(1535) Designated Nursing Code Teams Improve CPR Quality During In-Hospital Cardiac Arrests

Introduction: In September 2020, our hospital replaced "all-call" code responses with a designated nursing code team (DNCT) with defined intra-arrest roles. This team consisted of critical care nurses who received additional training. They also participated in a feedback system of monthly data debriefs to improve arrest management for patients suffering from in-hospital cardiac arrest (IHCA). We hypothesized that the DNCT would provide higher-quality CPR during IHCA resuscitations, helping to improve outcomes.

Methods: We assessed IHCA events between 2019 and 2021. The DNCT intervention began on September 1st, 2020, at 0700. CPR data were collected using Zoll-R® defibrillators and analyzed via the Zoll® RescueNet Code Review Program (Zoll® Medical Corp, USA). Of 379 IHCA events in 2019-2021, 166 (44%) had CPR quality data available; 82 arrests in the pre-DNCT group and 84 arrests in the post-DNCT group. The primary outcome was the product of the percentage of time that compressions were performed at a goal rate of 100-120 compressions per minute and the percentage of time compressions were performed at the Zoll®-defined goal depth or deeper (≥ 2 inches of chest depression, measured by the Zoll® system defibrillator pads). Secondary outcomes included the percentage of total arrest time that compressions were administered (compression fraction), the rate of return of spontaneous circulation (ROSC) and survival to hospital discharge.

Results: After the implementation of the DNCT, the product of compressions performed at goal rate and at or deeper than goal depth increased from 41% to 50% (p=0.048). Compression fraction increased from 11% to 16% (p=0.038). The % of compressions performed at goal rate increased from 49% to 71% (p < 0.001). No significant difference was found in % goal depth (76% versus 69%, p=0.098). The study was not adjusted for common CPR and patient-related features that impact mortality outcomes, however, ROSC (72% versus 76%, p=0.37) and survival to discharge (31% versus 29%, p=0.74) were not significantly different between cohorts.

Conclusions: Implementation of a DNCT improved the time compressions were performed at goal rate and goal depth or deeper. The compression fraction also improved. Zoll®-obtained CPR quality metrics are now part of code-debriefing throughout our hospital system.