Measuring and Improving Cardiac Arrest Resuscitation in the Emergency Department (MI-CARE)

Speakers: Dr. Garrick Mok and Dr. Victoria Myers

Measuring and Improving Cardiac Arrest Resuscitation in the Emergency Department (MI-CARE)

High-quality CPR is the single most important intervention in cardiac arrest care. Yet, we often overestimate our performance. The MI-CARE project demonstrates how CPR quality can be improved in real-time through data collection, post-event debriefing, and the introduction of a dedicated CPR coach role.

The Problem:

Despite clear American Heart Association targets—depth 5–6 cm, rate 100–120/min, minimal pauses—most EDs don’t track CPR quality. Studies show large gaps between perceived and actual CPR performance. In Canada, only 12% of emergency physicians use any CPR feedback tools. Many rely on visual judgment or pulse palpation, which aren’t guideline-recommended.

The MI-CARE Approach:

1. Measure CPR Performance

   • Built a system to collect real-time CPR data (using Zoll pucks + manual chart review).

   • Created a centralized database to analyze every ED cardiac arrest.

   
   

2. Close the Feedback Loop

   • Real-time post-event debriefs using compression depth, rate, pause timing, and case-specific visuals.

   • Enabled frontline providers to see and discuss what worked, what didn’t.

   
   

3. Train and Support

   • Introduced a CPR Coach role—distinct from the team lead.

     
     

     • Focuses exclusively on CPR quality: rate, depth, minimizing pauses.

     • Provides live guidance and facilitates compressor switches.

     
     

4. Change Culture

   • Built multidisciplinary engagement: MDs, nurses, paramedics, QI and simulation leads.

   • Fostered interest in performance metrics and ownership of outcomes.

   • Staff now ask to see their data post-arrest.

     
     

Results So Far:

• CPR quality improved significantly when using a CPR coach:

  • Without Coach: 39% in target (rate & depth)

  • With Coach: 76% in target

  
  

• Real-time coaching reduced over-compression and improved pause management.

• Data capture improved from 50% to >95% of all cardiac arrests.

Take-Home Message:

“You can’t improve what you don’t measure.”

CPR feedback tools, data-driven debriefs, and a CPR coach role dramatically improve performance—and are well worth the investment. MI-CARE is a scalable, team-driven model that other EDs can adopt to improve resuscitation outcomes.