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.

• In-hospital 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 evidence-based, quality improvement
program of patient safety, medical emergency team
response, effective resuscitation, and
post-emergency care. Focused on reducing death
and disability from in-hospital cardiac arrest,
NRCPR allows participating hospitals to track the
characteristics, treatment and outcomes of
persons who develop cardiac arrest in-hospital.
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
• Pre-existing conditions
• Interventions in place at time of event
• Event Specifics
• Presenting rhythm
• Interventions
• Timing of interventions
• Post-event Interventions
• Outcomes

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Events as of Q1 2008 169,819
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Chain of Survival - Refined for in-hospital

• EARLY RECOGNITION RESPONSE or prevention of the
  event
• EARLY CPR provided according to guidelines
• EARLY DEFIBRILLATION by first responders
• EARLY ADVANCED CARE including evidenced-based
  post-resuscitation care

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NRCPR Research

• Survival from in-hospital cardiac arrest during
  nights and weekends. JAMA 2008299(7).
• 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 in-hospital
  cardiac arrest. New England Journal of
  Medicine. 2008 Jan 3358(1)9-17.
• 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
  Sep58(3)297-308.
• Peberdy MA, Kaye W, Ornato JP, Larkin GL,
  Nadkarni V, Mancini ME, Berg RA, Nichol G,
  Lane-Trultt T.

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Opportunity For Improvement- ? Or !

• Delayed defibrillation occurred in 30.1 of
  in-hospital 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 p-value.