CPR—The Vanishing Competency

...somehow I’m not convinced that even more practice, more complex technology, more measurements, and/or more data will effect better CPR. CPR—Investments For the better part of the past 40 or 50 years, healthcare professionals of all stripes have been learning, certifying, and annually recertifying in that most fundamental of lifesaving skills, cardiopulmonary resuscitation (CPR). Countless hours have been devoted to palpating, looking-listeningfeeling, ventilating, thumping, compressing, counting cadences, and attempting to coordinate all of the procedural components of CPR over and over again until we finally get it right—that is, execute the procedure as specified in the American Heart Association (AHA) guidelines. Every few years, when revised guidelines are issued, we struggle to break and unlearn the previously used behavioral sequences and embed new neuronal imprinting that coincides with the latest research evidence and best practices. During more than 10 of those 40-plus years, that pristine moment of “getting it right” required a CPR instructor to observe our efforts and subjectively determine whether they collectively qualified us to be certified (or recertified) in CPR. We weren’t required to repeat a perfect behavioral sequence numerous times; a single correct demonstration could suffice (though that feat may have required hours to achieve). Some years later, CPR performance expectations were made more objective and quantitative when they were explicitly detailed with timing elements on a printed checklist. As CPR instructional technology continued to advance, we encountered mannequins with increasingly more sophisticated recording devices designed to objectively measure performance parameters related to timing, volume, and pressure and print out a strip for documentation. In addition to a passing score on the customary written test, CPR skill certification now required explicit, detailed, quantitative, objective evidence (ie, “a perfect strip”) rather than a generic, summary, qualitative, subjective judgment. Now, these mannequins are remotely controlled for a range of clinical data and clinical response and can record discrete and detailed measurements of whether performance meets the litmus test accorded by the AHA guidelines.