Inclusion/Exclusion Criteria

(Updated May 2007)

CPA Inclusion Criteria

All patients*, visitors, employees, and staff within the facility campus (inpatient areas and ambulatory areas adjacent to the hospital and surrounding areas).

1. Who experience a cardiopulmonary resuscitation event, defined as either a pulselessness or a pulse with inadequate perfusion requiring:
   
   • Chest compressions¹ and/or
   • Defibrillation of ventricular fibrillation or pulseless ventricular tachycardia
   AND
2. The event elicits EITHER a hospital-wide (e.g., for general inpatient area) or unit-based (ICU, ED, OR, PACU, delivery room…) emergency response by acute care facility personnel.²;

*No minimum hospital stay is required.

¹ Patients with pulse, but hypoperfusion requiring chest compressions, are included. (Example: child with bradycardia, pulse and poor perfusion who receives chest compression during resuscitation).
²All events requiring chest compression and/or defibrillation in the ICUs, PACU, OR or Delivery Room should be captured and entered into the Registry - even if it requires requesting that hospitals make certain that resuscitation records are completed for these events.

CPA Exclusion Criteria

The following resuscitation events are excluded:

• Events beginning outside the facility campus, including during transport to and from the facility.
  • CPA stabilized prior to arrival, ongoing resuscitation continued in ED after arrival, and resuscitation restarted in ED after arrival prior to achieving >20 minutes sustained ROC3,4.
• Events beginning within the facility campus with response by facility first-responders, but on-going resuscitation transferred to EMS personnel (e.g., fire, paramedic, ambulance)
• Events not requiring chest compression and/or defibrillation.
• Events with a pulse requiring synchronized or unsynchronized cardioversion, not requiring chest compression and/or defibrillation of VF or pulseless VT.
• Successful ICD defibrillation of ventricular fibrillation/pulseless ventricular tachycardia not requiring chest compression and/or external defibrillation.
• Chemical Code - modified DNR/DNAR status allowing only drugs without either chest compression or defibrillation initiated during the event.
• Events occurring after brain death has been established.

³Pre-hospital events are not considered 'ended' until the patient has sustained >20 minutes ROSV. For example, patient stabilized 5 minutes prior to ED arrival and requires additional CPA resuscitation interventions 7 minutes after ED arrival would be considered a single, ongoing event.
⁴ If a subsequent CPA event occurs in the ED after ROC sustained for >20 minutes, the CPA event is included.

CPA End of Event Definition

A resuscitation event ends when:

There is restoration of circulation (ROC) that is sustained for > 20 minutes with no further need for chest compression, including with pacemaker or cardiopulmonary bypass/extracorporeal CPR⁵;
OR
The resuscitation event is terminated and the patient is declared dead (unresponsive to ALS, medical futility, advance directive, restrictions by family).

⁵ Any event that follows after ROC > 20 min is defined as a new event.

ARC Inclusion Criteria

All patients*, visitors, employees, and staff within the facility (in inpatient areas and ambulatory areas adjacent to the hospital and surrounding areas)

1. Who experience Acute Respiratory Compromise (ARC) requiring emergency¹ assisted ventilation²(mouth-to-mouth, mouth-to-barrier device, bag-valve-mask, or invasive airway), including NEWBORNS receiving at least 2 minutes of assisted ventilation;^2,3
   AND
2. The event elicits EITHER a hospital-wide (e.g., for general inpatient area) or unit-based (ICU, ED, OR, PACU, delivery room, newborn nursery, etc…) emergency response by acute care facility personnel.⁴

*No minimum hospital stay is required.

¹ Events must be emergent (e.g., elective tracheal intubation for procedure is not included).
²Assisted ventilation is non-invasive (e.g., mouth-to mouth, mouth-to-barrier devise, bag-valve-mask, mask/nasal CPAP/BiPAP) or via invasive airway (e.g., endotracheal/tracheostomy tube, laryngeal mask airway) positive (or negative) pressure ventilation. Does not include nasal cannula, face mask, hood or tent oxygen or oral/nasopharyngeal airway.
³ Events in delivery room, newborn nursery and neonatal ICU requiring CPAP that do not proceed to intubation are not included (see exclusion criteria).
⁴ Patient who fails extubation in PACU, OR, or ICU would not be included, unless an organized team emergency response is elicited. Also not included is elective intubation without Acute Respiratory Compromise, e.g., for CT scan, shock, control of intracranial pressure.

ARC Exclusion Criteria

The following resuscitation events are excluded:

• Events beginning outside the facility, including during transport to and from the facility.
• ARC stabilized prior to arrival, ongoing resuscitation continued in ED after arrival, and resuscitation restarted after arrival prior to receiving >20 minutes sustained ROSV or control of ventilation. ^5,6,7
• Events beginning within the facility campus with response by facility first-responders, but on-going resuscitation transferred to EMS personnel (e.g., fire, paramedic, ambulance)
• Events in delivery room, newborn nursery and neonatal ICU requiring CPAP that do not proceed to intubation
• Events that are not emergency assisted ventilation⁸

⁵ Pre-hospital events are not considered 'ended' until the patient has sustained >20 minutes of ROSV or control of ventilation. For example, patient stabilized 5 minutes prior to ED arrival and requires additional ARC resuscitation interventions 7 minutes after ED arrival would be considered a single, ongoing event.
⁶ If a subsequent ARC event occurs in the ED after ROSV or control of ventilation sustained for >20 minutes, the ARC event is included.
⁷ If the ARC event progresses to a CPA event, the CPA event is included.
⁸ For example, an elective tracheal intubation for a patient who needs deep sedation/intubation for an MRI or CT scan. If that same patient was emergently intubated for a deterioration in mental status and transported to CT scan then the patient would be included.

ARC End of Event Definition

Acute Respiratory Compromise ends:

1. With return of spontaneous ventilation (ROSV) that is sustained for >20 min.
   OR
2. With control of ventilation with assisted ventilation that is sustained for > 20 min either: OR
   • non-invasively (includes mask CPAP/BiPAP, nasal CPAP/BiPAP, negative pressure ventilation; excludes manual bag-valve-mask ventilation)
     OR
   • via an invasive airway (e.g., endotracheal/tracheostomy tube).
3. With transfer of newborn out of the delivery room (usually to Newborn Nursery [NBN], Neonatal ICU [NICU] or Operating Room), when transfer occurs prior to 20 minutes of spontaneous ventilation (ROSV) or controlled ventilation
   OR
4. When the need for chest compression (and/or defibrillation of ventricular fibrillation or pulseless ventricular tachycardia) is first identified (at which point it becomes cardiopulmonary arrest).

Note: Any event that follows after ROSV > 20 min is defined as a new event.