In-Hospital CPR Quality
Many studies have shown that in-hospital CPR quality is variable and devices that provide audio and visual feedback improve CPR quality. These CPR quality feedback devices are on units throughout the health system to improve CPR quality during a cardiac arrest and to help us determine how to improve CPR performance in the in-hospital setting.
There are many inflammatory events that occur during and after a patient has a cardiac arrest and has return of spontaneous circulation (ROSC). To help determine some of the biomarkers involved, we analyze blood from cardiac arrest patients who regain a pulse at the time of ROSC and at a variety of time points over 72 hours. By performing these blood tests we hope to determine how these biomarkers are involved in the post-arrest phase and if there is a correlation between these biomarkers and outcome.
To determine what factors affect the quality of CPR by trained rescuers, we perform simulated manikin studies recruiting medical students, doctors, nurses and other healthcare professionals. Using CPR quality recording devices, we can analyze provider CPR and assess areas that can be improved upon with training, or determine areas that require further investigation.
Targeted Temperature Management (TTM) has been shown to dramatically improve survival in patients who regain their pulse after a cardiac arrest; however, determining who ultimately will do well and who will do poorly is still extremely difficult. One area being examined currently is the use of bispectral index monitoring (BIS) in this patient population. BIS is routinely used in the operating room setting to determine adequate sedation, although its usefulness during TTM is unknown. We have examined the use of BIS and patient outcome, although more studies need to be performed to determine its usefulness in with TTM.
The advent of targeted temperature management (TTM) has led to an increase of post-cardiac arrest survivors, yet there is often variable neurologic recovery for these patients. Few studies have quantitatively evaluated TTM-treated arrest survivors for long-term neurocognitive deficits. Using a validated computer-based neurocognitive battery, we examine survivors who underwent TTM and those who had not undergone TTM to determine what motor and sensory deficits exist and the extent of those deficits.
Benjamin S. Abella MD, MPhil firstname.lastname@example.org
Marion Leary, BSN, RN email@example.com
CPR Hospital-Initiated Training Project (CHIP)
Since approximately 80% of all out-of-hospital cardiac arrest occur in the home environment, CPR training is important for those with family members or friends at risk for cardiac arrest. The goal of CHIP is to use the hospital as a unique "point of capture" to empower at-risk families with the skill of CPR. We offer CPR training on the cardiology and telemetry wards of three University of Pennsylvania Health System hospitals (Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Penn Presbyterian Medical Center), with the goal of developing a sustainable CPR training model by utilizing resources within the hospital.
Community: Significant disparities in cardiovascular health education exist among various populations within the United States. We partner with community based organizations and church leadership to organize CPR training sessions for members of these communities in the Philadelphia area. For example, in 2009 we helped run an event at the Philadelphia City Hall where numerous Philadelphia City employees received CPR Anytime training. We also support community-wide initiatives like Heart Safe Philadelphia, which combines members from the Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia EMS, police and fire departments, school districts, and other groups to improve heart health education for community members.
Blewer, A.L., Leary, M., Decker, C.S., Andersen, J.C., Fredericks, A.C., Bobrow, B.J., Abella, B.S. (2010).
Cardiopulmonary resuscitation training of family members before hospital discharge using video self-instruction: a feasibility trial.
Journal of Hospital Medicine. [Epub ahead of print] PMID: 21061423
Penn Alliance for Therapeutic Hypothermia (PATH)
Penn's Center for Resuscitation Science has created the first national U.S. clinical registry focused on therapeutic hypothermia after cardiac arrest.
PATH includes information on cardiac arrest events occurring in the pre-hospital and in-hospital settings and will focus extensively on those patients who have undergone therapeutic hypothermia (TH) after initial resuscitation form cardiac arrest.
PATH is a web-based registry that will allow institution's to benchmark against other institutions across the country. The purpose of this database is to have a comprehensive look at cardiac arrest care and outcomes in those patients undergoing TH. The database will also be open for research proposals for those participating in PATH.