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Recommended Citation
Helms K. "Improve Compliance of End-Tidal Monitoring During Cardiac Arrest in the Emergency Department". Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
The use of end-tidal monitoring during resuscitative efforts for cardiac arrest events is considered the gold standard of care per the American Heart Association guidelines published in 2020. Despite this, there is no universal adoption of the use of end-tidal monitoring during resuscitation efforts (Merchant et al., 2020 & Chan et al.,2022).
Local Problem
A review of calendar year 2023 cardiac arrest charting at the project site indicated end-tidal was used in less than 16% of emergency department cardiac arrest events. The lack of monitoring can negatively impact care as end-tidal can be a predictive indicator of the return of spontaneous circulation, can be used to guide resuscitation efforts by indicating the quality of resuscitation actions being performed, and can be an indicator for discontinuation of care discussions.
Method
A quality improvement project was initiated to increase end-tidal usage to 80% in calendar year 2024. This project included conducting a pre-test for staff to gauge the knowledge gaps in end-tidal use; producing education for all staffing regarding the importance of end-tidal monitoring during cardiac arrests; conducting practical labs during in-service training and a post-test to gauge knowledge levels following training; and reviewing records following the roll-out of the program.
Results/Conclusion
Following project roll-out, there were 16 cardiac arrests in the emergency department, during which end-tidal monitoring was used in seven. This indicates an immediate increase in compliance to 44%. The post-test survey indicates that over 95% of staff feel they have a better understanding of the importance of its use.
Implications for Practice
Further research is needed to fully investigate this issue, and further monitoring of the project site is required to ensure the goal of 80% compliance is met. Potential further measures may be required, such as refresher training and adding end-tidal exercises to the simulation lab rotation.
References:
Chan, P. S., Spertus, J. A., Kennedy, K., Nallamothu, B. K., Starks, M. A., Girotra, S., & American Heart Association’s Get with the Guidelines–Resuscitation Investigators. (2022). In-hospital cardiac arrest survival in the United States during and after the initial novel coronavirus disease 2019 pandemic surge. Circulation: Cardiovascular Quality and Outcomes, 15(2), e008420. https://doi.org/10.1161/CIRCOUTCOMES.121.008420
Christoff, P. (2018). Running PDSA cycles. Current problems in pediatric and adolescent health care, 48(8), 198-201. DOI: 10.1016/j.cppeds.2018.08.006
Merchant, R. M., Topjian, A. A., Panchal, A. R., Cheng, A., Aziz, K., Berg, K. M., & Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. (2020). Part 1: Executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.https://doi.org/10.1161/cir.0000000000000918
Paiva, E. F., Paxton, J. H., & O’Neil, B. J. (2018). The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review. Resuscitation, 123, 1-7. https://doi.org/10.1016/j.resuscitation.2017.12.003
Document Type
Poster
Publication Date
11-13-2024
"Improve Compliance of End-Tidal Monitoring During Cardiac Arrest in the Emergency Department"
Background
The use of end-tidal monitoring during resuscitative efforts for cardiac arrest events is considered the gold standard of care per the American Heart Association guidelines published in 2020. Despite this, there is no universal adoption of the use of end-tidal monitoring during resuscitation efforts (Merchant et al., 2020 & Chan et al.,2022).
Local Problem
A review of calendar year 2023 cardiac arrest charting at the project site indicated end-tidal was used in less than 16% of emergency department cardiac arrest events. The lack of monitoring can negatively impact care as end-tidal can be a predictive indicator of the return of spontaneous circulation, can be used to guide resuscitation efforts by indicating the quality of resuscitation actions being performed, and can be an indicator for discontinuation of care discussions.
Method
A quality improvement project was initiated to increase end-tidal usage to 80% in calendar year 2024. This project included conducting a pre-test for staff to gauge the knowledge gaps in end-tidal use; producing education for all staffing regarding the importance of end-tidal monitoring during cardiac arrests; conducting practical labs during in-service training and a post-test to gauge knowledge levels following training; and reviewing records following the roll-out of the program.
Results/Conclusion
Following project roll-out, there were 16 cardiac arrests in the emergency department, during which end-tidal monitoring was used in seven. This indicates an immediate increase in compliance to 44%. The post-test survey indicates that over 95% of staff feel they have a better understanding of the importance of its use.
Implications for Practice
Further research is needed to fully investigate this issue, and further monitoring of the project site is required to ensure the goal of 80% compliance is met. Potential further measures may be required, such as refresher training and adding end-tidal exercises to the simulation lab rotation.
References:
Chan, P. S., Spertus, J. A., Kennedy, K., Nallamothu, B. K., Starks, M. A., Girotra, S., & American Heart Association’s Get with the Guidelines–Resuscitation Investigators. (2022). In-hospital cardiac arrest survival in the United States during and after the initial novel coronavirus disease 2019 pandemic surge. Circulation: Cardiovascular Quality and Outcomes, 15(2), e008420. https://doi.org/10.1161/CIRCOUTCOMES.121.008420
Christoff, P. (2018). Running PDSA cycles. Current problems in pediatric and adolescent health care, 48(8), 198-201. DOI: 10.1016/j.cppeds.2018.08.006
Merchant, R. M., Topjian, A. A., Panchal, A. R., Cheng, A., Aziz, K., Berg, K. M., & Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. (2020). Part 1: Executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.https://doi.org/10.1161/cir.0000000000000918
Paiva, E. F., Paxton, J. H., & O’Neil, B. J. (2018). The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review. Resuscitation, 123, 1-7. https://doi.org/10.1016/j.resuscitation.2017.12.003
Affiliations
Atrium Health University City