Invest to Save: Invest to Save: Cardiopulmonary Resuscitation inCardiopulmonary Resuscitation inQueen Mary HospitalQueen Mary Hospital

Dr W M CHANDr W M CHANConsultantConsultantAdult Intensive Care UnitAdult Intensive Care UnitQueen Mary HospitalQueen Mary Hospital

Hospital Authority Convention 2007 (8 May 2007 Presentation SPP-6.1)

2

InIn--hospital Resuscitationhospital Resuscitation

It is better to It is better to anticipateanticipate than to than to resuscitateresuscitate

CardioCardio--pulmonarypulmonary--cerebral resuscitation cerebral resuscitation (CPCR) rather than Cardiopulmonary (CPCR) rather than Cardiopulmonary Resuscitation (CPR)Resuscitation (CPR)

Activate InActivate In--hospital Resuscitation Team via hospital Resuscitation Team via CPR Hotline (Ext. 3333)CPR Hotline (Ext. 3333)

3

Line of ActivationLine of Activation

Routine daily checking calls by Telephone Routine daily checking calls by Telephone Operator in the morning for all CPR PagersOperator in the morning for all CPR Pagers

CPR Hotline Ext 3333

Telephone Operator should answer Telephone Operator should answer the call within 3 rings bythe call within 3 rings by

Basic Life Support must be initiatedBasic Life Support must be initiated

Once paged to a CPR scene, the doctor(s) should make every effort to arrive at the scene within 2-3 minutes

4

CPR Hotline (Ext. 3333)CPR Hotline (Ext. 3333)

333 - xxxx - YYY

Hospital message code for CPR

Extension of the Ward

Location of the Ward

5

Cardiopulmonary Resuscitation TeamsCardiopulmonary Resuscitation Teams

Organization of CPR in QMHOrganization of CPR in QMH

Parent Team Doctors, Dept of Medicine Dept of SurgeryDept of Clinical Oncology

Parent Team Doctors, Parent Team Doctors, Dept of Dept of Medicine Medicine Dept of Dept of SurgerySurgeryDept of Dept of Clinical OncologyClinical Oncology

Central Resuscitation TeamIntensivistAnaesthestist

Always back up by on-site Specialist

Central Resuscitation TeamCentral Resuscitation TeamIntensivistIntensivistAnaesthestistAnaesthestist

Always back up by onAlways back up by on--site site SpecialistSpecialist

6

Review on CPR Activities in 2005

A total of 273 CPR episodesA total of 273 CPR episodesReviewed 203 resuscitation records that was sent to the CND Reviewed 203 resuscitation records that was sent to the CND

CPR in AICU & OTS were excludedCPR in AICU & OTS were excludedPaediatricPaediatric CPR ExcludedCPR Excluded

Comparing Central Resuscitation Team (CT) Comparing Central Resuscitation Team (CT) vsvs Parent Team (PT):Parent Team (PT):Baseline Demographic DataBaseline Demographic Data

No. of CPR episodesNo. of CPR episodesDepartments, age, etc.Departments, age, etc.

Surrogate Outcomes of CPRSurrogate Outcomes of CPRPagePage--toto--Turn up Time Turn up Time Restoration of Spontaneous Circulation (ROSC)Restoration of Spontaneous Circulation (ROSC)

7

Results (1)

CT attended to only 6.6% of all CPRCT attended to only 6.6% of all CPRTime of CPR activationTime of CPR activation

08300830--2030:2030: 47.3%47.3%20302030--0830: 0830: 52.7%52.7%

Department Code

151 55.3 55.3 55.342 15.4 15.4 70.715 5.5 5.5 76.254 19.8 19.8 96.03 1.1 1.1 97.18 2.9 2.9 100.0

273 100.0 100.0

MedSurgO&TInside AICUOthersInside OTTotal

ValidFrequency Percent Valid Percent

CumulativePercent

8

Results (2)Results (2)

--1818185185Total No. of CPR EpisodesTotal No. of CPR Episodes

ppCTCTPTPT

9

Results (3)Results (3)

NoNo significant difference for PT and CT on:significant difference for PT and CT on:Immediate outcomeImmediate outcome

Timeliness of activation of CPRTimeliness of activation of CPR

LimitationsLimitationsRetrospective dataRetrospective data

Hospital Survival not measuredHospital Survival not measured

Small Number of CPR by Central TeamSmall Number of CPR by Central Team

10

Strategy for Further Improvement

A Dedicated Central Team to take care of A Dedicated Central Team to take care of all CPR in the Hospital is unlikely to all CPR in the Hospital is unlikely to improve CPR outcomeimprove CPR outcome

The latest CPR Guidelines were simplified The latest CPR Guidelines were simplified to make it easier for everybody to learnto make it easier for everybody to learn

Crucial for PT to initiate CPR at bedsideCrucial for PT to initiate CPR at bedside

Empowerment Empowerment of PT in enhancing of PT in enhancing resuscitation care and practicesresuscitation care and practices

