(1252) Documenting CPR Quality: Unveiling Utstein Core and Supplemental Criteria During Cardiac Arrest

Introduction: Survival rates for out-of-hospital cardiac arrest (OHCA) have remained low and stagnant. The American Heart Association guidelines now emphasize the importance of interventions that enhance CPR quality during OHCA. Transesophageal echocardiography (TEE)-guided CPR aims to improve CPR quality. However, how well CPR quality markers are documented before and during TEE-guided OHCA is not clear. This study evaluates how often Emergency Medical Services (EMS) and emergency departments (ED) document Utstein criteria related to CPR quality in OHCA.

Methods: This is an observational, retrospective chart review on a convenience sample of OHCA patients who underwent TEE guided resuscitation in the ED. Two trained abstractors reviewed charts to evaluate the frequency of EMS and ED documentation of Utstein’s core and supplemental variables. The nine core variables include: age, gender, witnessed arrest, 1st rhythm, arrest cause/etiology, location, bystander response, response time, and drugs given. Supplemental variables included surrogates of CPR quality: use of mechanical CPR device, presence of CPR quality monitoring, and end-tidal CO2 (ETCO2) measurement. Descriptive statistics are presented.

Results: A total of 40 EMS and ED charts during OHCA were reviewed over a 4-year period (2019 – 2023). EMS and ED documentation of all 9 core Utstein criteria was 100%. Documentation details for supplemental variables about CPR quality were more variable. The frequency of EMS documentation for mechanical CPR device use (35%), CPR quality monitoring (3%), and ETCO2 (63%). ED documentation for use of mechanical CPR device was 13%, CPR quality monitoring was 0%, and ETCO2 reporting was 51%. Missing or unknown data points were high: use of mechanical CPR device (28%, 68%) and ETCO2 reporting (37%, 49%) in EMS and ED respectively.

Conclusions: Supplemental documentation of CPR quality during resuscitation for OHCA is both sparse and inconsistent. In contrast, documentation of core Utstein variables by EMS and EDs is generally reliable. These deficiencies in CPR quality data reporting pose significant obstacles to research and patient safety. Consequently, clinical trials with standardized protocols and documentation will be essential to assess the impact of CPR quality performance on OHCA resuscitation outcomes.