• Implementation of Resuscitated Cardiac Arrest Debriefing in the Medical Intensive Care Unit

      Fraser, Ruth-Anne M.; Jackson-Parkin, Maranda (2022-05)
      Problem: In 2020, a medical intensive care unit (MICU) at a large academic hospital experienced 47 resuscitated cardiac arrests, achieving return of spontaneous circulation (ROSC) in 66% (n = 33). An audit of the practices of the MICU identified that following cardiac arrest resuscitations, no processes existed for performing staff debriefing possibly contributing to inferior resuscitation quality. Debriefing is a focused, interdisciplinary discussion that provides participants with feedback and is demonstrated to improve patient outcomes including return of spontaneous circulation, and team performance. Purpose: The purpose of this Quality Improvement (QI) project was to implement a sustainable, structured, interdisciplinary debrief after all resuscitated cardiac arrest events in the MICU. Debriefing after resuscitated cardiac arrest events could improve CPR quality, return of spontaneous circulation rates, and communication. Methods: The QI project methods involved Resource Registered Nurses (RRN) facilitating an interdisciplinary debriefing following each resuscitation event in the MICU (September - December 2021), using the institution’s debrief tool. The debriefing tool was comprised of open-ended questions and quality metrics. Practice changes were achieved by using teach-back methods to train the RRNs on debrief facilitation. Emotional support was offered to staff. Compliance with debriefing and number of staff involved with events and debriefs were recorded. In addition, anonymous indicators of CPR quality as measured by chest compression depth, rate, and fraction was collected from the defibrillator. Finally, the rate of return of spontaneous circulation (ROSC) was collected. Results: During implementation, 92% (n = 13) of resuscitated cardiac arrests were debriefed, and 8 to 17 staff participated in each debrief. Comparison of CPR quality before and after implementation demonstrated marked improvement in median chest compression quality according to the American Heart Association (AHA) guidelines. Compression depth and rate medians increased from 22.0% to 39.5% (p = 0.012) and 63.9% to 75.6% (p = 0.497) respectively, and compression fraction median decreased from 95.3% to 94.9% (p = 0.35). Return of spontaneous circulation was achieved in 50% of the arrests. Conclusions: Project outcomes demonstrate that debriefing is associated with improved CPR quality and provides support for MICU staff after resuscitated cardiac arrest events.