Calculating The Odds: The National Registry of CardioPulmonary Resuscitation Mary E. Mancini RN, PhD


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Calculating The Odds The National Registry of
CardioPulmonary Resuscitation Mary E. Mancini
RN PhD CNA FAANProfessor Associate DeanThe
University of Texas at Arlington School of
NursingCONFLICT OF INTERESTChair NRCPR
Science Advisory BoardGrant Support American
Heart Association and Laerdal

• Sponsored by the American Heart Association

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Intervening between merely most sincerely
dead..
Shes not only merely dead shes truly most
sincerely dead.
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The Facts.

• Inhospital arrest outcomes are poor.

Source NRCPR Adult Index Events 1/2000
7/2005 Data Received Thru 07/31/2005
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NRCPR is an evidencebased quality improvement
program of patient safety medical emergency team
response effective resuscitation and
postemergency care. Focused on reducing death
and disability from inhospital cardiac arrest
NRCPR allows participating hospitals to track the
characteristics treatment and outcomes of
persons who develop cardiac arrest inhospital.
Getting The Facts..
The National Registry of CardioPulmonary
Resuscitation NRCPR

• Sponsored by the American Heart Association

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Data Elements Collected in NRCPR

• Facility Data Set
• Size and type of facility
• Response team variables
• Patient Demographics
• Preexisting conditions
• Interventions in place at time of event
• Event Specifics
• Presenting rhythm
• Interventions
• Timing of interventions
• Postevent Interventions
• Outcomes

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Events as of Q1 2008 169819
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Chain of Survival Refined for inhospital

• EARLY RECOGNITION RESPONSE or prevention of the
  event
• EARLY CPR provided according to guidelines
• EARLY DEFIBRILLATION by first responders
• EARLY ADVANCED CARE including evidencedbased
  postresuscitation care

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NRCPR Research

• Survival from inhospital cardiac arrest during
  nights and weekends. JAMA 20082997.
• Peberdy MA Ornato JP Larkin GL Braithwaite RS
  Kashner TM Carey SM Meaney PA Cen L Nadkarni
  VM Praestgaard AH Berg RA American Heart
  Association National Registry of Cardiopulmonary
  Resuscitation Investigators.

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Time of Day/Day of Week Matters

• Fewer CA events are monitored or witnessed on the
  night shift and outcomes are worse.
• Better mechanisms are needed for rapid
  identification of CA in the hospital.
• Hospitals need to evaluate their staff training
  and response to CA especially during the night
  shift.

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NRCPR studies show that delayed time to
defibrillation significantly effects survival to
discharge.
NRCPR Research

• Delayed time to defibrillation after inhospital
  cardiac arrest. New England Journal of
  Medicine. 2008 Jan 33581917.
• Chan PS Krumholz HM Nichol G Nallamothu BK
  American Heart Association National Registry of
  Cardiopulmonary Resuscitation Investigators.
• Cardiopulmonary resuscitation of adults in the
  hospital a report of 14270 cardiac arrests from
  the National Registry of Cardiopulmonary
  Resuscitation. Resuscitation. 2003
  Sep583297308.
• Peberdy MA Kaye W Ornato JP Larkin GL
  Nadkarni V Mancini ME Berg RA Nichol G
  LaneTrultt T.

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Opportunity For Improvement ? Or

• Delayed defibrillation occurred in 30.1 of
  inhospital patients
• Survival to discharge is directly related to time
  to defibrillation
• Defibrillation within 2 minutes 39.3 Survival
• Defibrillation after 2 minutes 22.2 Survival

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Definition of Insanity

• Doing the Same Things
• and
• Expecting Different Results.

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Why Participate in a Registry?

• Local Level
• Track and Trend Important Variables
• Performance Improvement Activities
• Registry Level
• Track Translation of Science into Practice
• Hypothesis Generation and Testing
• Generation of New Guidelines

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Measuring What Matters.. Its not just
about the pvalue.