Cardiopulmonary resuscitation quality during the transition in care from paramedic services to emergency department teams

OBJECTIVES: In patients who experience out-of-hospital cardiac arrest (OHCA), high quality cardiopulmonary resuscitation (CPR) is associated with improved outcomes. The transition of care from paramedic services to emergency department (ED) teams represents a potentially vulnerable period where CPR quality may deteriorate. This study evaluated CPR quality during the prehospital-to-ED transition. METHODS: We conducted a retrospective observational study of adult patients with non-traumatic OHCA transported to a tertiary academic ED between August 2023 and August 2024. Metrics assessing CPR quality were obtained from prehospital and ED defibrillator recordings. Four predefined intervals were analyzed: paramedic baseline, paramedic pre-transition, ED post-transition, and ED baseline. The primary outcome was each adherence to the American Heart Association (AHA) guidelines defined as the mean depth of compressions, mean rate of compressions, and mean chest compression fraction for each interval. Secondary outcomes included comparison between intervals for each metric. Continuous variables were compared using a linear mixed effect model and comparison of categorical data, including the proportion of cases adhering to AHA guidelines, was done using the Cochran's Q test. RESULTS: Thirty-five OHCA cases met inclusion criteria. Mean patient age was 49.9 years (SD 13.6), and 80.0% were male. Mean CCF was guideline compliant throughout all intervals (89-92%) with no significant differences between intervals. Compression rate was guideline compliant across all intervals (109.9-117.5 compressions/minute). Compression depth was guideline compliant during paramedic intervals (5.8 and 5.9 cm) and was significantly higher (p < 0.001) during ED transition and ED baseline intervals (6.4 and 6.8 cm) exceeding guideline targets. No significant differences across intervals were observed in the proportion of cases meeting guideline targets for CCF, rate, or depth. CONCLUSIONS: Quality of CPR was overall maintained during the transition of care from paramedic services to the ED, with no deterioration in chest compression fraction or overall guideline adherence. Compression depth exceeded guideline recommendations in the ED, representing a potential target for future quality improvement initiatives.