11

CPR is Made Easy

12

TrainingTraining

Policy on CPR Training for NursesPolicy on CPR Training for Nurses

Refresher Seminars for NursesRefresher Seminars for Nurses

Seminar on Seminar on ““Update on CPR Update on CPR GuidelinesGuidelines””

Highlighting the 2005 American Highlighting the 2005 American Heart Association Guidelines for Heart Association Guidelines for Cardiopulmonary Resuscitation and Cardiopulmonary Resuscitation and Emergency Cardiovascular CareEmergency Cardiovascular Care

Abbreviated doctorsAbbreviated doctors’’ training training workshopsworkshops

13

Pocket Sized Cue CardsPocket Sized Cue Cards

For Neonatal & For Neonatal & PaediatricPaediatric CPRCPR

For Adult CPRFor Adult CPR

14

Operation ManualOperation Manual

33rdrd Edition of Edition of ““Operation Operation Manual for InManual for In--hospital hospital ResuscitationResuscitation””

CPR Hotline 急救熱線

Caller來電者

TelephoneOperator

電話接線生

是否有提供所需醫生姓名

問明病房所屬專科、位置、內線號碼

是發出 CPR 訊息

代號 333 – 內線 – 位置

否

I. 腫瘤科 Primary Team # On-call MOCOD

II. 內科 Primary Team #, 各病房專責Med. 9300, 9339 On-call MO,

9300, 9339

III. 腦外科 Primary Team #, On-call MONeurosurgery On-call MO

IV. 兒科 Primary Team #, 9682, 9220Paed. 9682, 9220(初生嬰兒一個月以下) (Neonates & Obstetrics)

V. 兒科. Primary Team #, 9220, 9221Paed 9220, 9221

(一個月或以上至18歲以下)

VI. 小兒外科 Primary Team #, On-call MO,Paed. Surgery On-call MO, 9220, 9221

9220, 9221

VII. 外科 Primary Team #, On-call MOSurgery On-call MO

發出 CPR 訊息代號 333 – 內線 – 位置

個別臨床部門專責急救醫生

辦工時間 非辦工時間

• ENT 耳、鼻、喉科

• Ophthalmology 眼科

• O&G 婦產科

• Oral Maxillofacial & Dental Surgery 口腔頜面外科及牙科

• O&T 矯形及創傷外科

• Psychiatry 精神科

• Radiology (X-ray) 放射科

• SOPCs, Blk S S座專科門診

• Chemotherapy Day Centre (K6N) 日間化療中心

• Dental Clinic 牙科門診 註︰1. # Primary Team 醫生姓名須由病房/單位提供。2. 電話接線生必須與來電者確認需傳呼之專責急救醫生，

以確保CPR訊息正確無誤。

辦工時間 非辦工時間

部門是否有專責急救之

醫生

是

中央急救隊 Central Resuscitation Team (CRT)

否

一個月或以上至18歲以下9220, 9221

電話接線生需填寫以下資料:

日期：________________________________

時間： ________________________________

病房/單位： ____________________________

所屬專科： ____________________________

來電內線號碼： ________________________

專責急救醫生：______________*個別部門 / 中央急救隊 (*成人 / 兒科 / 初生嬰兒)

專責急救醫生傳呼機號碼： ______________

發放訊息時間： ________________________

CAS call status checked：* Yes / No

* 請刪除不適用者

中央急救隊CPR Team支援之臨床部門

初生嬰兒 一個月以下

9682, 9220

18歲或以上9460, 9333

Before Arrival of Doctor After Arrival of Doctor One Nurse Nurse A

(Team Leader) Nurse B Doctor

(Team Leader) Nurse A Nurse B

Level of support BLS BLS ALS

Co-ordination

Call for help & activate medical support

Airway/breathing * * *

Circulation * * *

IV access & medication

Prepare / Assist

Defibrillation

Prepare when it is feasible

Prepare / Assist

Documentation

* Rotate the compressor role every 2 minutes or 5 cycles of CPR

Role Delineation within the Adult CPR TeamRole Delineation within the Adult CPR Team

Standardized E-Trolley Content and Layout

18

Acknowledgement

Members of Resuscitation Subcommittee

I came to realize that life lived to help others is the only one that matters and that it is my duty... This is my highest and best use as a human. Ben Stein, E! Online, 12-20-03

I came to realize that life lived to I came to realize that life lived to help others is the only one that help others is the only one that matters and that it is my duty... matters and that it is my duty... This is my highest and best use as This is my highest and best use as a human. a human. Ben SteinBen Stein, , E! Online, 12E! Online, 12--2020--0303

In-hospital ResuscitationLine of ActivationCPR Hotline (Ext. 3333)Cardiopulmonary Resuscitation TeamsReview on CPR Activities in 2005Results (1)Results (2)Results (3)Strategy for Further ImprovementCPR is Made �EasyTrainingPocket Sized Cue CardsOperation ManualStandardized E-Trolley Content and LayoutAcknowledgement