Adherence to CPR Guidelines: Assess how well healthcare providers
follow established CPR protocols, such as chest compression depth, compression
rate, and time to defibrillation.
2. Identify Delays and Inefficiencies: Investigate potential delays in CPR initiation
and defibrillation, as well as any gaps in the process that hinder effective
resuscitation.
3. Examine Patient Outcomes: Review patient survival rates and neurological
recovery following CPR to understand the effectiveness of CPR interventions in
clinical practice.
4. Recommend Improvements: Based on the findings, suggest evidence-based
strategies to enhance CPR training, team performance, and the timely application of
resuscitation interventions.
PERIOD OF STUDY:
NOVEMBER 2024 to JANUARY 2025
AUDIT MEMBERS :
1. Dr. Haritha Kumari Landa
2. Ms. Omna
INTRODUCTION:
CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed
when the heart stops beating. Immediate CPR can double or triple chances of survival after
cardiac arrest.
CPR has evolved over the years, with substantial improvements in techniques and
guidelines. Key points include:
Basic CPR (BLS) involves chest compression and rescue breaths for individuals
who are unresponsive and not breathing normally.
Advanced Life Support (ALS) focuses on advanced airway management and
defibrillation, typically performed by healthcare providers.
The AHA guidelines emphasize high-quality chest compression (5-6 cm depth,
100-120 compression per minute), early defibrillation, and effective ventilation.
Evidence indicates that immediate CPR, especially when combined with early
defibrillation, can double or triple the chances of survival after a cardiac arrest.
How is CPR Performed?
There are two commonly known versions of CPR:
1. For healthcare providers and those trained: conventional CPR using chest
compression and mouth-to-mouth breathing at a ratio of 30:2 compression-to-
breaths. In adult victims of cardiac arrest, it is reasonable for rescuers to perform
chest compression at a rate of 100 to 120/min and to a depth of at least 2 inches (5
cm) for an average adult, while avoiding excessive chest compression depths
(greater than 2.4 inches [6 cm]).
2. For the general public or bystanders who witness an adult suddenly collapse:
compression-only CPR, or Hands-Only CPR. Hands-Only CPR is CPR without mouth-
to-mouth breaths. It is recommended for use by people who see a teen or adult
suddenly collapse in an out-of-hospital setting
High-quality CPR is the primary component in influencing survival from cardiac arrest. To
save more lives, healthcare providers must be competent in delivering high-quality CPR,
and patient care teams must be coordinated and competent working together effectively.
High-quality CPR performance metrics include:
Chest compression fraction >80%
Compression rate of 100-120/min
Compression depth of at least 50 mm (2 inches) in adults and at least 1/3 the AP
dimension of the chest in infants and children
No excessive ventilation
CPR PATHWAY:
DATA ANALYSIS :
Sample size – 20
- 19 patients met with the criteria, which is equal to 95%
- 1 patient did not meet the criteria (Attenders has signed DNR), which is equal to 5%
No. of deceased cases – 18
No. of revived case – 1
COMPARISON CATEGORY :
The cases have been categorized based on the type of heart rate, which are as follows:
1. Sinus Bradycardia-
12 cases reviewed, that is 63%, out of which 1 patient could be revived, 1
patient underwent CPR 2 times, where the first time the patient was revived, but
within an interval of 1 hour, the patient passed away.
2. Asystole-
5 cases were reviewed, that is 26%
3. Atrial Fibrillation-
1 case was reviewed, that is 5%
4. Ventricular Tachycardia-
1 case was reviewed, that is 5%
Type of Heart DIAGNOSIS
Rate
1. Dyselectrolytemia, septic shock with encephalopathy,
hyponatremic shock
2. Aspiration, pulmonary edema, secondary to CAD
3. LRTI, old Koch’s, refractory hypotension, hypoxia due to multi
organ failure
4. Hemoptysis viral pneumonia
5. Sickle cell crisis, fever for evaluation
Sinus 6. Encephalopathy for evaluation, CVA, Refractory hypotension,
Bradycardia severe metabolic acidosis, septic shock
7. CKD, CAD
8. Left massive pleural, cardiogenic shock, secondary to
myocarditis
9. Pancytopenia for evaluation, SOB for evaluation
10.Community acquired pneumonia
11.Encephalopathy for evaluation, refractory shock & liver failure
12.CAD, CCP post CABG
1. SOB, arrived in gasping condition
2. CKD, infective endocarditis, septic shock
Asystole 3. Bilateral lower limb cellulitis, thrombocytopenia, septic shock
4. High risk neonate, CHD ASD with PDA
5. Burns 75%-85%, severe metabolic acedosis
Atrial 1. Hypoglycemia for evaluation, sepsis, right sided pneumonia,
Fibrillation aspiration pneumonia
Ventricular 1. LV dysfunction, severe metabolic acedosis
Tachycardia
INFERENCE :
The audit revealed both strengths and areas for improvement in CPR practices within the
healthcare setting. Few of the notable points are as follows :
1. There should be adequate CPR given to the respective patient with the cardiac
arrest.
2. Absolutely no delays and inefficiencies should be accepted.
3. Depending on the diagnosis & prognosis of the patient, the chances of cardiac arrest
should be predicted and evaluated & the chances the patient might require a CPR.
4. On the basis of the outcome of the CPR, it should be analyzed when the condition is
correctable or non-correctable or whether the clinical status will deteriorate.
5. Corrective and preventive actions should be taken into place from the moment the
patient gets admitted to a hospital, such that occurrence of CPR can be mitigated with
correct treatment.
6. Only members of the Code Blue Team should be present at the site of occurrence, so
that there is no confusion in role assignment and haphazard situations are avoided.
CONCLUSION:
CPR remains a vital skill in improving survival rates following cardiac arrest. While the
audit revealed that CPR guidelines are largely followed, there are critical areas where
improvement is needed. By addressing delays in response time, enhancing training, and
improving team coordination, we can significantly improve CPR quality and patient
outcomes.
