CAROLINAS HEALTHCARE SYSTEM
POLICY AND CLINICAL PRACTICE GUIDELINES
TEAM FOCUSED ADULT RESUSCITATION
Written: 06/15
I.
POLICY
It is the policy of Carolinas HealthCare System (CHS) to design and support a process that provides
appropriate teammates to patients in need of resuscitation. This policy outlines a maximally effective
process for this care.
II.
SUMMARY
This policy applies to CHS areas providing resuscitation. The desired goal is to continuously improve
outcomes for in-hospital cardiac arrest.
PERFORMED BY
Nine key teammates with specific functions further described in this policy
III.
INTERVENTION
A.
Team Leader-Physician/Advanced Care Provider
1.
Facilitate placement of appropriate advanced airway
2.
Oversee appropriate ventilatory support by RT
3.
Oversee management of resuscitation including:
a)
monitor quality of CPR,
b)
Monitor quality of ventilator support
c)
Interpret cardiac rhythm
d)
Oversee and call for defibrillation
e)
Oversee and call for appropriate medication administration
4.
Oversee management of rhythm interpretation, defibrillation and medication administration
5.
Ensure limited interruptions in compressions during resuscitation, especially avoiding
unnecessary pulse checks, minimize perishock pauses.
6.
Search for reversible causes of arrest
7.
ROSC---Code Cool candidate?
B.
Compressor 1:
1.
Perform high quality CPR with limited interruptions per AHA guidelines
2.
Rate at least 100/minute
3.
Depth > 2 inches
4.
Full recoil
5.
Switch every 2 minutes
6.
Run labs after 2 minutes of CPR. ECHO machine comes in here after first 2 minutes
7.
Assist with procedures as needed, as long as it does not interfere with compressor role
C.
Compressor 2:
1.
Perform high quality CPR with limited interruptions per AHA guidelines
2.
Rate at least 100/minute, counts out loud with every 20th chest compressions
3.
Depth > 2 inches
4.
Full recoil
5.
Switch every 2 minutes (After total of 200 Compressions)
6.
Assist with procedures as needed, as long as it does not interfere with compressor role
D.
E.
Compressor 3:
1.
Perform high quality CPR with limited interruptions per AHA guidelines
2.
Rate at least 100/minute, counts out loud with every 20th chest compressions
3.
Depth > 2 inches
4.
Full recoil
5.
Switch every 2 minutes (After total of 200 Compressions)
6.
Assist with procedures as needed, as long as it does not interfere with compressor role.
RN 2 (Code Cart RN):
1.
Assist with rhythm interpretation
2.
Operate defibrillator as ordered/needed, charges defibrillator at compressors count of 180,
delivers shock if indicated after 200 compressions complete and rhythm is analyzed.
3.
Deliver medications from Code Cart, mix and deliver all stat drips
4.
Ensure adequate IV/IO access
5.
Send runner for medications not in Code Cart
6.
Ensure team leader and recorder are aware of all treatments
F.
RN 3 (Bedside RN):
1.
Assist with compressions as needed
2.
Obtain specimens and additional IV access as ordered/needed
3.
Prepares stat drips of medications not on Code Cart, checks dosages with Recorder/CPR
Quality Monitor or Code Cart RN
4.
Ensure team leader and recorder are aware of all medications administered
5.
Ensure team leader and recorder are aware of all procedures performed on patient
G.
Respiratory Therapy:
1.
Obtain/Maintain appropriate airway
2.
Provide appropriate ventilations—Do not hyperventilate
3.
Breaths <12/minute with minimal chest rise, gives a breath with every 20th chest
compression
4.
Monitor ETCO2
H.
Recorder RN 1:
1.
Records resuscitation efforts on appropriate Code Sheet
2.
Monitors and records times of CPR cycles, medication administration and other procedures
as performed
3.
Prompts team leader when CPR cycles are about to be completed, providers information to
team leader as requested
I.
Manager, Nursing Supervisor, Clinical Supervisor or Charge Nurse
1.
Manage personnel and visitors
2.
Provides family support, if needed
3.
Obtain medications and supplies not available at bedside
J.
Family Support Facilitator
1.
Provide information, explanations and general support to family present during resuscitation
2.
