NATIONAL REGISTRY OF CARDIOPULMONARY RESUSCITATION

Overview of NRCPR

The National Registry of Cardiopulmonary Resuscitation (NRCPR) is an international database of in-hospital resuscitation events that is sponsored by the AHA and managed by Digital Innovation, Inc. “The Mission of NRCPR Hospital Safety Program is to reduce disability and death from cardiac and respiratory emergencies by providing an evidence-based, quality improvement program of patient safety, medical emergency team response, effective resuscitation, and post-emergency care.”

The types of resuscitation events tracked within NRCPR are:

• Cardiopulmonary resuscitation (CPA; events in which compressions and/or defibrillation are delivered)
• Acute respiratory compromise (ARC; events that require emergency assisted ventilation)
• Medical emergency team/rapid response team (MET)

Since its inception in 2000, the number of cardiopulmonary events submitted continues to grow; see the figure below. Through January 31, 2007, the NRCPR Central Site database has received data on 93,975 patients who have had a total of 106,410 cardiopulmonary resuscitation events.

Additionally, since the November 2004 introduction of tracking ARC events, the NRCPR has received data on 6089 patients who have had 6397 ARC events. The ability to track MET events within NRCPR began in mid 2006, and 7034 MET events have been submitted as of January 31, 2007.

Since its inception, 516 total hospitals in the US, Canada, Germany, Brazil and Japan have submitted data to NRCPR. The figure below shows the number of active US and Canadian participants by state/province for the last quarter of 2006. The median number of beds in the participating hospitals is 265 and the smallest and largest participants have 26 and 2346 beds, respectively.

 

Benefits of NRCPR

Several benefits from participating in NRCPR include:

• Identify opportunities for improvement with in-hospital resuscitation practice management.
• Reduce variance in protocol compliance so that liability is decreased.
• Measure compliance with the latest American Heart Association resuscitation guidelines.
• Improve staffing, training and equipment allocation based on data, not intuition.
• Comply with Joint Commission standards for monitoring in-hospital resuscitation.

How It Works

NRCPR provides a Windows-based data collection software program to institutions for a yearly fee. Standardized universal code sheets and quality reports are provided, which can be customized to meet an individual institution’s documentation needs and requirements. Data is abstracted from the CPR records and medical records for patients of all ages at the institution, entered into the database and then submitted to NRCPR electronically in a HIPAA-compliant manner. The data collected is that specified in the Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital 'Utstein Style.' There are strict definitions for each data point so that comparison among hospitals is valid. Included in these data are hospital demographics, patient demographics, pre-event clinical status, event data (such as time of response, medications), immediate patient outcome and quality issues. The database continues to be updated based on current scientific evidence. For example, a section was recently added to collect data on the quality of CPR provided at a code, e.g., was a compression rate of about 100/minute maintained during CPR? Recently NRCPR added the ability for an institution to track custom data elements that are important to them, which are not submitted to the NRCPR central site. Reports of the institution’s resuscitation data (describing resuscitation events, processes of resuscitation care and patient outcomes) along with comparative data from the aggregate member hospitals are provided from the website on a quarterly and annual basis. Templates are provided for each institution to design graphs that will make their data meaningful for presentation and discussion. 

Support to Users

Participants are oriented to NRCPR through an interactive training CD and workbook. Certification in data abstraction must occur before the local administrator can submit data to NRCPR. Monthly conference calls are held with participants on a variety of resuscitation topics that are supported with online visual aids, and national conferences are held annually. 

Questions NRCPR Can Help You Answer

With the information provided in the NRCPR reports, examples of some of the questions your hospital may be able to answer are:

• In what units are resuscitations occurring more often?
• Are resuscitations occurring throughout the 24-hour period, or are they occurring in obvious time intervals?
• Is the overall patient discharge rate similar to that for the aggregate hospital members?
• Is the average time to defibrillation within the three minutes recommended by the AHA?
• Is amiodarone the first antiarrhythmic used in codes?
• Are AEDs located in the areas with most frequent arrests? 

Research Results

NRCPR is the largest database of in-hospital resuscitation events in the world. With over 100,000 cardiopulmonary resuscitation events in the database, the information has been quite enlightening. Publications from members of the NRCPR Scientific Advisory Board are listed below. 

ZOLL CodeNet Link to NRCPR

To enter data into the NRCPR database, the CPR administrator at a hospital abstracts the data from the CPR records and medical records. The data is usually hand entered into the data collection forms that are online, and checks are made on its validity prior to electronic submission to NRCPR. ZOLL Medical Corporation now provides a technological means for entering much of the data during the actual resuscitation event using their resuscitation information management software, CodeNet. CodeNet Writer is their pocket PC-based PDA application for recording information about the events occurring during a code. Data may be entered by tapping the screen in any of the programmed fields, by writing a “scribble note,” or by voice note. At the end of the code, patient identification information is added along with quality data and names of the CPR team members. ECG data is downloaded from the ZOLL defibrillator to the pocket PC so the record is complete. The documenter then docks the pocket PC and transmits the record to CodeNet Central online, reviews the record for completeness and accuracy and then submits the record electronically to the CPR committee representative. The local administrator abstracts the remaining information from the patient’s medical record, and then electronically transmits the data to NRCPR – without having to retype the same data from the electronic CodeNet CPR record into NRCPR – an enormous saving of time and resources.