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Debriefing of resuscitation performance

Question Type:
Intervention
Full Question:
Among rescuers who are caring for patients in cardiac arrest in any setting (P), does briefing or debriefing (I), compared with no briefing or debriefing (C), change improve survival, skill performance in actual resuscitations, improve quality of resuscitation (eg reduce hands-off time allow for continuous compressions), cognitive knowledge (O)?
Consensus on Science:
There were no RCTs and no studies comparing briefing as the sole intervention. Data from 2 in-hospital observational before-after studies, 1 in adults(Edelson 2008, 1063) and 1 in pediatrics,(Wolfe 2014, 1688) involving a total 318 patients and 2494 epochs of chest compressions demonstrate improved outcomes after implementation of a data-driven, performance-focused debriefing program for resuscitation team members using CPR-quality defibrillator transcripts. For the critical outcome of survival with favorable neurologic outcome at discharge in in-hospital cardiac arrest (IHCA), very-low-quality data (downgraded for imprecision) demonstrated an improvement with debriefing from 28.8% to 50.0% (RR, 1.73; 95% CI, 1.04–2.43). For the critical outcome of survival to hospital discharge, very-low-quality evidence (downgraded for inconsistency) yielded an insignificant improvement from 17% to 18.8% (RR, 1.35; 95% CI, 0.81–2.1). For the critical outcome of ROSC, low-quality evidence associated the intervention with an increase of 54.7% to 66.5% (RR, 1.25; 95% CI, 1.06–1.41). For the critical outcomes of compression depth and compression rate within target range, moderate-quality data (upgraded for strong association) demonstrated an improvement for both (RR, 1.18; 95% CI, 1.15–1.21 and RR, 1.25; 95% CI, 1.21–1.29, respectively). For these same outcomes in the out-of-hospital setting, the quality of evidence was further downgraded for indirectness, resulting in very-low-quality evidence for the 3 survival outcomes and low-quality evidence for the 2 process outcomes.
Treatment Recommendation:
We recommend data-driven, performance-focused debriefing of rescuers after IHCA in both adults and children (strong recommendation, low-quality evidence). We suggest data-driven, performance-focused debriefing of rescuers after OHCA in both adults and children (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making the discordant recommendation for IHCA, we have placed a high value on the consistency and precision of the improvement in CPR quality and short-term survival as the proximal end points of the educational intervention. We have placed a lesser value on the potential costs of implementation.
CoSTR Attachments:
GRADE outcomes debriefing IHCA.pdf    
GRADE outcomes debriefing OHCA.pdf    

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