Provide updates to family not present at bedside
Maintain/Obtain appropriate airway
Team Resuscitation Positions
Provide appropriate ventilations--Do not
hyperventilate. Breaths<12/minute with
minimal chest rise, give breath with
every 20 chest compression
Counts out loud with every
20th chest compression
(Switch after 200
compressions)
Compressor
3
Monitor ETCO2
Depth > 2 inches
Respiratory Therapist
Counts out loud with
every 20th compression
(Switch after 200
compressions)
Full recoil
Run labs after 2 minutes of
CPR. US machine comes in
here after first 2 minutes
Depth >2 inches
Compressor
2
Assist with compressions as needed
Compressor
1
Full recoil
RN
Obtain specimens and additional IV access
as ordered/needed
RN
3
2
Prepares stat drips of medications not on
Code Cart, checks dosages with
Recorder/CPR Quality Monitor or Code
Cart RN
Charges Defib at Compression
count 180, delivers shock if
indicated after 200 compressions
complete and rhythm is analyzed
Ensure team leader and recorder are aware
of all medications administered
Ensure team leader and recorder are aware
of all procedures performed on patient
Assist with Rhythm
interpretation
Physician
CODE CART
Deliver medications from Code
Cart, mix and deliver all stat drips
1
Monitor/Defib
Ensure team leader and recorder
are aware of all treatments
Facilitate placement of appropriate advanced airway
Oversee appropriate ventilator support by RT
Recorder
RN 1
Physician
Records resuscitation efforts on appropriate Code
Sheet
Monitors and records times of CPR cycles, medication
administration and other procedures as performed
Prompts team leader when CPR cycles are about to be
completed, provides information to team leader as
requested
Monitors compressions and resuscitation process
Provide information, explanations and
general support to family present during
Family
resuscitation
Support
Facilitator
Provide updates to family not present at
bedside
2
Oversee management of resuscitation-monitoring
quality of CPR, ventilations etc. (Physician 1 feels for
pulse at compression count of 160, at count 200
analyze rhythm for possible shock)
Oversee management of rhythm interpretation,
defibrillation and medication administration
Ensure limited interruptions in compressions during
resuscitation, especially avoiding unnecessary pulse
checks, minimize perishock pauses
Search for reversible causes of arrest
Manager/Nursing
Supervisor/Charge
RN/Clinical
Supervisor
Manage personnel and visitors
Provides family support if
needed
Obtains medications and
supplies not at bedside
Team Resuscitation Positions
Respiratory Therapist
Compressor 3
Compressor
2
Compressor
1
RN
RN 3
2
Recorder/
RN 1
CODE CART
Monitor/Defib
Physician 1
Physician 2
Family
Support
Facilitator
Manager/Nursing
Supervisor/Charge
RN/Clinical
Supervisor
TFCPR
Resuscitation Immediate Debrief Tool
Task
Yes No
Comments/Intervention
(If No  Why?)
Team Structure & Dynamics
All roles were assigned/managed
Team leader easily identified
Appropriate personnel available
Was noise limited & teammate instructions easily heard?
Observers kept to a minimum/observed from doorway?
Mechanisms to determine quality of compressions used:
ETCO2
CPR Monitoring Device
Defibrillator monitor feedback
Team leader monitoring & feedback
Minimally-interrupted chest compression/high-quality CPR performance
CPR initiated within 10 seconds of arrest
All compression cycles (2 minutes or 200 compressions)
performed to completion
Compressions continued during IV/IO access
Compressions continued during airway management (BVM,
KingLT, ETI)
Interruptions limited to < 10 seconds when no return of
circulation identified
Vast majority of compressions were of high-quality (appropriate
rate, depth, full recoil)?
Compressors rotate every 2 minutes
Ventilation given every 20 compressions
Early defibrillation
Charging defibrillator occurred at 180 compressions every cycle
Post-arrest care
Code Cool Initiated?
Other comments:
Teammate name debriefing_________________Signature: ______________ Date: _______ Location: ________
Teammate’s names (participating in cardiac arrest resuscitation):
RT: ______________________________________ Compressor 1: ________________________________
Compressor 2: _____________________________Compressor 3: ________________________________
RN 1: _________________________________________ RN 2: _________________________________________
RN 3: _________________________________________ Physician 1: _________________________________
Physician 2: ____________________________________ Family Support Facilitor: __________________________