CPR: Know Better, Do Better

If you have a driver's license are you a good driver?  I bet you think you are a good driver and I believe I'm a great driver!  And yet our driver's license simply shows we know how to drive, not whether we are good drivers.

If you have a Basic Life Support card (or ACLS or PALS card), are you good at CPR?  I'm sure you think you are good at CPR and I hope you are!  And yet, your BLS card simply shows you know how to do CPR and there is no way to know if you actually perform good CPR just by looking at your BLS card.

Poor CPR performance is devastating to patient outcomes.

Since modern-day CPR was invented in 1960, it is estimated that several hundred million people have been trained to become lifesavers around the world, and as a result, there is reason to believe that over 5 million lives have been saved.  This is truly remarkable, and every life should be celebrated!

And yet, there is even more that we can do.  Today, typically most healthcare professionals attend a basic or advanced life support course once every two years to renew their resuscitation training.  At the completion of this training, the healthcare professional is tested on his/her knowledge and skills as observed by an instructor and then upon passing, issued a course completion card and asked to come back again in two years.  The knowledge and skills learned at well taught courses are valuable and helps prepare healthcare providers to treat cardiac arrest patients.

The problem is that we know CPR skills decay rapidly. The 2015 American Heart Association Guidelines for ECC & CPR clearly state that two-year retraining cycles are not optimal for healthcare professionals and that more frequent training in BLS and retraining in ACLS is needed. Numerous studies have shown that CPR skills decline over 3-6 months, including this study that showed the importance of frequent skills practice to maintain effective performance.

The first problem is CPR skills decay.  The second problem is the gap between knowing CPR and performing high quality CPR, every time on every patient.

Recently the AHA published an Education Statement stating that “...mastery learning is the key to skill retention and the prevention of rapid decay in skills and knowledge...the goal of mastery learning is to have learners achieve the highest standards for all educational outcomes instead of simply meeting the minimum standard.”

I don't know about you, but I can't think of many things in life that can be mastered by practicing once every two years.

High quality CPR saves lives.  Easy to know - minimize interruptions, compress at the right rate and depth, don't lean on the chest and don't hyperventilate - but not easy to do without lots of practice.  In 2005, two sentinel studies published in JAMA showed that highly skilled, highly trained healthcare professionals both in-hospital and out-of-hospital were unable to consistently perform high quality CPR on every patient.

Numerous additional studies over the past decade underscore that the vast majority of cardiac arrest patients are not reliably receiving high quality CPR.  I believe that healthcare professionals undertake good training, are motivated and engaged to provide the best possible care - so what can we do to ensure all cardiac arrest patients benefit from receiving high quality CPR every time?

It is often said "practice makes perfect" but in the case of CPR, with lives on the line, it is "perfect practice that makes perfect"!

We need a new standard of care, one that has healthcare professionals ready and able to demonstrate verified competence in CPR skills to ensure high quality CPR is performed every time on every patient.

We know that this can be very effectively accomplished through a program of low dose, high frequency quality improvement sessions every three months using automated feedback to measure, correct and assess CPR skill performance.  The American Heart Association & Laerdal Medical launched the Resuscitation Quality Improvement® (RQI®) program in 2015 to address the "competency gap" between knowing CPR and doing good CPR.  Several early adopters (RQI Pioneers) are transforming cardiac arrest care by using RQI® to deliver quality and value to their patients and providers.

Poor quality CPR is a preventable harm.

CPR training has saved countless lives over nearly sixty years.  We know now that high quality CPR performance is the single most critical component of cardiac arrest survival and with the recent convergence of technology, science and educational research it is no longer enough for healthcare professionals to be trained in CPR once every two years.  They must undertake regular sessions of perfect practice every 3-6 months to ensure skills mastery through effective measurement and feedback so they are prepared to reliably deliver high quality CPR.

We need all healthcare professionals to perform high quality CPR on every patient, every time.  Now that we know better, we must do better.  Together, we can help save many more lives when every cardiac arrest patient receives high quality CPR.