Proposal: The European Resuscitation Database
a versatile system of real-time data registration and its semi-automated storage
in a new Pan-European database
easy access and comprehensive analysis to benefit future treatments
CPR is a dynamic process... does its documentation show that clearly enough?
The better all resuscitations are documented, the easier is for us to analyse these processes afterwards in order to improve our practices.
Usually all we get is a summary: the amount of shocks applied, doses of Epinephrine and other drugs used. Routinely recorded data alone (doses, parameters and the outcome) do not reflect all the dynamics of the CPR, some other details are missing… Even less information is provided for statistical purposes.
What about making the documentation more transparent?
Time is crucial
During the CPR, time is essential. Shouldn't the documentation reflect it with greater accuracy?
The time-scale should be ubiquitous:
- time stamp everywhere in the documentation
- timing as a base for assessing the effectiveness
- timing passed on to further statistic analysis.
Many CPRs are documented first on paper. To save time?
Time is precious, time is scarce...
Which is faster, pen or computer?
A few severe limitations of electronic CPR documentation:
- site and resources: difficult conditions? few rescuers?
- device might be not present or not ready to use
- software unsuitable, too slow or non-existent
- attitudes: “there are more important things to do right now”
- cables? wireless? manually? - all input methods have their weaknesses
If the application is slower or less reliable than handwriting, it cannot be accepted!
An ideal tool for CPR documentation?
- Immediately available at the scene
- Fast and easy to use
- Asking the right questions at the right time
- Intuitive, anticipating
- No need to write, just selecting options
- The input completable with further details after CPR
- The same data should be usable in at least two ways:
- as an individual document (a concrete patient's case)
- as an input to the database (statistics and research)
The task: European database of resuscitations
What about gathering all CPR data in one European database?
- the detailed knowledge of every resuscitation is being electronically registered
- all events saved including their timing and characteristics with as much details as necessary
- automated processing of shared data removes private entries (names, id's)
- the data saved is being sent to a central database (both national and European)
- the researchers are being able to fetch, compare and analyse data any time
- sharing the knowledge becomes as easy as never before
- merging into a new, versatile and continuous EuReCa “live” or “express”?
Need to discuss the benefits?
European CPR database: how easily achievable?
- creation of common (better) standard for emergencies' data collection and exchange (compatible with HL7)
- common interface for tablet-style devices
- software (almost?) free for end users
- standardized entries in the national and European databases
- dedicated team of medical and IT specialists given the task
- good patronage and financing
- some legal issues to be clarified
- translations of the interface to numerous languages (text files)
CPR data: real time acqisition
- Dedicated tablet in every crash/emergency trolley
- Application ready to use almost instantly
- Time plays a key role. Time counting starts from the observed or
estimated cardiac arrest. Important time intervals are displayed.
- direct data acquisition will be usually limited (especially outside the ICU and due to problems with availability, reliability or accessibility), thus...
- the application should be able to work in entirely manual mode (touch screen)
- the clinical details should be prioritized (neither name nor ID first → these to be added later)
CPR data: post-processing
After the most important CPR data is saved locally...
- correction of entries, if inexact
- adding the background information: circumstances, patient's age and diseases, resources, outcome details, laboratory tests, follow-up care
- the personal details entered for case history will be automatically removed from data intended for the resuscitation database
- dispatching data to patient's medical records and creating a code for a CPR database
- automated data transfer from the memory of local computer to central database(s)
Under development: CPR Aide software
CPR Aide: What it does?
- The software is able to register every important information by means of making simple logical choices via touch screen or mouse
- The event is usually an observation, procedure or medication. Any possible value (level, dose etc.) is selectable from a simple scale.
- Every event gets a double time stamp:
- time of the event as selected by rescuer
- actual time of event's registration
- The application can support the decision making and can be used for training purposes
- An option to expand to handle other emergencies as well
- Customisation and creation of different language versions made easy
CPR Aide: the result?
The course of resuscitation is being displayed on screen as text and graphics, events are counted, their time is listed and intervals measured
The programme produces diverse files
- html file (to be read in browsers)
- xml file (to be shown using templates, complying with HL7 for data exchange)
- SQL file/stream (to send data directly to databases)
- code file (to display data within the original software)
After the creation of a central database a code, concise but rich in content, will be sent to dedicated server and saved as classified entities, making the events simple to reconstruct and results easy to compare.
Who am I to dare to suggest this?
Physician, graduated 1984, specialist in anaesthesia and intensive care, continuously in patient work (not a theoretician)
Over 20 years of programming experience (C++ environment)
Authored the operating room software (made on an “after work” basis, first released in 2001, now under further development)
Worked also as a medical and social journalist in radio and TV (long ago)
- Full of ideas and enthusiasm to share his vision on more efficient way of our creating the medical documentation and profiting from the data exchange.
- Profoundly interested in creation of fast, concise, intuitive and reliable IT systems in anaesthesia, emergency and intensive care.
Like the idea? Let's make it real! I’m at your disposal for setting up and leading a team under the auspices of ERC (!?) in university or research institute anywhere in Europe.
Registering the CPR events as they happen,
collecting the data for resuscitation research