Study: Hospital CPR quality is worse at night

Nov 14, 2010

CPR quality is worse during in-hospital cardiac arrests occurring overnight than those that happen during the day, according to a new University of Pennsylvania School of Medicine study that will be presented at the American Heart Association's annual Scientific Sessions on November 14. The researchers found that chest compression rates varied more at night - often dipping well below the rate per minute that's necessary to properly circulate blood - than during resuscitation efforts during the day, and rescuers paused for longer when switching between chest compressions and defibrillator shocks at night.

"Our study reveals an important factor to explain why, as previous studies have shown, patients who have cardiac arrests in hospitals during daytime hours are more likely to survive,” says senior author Benjamin Abella, MD, MPhil, an assistant professor of Emergency Medicine and clinical research director in Penn's Center for Resuscitation Science. “These findings suggest that more attention to clinical emergency training and staffing at night may be an important way to improve hospital safety and patient outcomes.”

The authors studied 173 cardiac arrests that occurred in non-intensive care settings over the course of two years at three urban teaching hospitals. Resuscitation efforts were monitored via a device that tracks compression depth and rates during CPR and the duration of pauses during defibrillation attempts. The results showed that mean chest compression rate was lower during resuscitations that took place at night, between 11 p.m. and 7 a.m., compared to those during the day -- 102 compressions per minute, with rates varying between 86 and 118, compared to 107, with variance between 100 and 114. One hundred chest compressions per minute is the recommended rate, and previous research shows that when compressions are performed at lower rates, patients are more likely to die or suffer permanent brain damage from prolonged oxygen deprivation. In addition, the researchers observed that staff members appeared to move slower when alternating between and defibrillation during night resuscitations – they stopped compressions for a mean of 15.8 seconds before shocking patients at night, vs. 11.9 seconds during the day, and for 4.6 vs. 2.8 seconds after shocking patients.

Among factors that the authors say may influence the variability in CPR quality between night and day: fatigue, lower staffing levels, and lack of supervision from supervising physicians, who are less likely to be present during overnight resuscitations. But Abella says these disparities could be addressed with a variety of interventions, including more widespread use of simulated event drills, devices that monitor CPR quality and provide real-time feedback, staff debriefings following resuscitations, and more supervising physician involvement in cardiac arrest care.

“Although these results show a disparity in the care cardiac arrest patients may receive overnight, we now have one answer about where to concentrate our efforts to better ensure the safety of patients around the clock,” he says.

Other study authors include Sarah Perman, MD, Douglas Smith, Marion Leary, RN, and Lance Becker, MD, at the University of Pennsylvania, and Noah Swann and Dana Edelson, MD at the University of Chicago.

Explore further: Oil-swishing craze: Snake oil or all-purpose remedy?

add to favorites email to friend print save as pdf

Related Stories

New studies confirm chest compressions alone

Dec 26, 2007

Two large-scale studies published in the Dec. 18 issue of the American Heart Association’s medical journal, Circulation, report that the chances of surviving cardiac arrest are no better – and may be worse – when b ...

Recommended for you

How to keep your fitness goals on track

19 minutes ago

(HealthDay)—The New Year's resolutions many made to get fit have stalled by now. And one expert thinks that's because many people set their goals too high.

Suddenly health insurance is not for sale

Apr 18, 2014

(HealthDay)— Darlene Tucker, an independent insurance broker in Scotts Hill, Tenn., says health insurers in her area aren't selling policies year-round anymore.

Study: Half of jailed NYC youths have brain injury (Update)

Apr 18, 2014

About half of all 16- to 18-year-olds coming into New York City's jails say they had a traumatic brain injury before being incarcerated, most caused by assaults, according to a new study that's the latest in a growing body ...

User comments : 0

More news stories

Low tolerance for pain? The reason may be in your genes

Researchers may have identified key genes linked to why some people have a higher tolerance for pain than others, according to a study released today that will be presented at the American Academy of Neurology's 66th Annual ...

How to keep your fitness goals on track

(HealthDay)—The New Year's resolutions many made to get fit have stalled by now. And one expert thinks that's because many people set their goals too high.

Cancer stem cells linked to drug resistance

Most drugs used to treat lung, breast and pancreatic cancers also promote drug-resistance and ultimately spur tumor growth. Researchers at the University of California, San Diego School of Medicine have discovered ...

Making graphene in your kitchen

Graphene has been touted as a wonder material—the world's thinnest substance, but super-strong. Now scientists say it is so easy to make you could produce some in your kitchen.

Easter morning delivery for space station

Space station astronauts got a special Easter treat: a cargo ship full of supplies. The shipment arrived Sunday morning via the SpaceX company's Dragon cargo capsule.