ALISO VIEJO, Calif. – Jan. 7, 2025 – Specialized training at a Wisconsin children’s hospital prepared pediatric critical care nurse practitioners to serve as designated cardiopulmonary resuscitation (CPR) coaches to support other clinicians responding to patients experiencing cardiopulmonary arrests.
The initiative significantly increased the presence of a CPR coach when a code team responded, which was associated with clinically significant improvements in quality CPR delivery metrics in real arrests.
The study was conducted in the 72-bed pediatric and cardiac intensive care unit (PICU) at Children’s Wisconsin Milwaukee Hospital, which is affiliated with Medical College of Wisconsin.
“Impact of a Quality Cardiopulmonary Resuscitation Coach on Pediatric Intensive Care Unit Resuscitation Teams” examines the descriptive statistics and comparison of arrest data from 2018 to 2021, before and after CPR coach training was implemented in fall 2019. The study is published in American Journal of Critical Care (AJCC).
Co-author Katie L. McDermott, PhD, MEHP, RN, CPNP-AC, is a critical care pediatric nurse practitioner in the PICU, part-time nursing faculty at Marquette University, Milwaukee, and program director of the Children’s Wisconsin Simulation Lab.
“A growing body of evidence shows that adherence to American Heart Association CPR quality metrics improved during simulated arrests when resuscitation teams incorporated a feedback device and a quality CPR coach,” she said. “Our work builds on that research by studying their impact in real compression events and can serve as a blueprint for other facilities seeking to improve quality CPR delivery at the patient bedside.”
A CPR coach is a supplementary team member who provides real-time, verbal feedback on chest compression quality during a patient’s cardiac arrest. The role is designed to support hospital-based resuscitation teams and allow team leaders to focus on advanced life support, including identifying and managing reversible causes of the arrest.
As part of a resuscitation quality initiative bundle, the PICU added a CPR coach to the response team during in-unit compression events and transitioned from standard defibrillator devices to one that functions as both a defibrillator and a feedback device. The new defibrillators from Zoll Medical Corporation require that adhesive pads be placed on the patient’s chest and back when compressions begin, not only if defibrillation is required. Chest compressions are performed with hands placed on the adhesive pad on the patient’s chest, and the feedback device technology displays visual information regarding the depth and rate of chest compressions as they are occurring in real time.
The unit developed the training to orient clinicians to serve as CPR coaches and improve consistent use of a code team member in the coach role, with application of the Zoll defibrillator pads, and use of the visual feedback data during in-unit cardiopulmonary arrests. Participants completed a series of progressive simulation cases using rapid cycle deliberate practice, which focuses on rapid acquisition of necessary skills to improve performance in low-volume, high-risk patient events.
After the intervention, the presence of a CPR coach increased from 35% to 72%, while application of the Zoll defibrillator pads increased from 50% to 72%.
Additionally, the frequency of the presence of a quality CPR coach and the frequency of Zoll defibrillator pad placement were identical after the intervention, implying that the CPR coach contributed to timely use of the Zoll defibrillator pads as part of the response.
The PICU had 148 cardiopulmonary arrests from 2018 through 2021. Exclusion criteria were that the arrest occurred outside the PICU, in a patient older than 18 years, lasted for less than one minute or entailed use of the LUCAS Chest Compression System. In addition, multiple arrests for the same patient were excluded from the analysis, as well as those that occurred during the training period from Sept. 30 to Dec. 5, 2019. After the research team removed excluded events, 40 pre-training and 39 post-training cardiopulmonary arrests remained for analysis.
Since the study was concluded, the research team has focused on sustainability and refinement of the quality CPR coach role in the PICU. Early work has begun to explore adding the role to the code teams who respond to compression events in other areas of the hospital. To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.
About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of about 130,000 acute and critical care nurses and can be accessed at www.ajcconline.org.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme