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Guetterman TC, Kellenberg JE, Krein SL, Harrod M, Lehrich JL, Iwashyna TJ, Kronick SL, Girotra S, Chan PS, Nallamothu BK. Nursing roles for in-hospital cardiac arrest response: higher versus lower performing hospitals. BMJ Qual Saf 2019; 28:916-924. [PMID: 31420410 DOI: 10.1136/bmjqs-2019-009487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lower performing hospitals in IHCA survival. METHODS We conducted a descriptive qualitative study at nine hospitals in the American Heart Association's Get With The Guidelines-Resuscitation registry, purposefully sampling hospitals that varied in geography, academic status, and risk-standardised IHCA survival. We conducted 158 semistructured interviews with nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, and administrators. Qualitative thematic text analysis followed by type-building text analysis identified distinct nursing roles in IHCA care and support for roles. RESULTS Nurses played three major roles in IHCA response: bedside first responder, resuscitation team member, and clinical or administrative leader. We found distinctions between higher and lower performing hospitals in support for nurses. Higher performing hospitals emphasised training and competency of nurses at all levels; provided organisational flexibility and responsiveness with nursing roles; and empowered nurses to operate at a higher scope of clinical practice (eg, bedside defibrillation). Higher performing hospitals promoted nurses as leaders-administrators supporting nurses in resuscitation care at the institution, resuscitation team leaders during resuscitation and clinical champions for resuscitation care. Lower performing hospitals had more restrictive nurse roles with less emphasis on systematically identifying improvement needs. CONCLUSION Hospitals that excelled in IHCA survival emphasised mentoring and empowering front-line nurses and ensured clinical competency and adequate nursing training for IHCA care. Though not proof of causation, nurses appear to be critical to effective IHCA response, and how to support their role to optimise outcomes warrants further investigation.
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Affiliation(s)
- Timothy C Guetterman
- Interdisciplinary Studies, Creighton University, Omaha, Nebraska, USA
- Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly Harrod
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | - Jessica L Lehrich
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Theodore J Iwashyna
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | | | - Saket Girotra
- Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Paul S Chan
- Internal Medicine, Saint Luke's Health System, Kansas City, Missouri, USA
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Factors influencing the intentions of nurses and respiratory therapists to use automated external defibrillators during in-hospital cardiac arrest: a qualitative interview study. CAN J EMERG MED 2016; 20:68-79. [DOI: 10.1017/cem.2016.403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesNurses and respiratory therapists are seldom allowed to use automated external defibrillators (AED) during in-hospital cardiac arrest. This can result in significant time delays before defibrillation occurs and lower survival for cardiac arrest victims. We sought to identify barriers and facilitators to AED use by nurses and respiratory therapists.MethodsWe conducted semi-structured qualitative interviews with a purposeful sample of nurses and respiratory therapists. We developed the interview guide based on the constructs of the theory of planned behaviour, which elicits salient attitudes, social influences, and control beliefs potentially influencing the intent to use an AED. Interviews were recorded, transcribed verbatim, and analysed until achieving data saturation. Two independent reviewers performed inductive analyses to identify emerging categories and themes, and ranked them by frequency of the number of participants stating the topic.ResultsDemographics for the 24 interviewees include mean age 40.5, 79.2% female, 87.5% performed cardiopulmonary resuscitation (CPR), 29.2% defibrillated a patient. Identified attitudes pertained to the timeliness of defibrillation, patient survival, simplicity of AED use, accuracy of rhythm recognition, and harm to self or others. Social influences consisted of physician and hospital administration support of AED use. Control beliefs included training on AED use, policy allowing AED use, familiarity with AED, and task burden during resuscitation.ConclusionsMost nurses and respiratory therapists intended to use an AED if permitted to do so by a medical directive. Successful implementation would require educational initiatives focusing on safety and efficacy of AEDs, support from physicians and hospital administrators, and additional training on AED use.
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Laws TA, Zeitz K, Fiedler BA. Seeking an Explanation for the Poor Uptake of In-Hospital AED Programs. Eur J Cardiovasc Nurs 2016; 3:195-200. [PMID: 15350228 DOI: 10.1016/j.ejcnurse.2004.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2003] [Revised: 05/18/2004] [Accepted: 05/27/2004] [Indexed: 11/21/2022]
Abstract
The automated external defibrillator (AED) has been adopted by emergency service personnel as a first-line intervention in the management of out-of-hospital cardiac arrest (OHCA). AED leads to more successful Advanced Cardiac Life Support; consequently, national resuscitation organisations worldwide have recommended that nurses and doctors also integrate AEDs as a component of their basic life-support response to cardiac arrest. Despite these recommendations, the implementation of AED programs within hospitals has been generally sporadic and isolated. A continuation of this situation will most likely disturb and perplex nurses and patients, as they are key stakeholders with respect to upholding recommended BLS practices. In the absence of any explanation from change agents within hospitals, this paper seeks, by way of a pilot study and a review of the literature, to identify the extent of the problem and identify factors contributing to the relatively slow uptake of this device. We argue that nurses and other first responders to in-hospital cardiac arrest (CA) have much to gain, in the context of Occupational Health Safety and Welfare (OHS and W), from ready access to AEDs. Cost factors are also considered, with initial cost of AED purchase likely to be a major concern for managers of hospital budgets. The issues we discuss in this paper clearly support the need for further research to (a) explain the nature of public hospital resistance to AEDs and (b) to consider whether AEDs will provide practical advantages to public hospitals from an occupational, social and economic perspective.
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Affiliation(s)
- Tom A Laws
- Division of Health Sciences, School of Nursing and Midwifery, University of South Australia, City East Campus Nth Terrace, Adelaide 5000, Australia.
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Mäkinen M, Castrén M, Nurmi J, Niemi-Murola L. Trainers' Attitudes towards Cardiopulmonary Resuscitation, Current Care Guidelines, and Training. Emerg Med Int 2016; 2016:3701468. [PMID: 27144027 PMCID: PMC4837270 DOI: 10.1155/2016/3701468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/20/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers' attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D), Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland (N = 185) focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree). Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse's Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation). Cronbach's alphas were 0.92-0.51. Statistics were Student's t-test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (p < 0.01). Participants scoring high on Hesitation scale (p < 0.01) were less confident about their Nurse's Role (p < 0.01) and Nontechnical Skills (p < 0.01). Conclusion. Quality of undergraduate education affects the work of CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills.
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Affiliation(s)
- M. Mäkinen
- Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, HUS, Stenbäckinkatu 9, 00029 Helsinki, Finland
- Department of Clinical Science and Education and Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Solnavägen 1, 17177 Stockholm, Sweden
| | - M. Castrén
- Department of Clinical Science and Education and Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Solnavägen 1, 17177 Stockholm, Sweden
- Department of Emergency Medicine, Helsinki University Hospital, HUS, Stenbäckinkatu 9, 00029 Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 6300014 Helsinki, Finland
| | - J. Nurmi
- Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, HUS, Stenbäckinkatu 9, 00029 Helsinki, Finland
| | - L. Niemi-Murola
- Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, HUS, Stenbäckinkatu 9, 00029 Helsinki, Finland
- Department of Clinical Science and Education and Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Solnavägen 1, 17177 Stockholm, Sweden
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Abstract
Early defibrillation is an essential step in the "chain of survival" for patients with in-hospital cardiac arrest. To increase the rate of early defibrillation by nurse first responders in noncritical care areas, our institution employed a quality resuscitation consultant, implemented nursing education programs, and standardized equipment and practices. Automated external defibrillator application by nurse first responders prior to advanced cardiac life support team arrival has improved from 15% in 2011 to 76% in 2013 (P < .001).
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Kloppe C, Jeromin A, Kloppe A, Ernst M, Mügge A, Hanefeld C. First Responder for In-Hospital Resuscitation: 5-Year Experience with an Automated External Defibrillator-Based Program. J Emerg Med 2013; 44:1077-82. [DOI: 10.1016/j.jemermed.2012.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 04/16/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
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Bradley SM, Huszti E, Warren SA, Merchant RM, Sayre MR, Nichol G. Duration of hospital participation in Get With the Guidelines-Resuscitation and survival of in-hospital cardiac arrest. Resuscitation 2012; 83:1349-57. [PMID: 22429975 DOI: 10.1016/j.resuscitation.2012.03.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 03/01/2012] [Accepted: 03/12/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Get With the Guidelines (GWTG-R) is a data registry and quality improvement program for in-hospital cardiac arrest (IHCA). It is unknown if duration of hospital participation in GWTG-R is associated with IHCA outcomes. METHODS We analyzed adults with IHCA from 362 hospitals participating in GWTG-R between 2000 and 2009. Using logistic regression with generalized estimating equations to account for clustering on hospital, we determined the association between duration of hospital participation in GWTG-R and patient outcomes after IHCA, adjusted for patient and arrest characteristics and secular trend. Using these methods, we also evaluated the association between duration of participation and factors previously correlated with survival after IHCA, including ECG monitored status, after-hours arrest, and time to defibrillation. RESULTS Of 104,732 patients with IHCA, 17,646 patients (16.9%) survived to discharge. Duration of hospital participation in GWTG-R was associated with IHCA event survival (per year of participation, odds ratio [OR] 1.02; 95% CI 1.00-1.04; p=0.046) but not survival to discharge (OR 1.02; 95% CI 0.99-1.04; p=0.18). Among factors previously correlated with IHCA survival, duration of participation was associated with time to defibrillation ≤2 min (per year of participation, OR 1.06; 95% CI 1.03-1.10; p<0.001), but not ECG monitored status (OR 1.00; 95% CI 0.93-1.06; p=0.90) or survival of after-hours arrest (OR 1.01; 95% CI 0.99-1.03; p=0.41). Among ventricular tachycardia or ventricular fibrillation (VT/VF) arrests, time to defibrillation attenuated the association between duration of hospital participation and outcomes. CONCLUSION Duration of hospital participation in GWTG-R was significantly associated with survival of the IHCA event, but not with survival to discharge. In VT/VF arrests, this association may have been mediated by improvements in time to defibrillation.
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Affiliation(s)
- Steven M Bradley
- VA Eastern Colorado Health Care System and University of Colorado-Denver, Denver, CO 80220-3808, USA.
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Lang D, Ang E. Effectiveness of using automated external defibrillator by trained healthcare professionals on survival outcomes among adult patients after in-hospital cardiac arrest: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2012; 10:1-10. [PMID: 27820408 DOI: 10.11124/jbisrir-2012-338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Dora Lang
- 1. Singapore National University Hospital Centre for Evidence Based Nursing: A Collaborating Centre of the Joanna Briggs Institute, 2. Singapore National University Hospital Centre for Evidenced Based Nursing: A Collaborating Centre of the Joanna Briggs Institute,
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Passali C, Pantazopoulos I, Dontas I, Patsaki A, Barouxis D, Troupis G, Xanthos T. Evaluation of nurses’ and doctors’ knowledge of basic & advanced life support resuscitation guidelines. Nurse Educ Pract 2011; 11:365-9. [DOI: 10.1016/j.nepr.2011.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 02/22/2011] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
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ICU nurses' perceptions of potential constraints and anticipated support to practice defibrillation: a qualitative study. Intensive Crit Care Nurs 2011; 27:186-93. [PMID: 21641223 DOI: 10.1016/j.iccn.2011.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 04/21/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
AIM The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation. METHOD This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview. RESULTS Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings. CONCLUSION Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed.
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Stewart JA. Focused nurse-defibrillation training: a simple and cost-effective strategy to improve survival from in-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2010; 18:42. [PMID: 20670421 PMCID: PMC2924258 DOI: 10.1186/1757-7241-18-42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 07/29/2010] [Indexed: 12/21/2022] Open
Abstract
Time to first defibrillation is widely accepted to correlate closely with survival and recovery of neurological function after cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Focused training of a cadre of nurses to defibrillate on their own initiative may significantly decrease time to first defibrillation in cases of in-hospital cardiac arrest outside of critical care units. Such a program may be the best single strategy to improve in-hospital survival, simply and at reasonable cost.
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Spearpoint K, Gruber P, Brett S. Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: An observational study over 6 years. Resuscitation 2009; 80:638-43. [DOI: 10.1016/j.resuscitation.2009.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/01/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
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Carabini L, Tamul P, Afifi S. Cardiopulmonary to Cardiocerebral Resuscitation: Current Challenges and Future Directions. Int Anesthesiol Clin 2009; 47:1-13. [DOI: 10.1097/aia.0b013e3181956298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cardiac arrests of hospital staff and visitors: Experience from the national registry of cardiopulmonary resuscitation. Resuscitation 2009; 80:65-8. [DOI: 10.1016/j.resuscitation.2008.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 09/10/2008] [Accepted: 09/18/2008] [Indexed: 11/18/2022]
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Miyadahira AMK, Quilici AP, Martins CDC, de Araújo GL, Pelliciotti JDSS. [Cardiopulmonary resuscitation with semi-automated external defibrillator: assessment of the teaching-learning process]. Rev Esc Enferm USP 2008; 42:532-8. [PMID: 18856122 DOI: 10.1590/s0080-62342008000300017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Studies demonstrate that, for every minute delayed on defibrillating a heart arrest patient, survival chances decrease by 10%, and that the same chances of survival are 98% effective when it is employed within 30 seconds. While attending a heart arrest patient, it is crucial that the use of external semi-automated defibrillator (AED) is included in the training. The purpose of the present study is to compare Psychomotor Ability and the Theoretical Knowledge of lay people on cardiopulmonary resuscitation (CPR) using AED, before and after training. This sample was composed of 40 administrative workers of a public institution that were trained on CPR technique using EAD, as an experiment. The significantly higher scores in the assessment instrument items of Psychomotor Ability and Theoretical Knowledge, after training, indicates that the participants have presented improvements in their performances.
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Affiliation(s)
- Ana Maria Kazue Miyadahira
- Departamento de Enfermagem Médico-Cirúrgica da Escola de Enfermagem, Universidade de São Paulo (EEUSP), São Paulo, SP, Brasil.
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Pytte M, Pedersen TE, Ottem J, Rokvam AS, Sunde K. Comparison of hands-off time during CPR with manual and semi-automatic defibrillation in a manikin model. Resuscitation 2007; 73:131-6. [PMID: 17270336 DOI: 10.1016/j.resuscitation.2006.08.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 08/21/2006] [Accepted: 08/29/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Rhythm analysis with current semi-automatic external defibrillators (AEDs) requires mandatory interruptions of chest compressions that may compromise the outcome after cardiopulmonary resuscitation (CPR). We hypothesised that interruptions would be shorter when the defibrillator was operated in manual mode by trained and certified ambulance personnel. MATERIALS AND METHODS Sixteen pairs of ambulance personnel operated the defibrillator (Lifepak((R))12) in both semi-automatic (AED) and manual (MED) mode in a randomised, cross-over manikin CPR study, following the ERC 2000 Guidelines. RESULTS Median time from last chest compression to shock delivery (with interquartile range) was 17s (13, 18) versus 11s (6, 15) (mean difference (95% CI) 6s (2, 10), p=0.004). Similarly, median time from shock delivery to resumed chest compressions was 25s (22, 26) versus 8s (7, 12) (median difference 13s, p=0.001) in the AED and MED groups, respectively. While sensitivity for identifying ventricular fibrillation (VF) in both modes and specificity in the AED mode were 100%, specificity was 89% in manual mode. Thus, some unwarranted shocks resulting in hands-off time (time without chest compressions) were given in manual mode. However, mean hands-off-ratio (time without chest compressions divided by total resuscitation time) was still lower, 0.2s (0.1, 0.3) versus 0.3s (0.28, 0.32) in manual mode, mean difference 0.10s (0.05, 0.15), p=0.001. CONCLUSION Paramedics performed CPR with less hands-off time before and after shocks on a manikin with manual compared to semi-automatic defibrillation following the 2000 Guidelines. However, 12% of the shocks given manually were inappropriate.
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Affiliation(s)
- Morten Pytte
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway.
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Einav S, Weissman C, Kark J, Lotan C, Matot I. Future shock: automatic external defibrillators. Curr Opin Anaesthesiol 2006; 18:175-80. [PMID: 16534335 DOI: 10.1097/01.aco.0000162837.79215.a7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW This review provides a practical overview of the performance capabilities of automatic external defibrillators (AEDs), and of advances in technology and dissemination programmes for these devices. RECENT FINDINGS Arrhythmia analysis by AEDs is extremely reliable in most settings (sensitivity 81-100%, specificity 99.9-97.6%). Accurate detection of arrhythmias has also been demonstrated in children, leading the US Food and Drug Administration to approve the use of several AEDs in children aged 8 years or younger. Factors that potentially may reduce the quality of arrhythmia detection are the presence of wide complex supraventricular tachycardia and location of an arrythmic event near to high-power lines. AED use by professional basic life support providers resulted in increased survival in the prehospital setting. However, provision of AEDs to nonmedical rescue services did not result in universal improvement in patient outcome. Public access defibrillation programmes have led to higher rates of survival from cardiac arrest. The role of AEDs in hospitals has yet to be elucidated, although in-hospital mortality from ventricular arrhythmias has been shown to decrease following AED deployment. SUMMARY Given the correct setting, AEDs can ensure that defibrillation is not limited by lack of medical knowledge or difficulties in decision making. However, event-related variables and operator-related factors, that are yet to be determined, can significantly affect the efficacy of automatic external defibrillation.
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Affiliation(s)
- Sharon Einav
- Department of Anaesthesiology and Critical Care Medicine, School of Public Health and Community Medicine, Hadassah Hebrew University Medical Centre, Ein-Kerem, Jerusalem, Israel
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Timsit JF, Paquin S, Pease S, Macrez A, Aim JL, Texeira A, Lefevre G, Scheuble A, Kermarrec N. Évaluation de la mise en place d'une formation continue du personnel de l'hôpital Bichat à la prise en charge des arrêts cardiocirculatoires intrahospitaliers. ACTA ACUST UNITED AC 2006; 25:135-43. [PMID: 16269232 DOI: 10.1016/j.annfar.2005.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 09/19/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Management of in-hospital cardiac arrest is now considered as a hospital quality indicator. Such management actually requires training health care workers (HCWs) for basic life support (BLS). OBJECTIVE To assess the usefulness and efficacy of a short mandatory BLS training course amongst general ward HCWs in a 1,200 bed teaching hospital. STUDY DESIGN The in-hospital medical emergency team (MET) established a 45-min BLS training course comprising 10 goals for basic CPR and preparing for the arrival of the MET. Assessment was based on satisfaction questionnaires, cross-sectional evaluation of knowledge and skills of HCWs before and 1 year after the start of the training course. Efficacy of BLS performed on ward was assessed by the MET on scene. RESULTS One year after, 68 training sessions had been fulfilled and 522 HCWs had been trained (46.27% of total HCWs). HCWs were satisfied with the teaching course. Instant retention of objectives was over 90%. Cross-sectional surveys showed an improvement of BLS knowledge and skills. The knowledge of initial clinical assessment remained low. Knowledge and skills were significantly higher amongst HCWs who had been trained than amongst those who had not. Unfortunately, general ward BLS performance showed no improvement. CONCLUSION Short mandatory training courses are stimulating and well appreciated amongst HCWs. Although basic knowledge and skills improve dramatically, no improvement of on-scene BLS performance occurs.
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Affiliation(s)
- J-F Timsit
- Réanimation médicale, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
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Affiliation(s)
- Michael Kyller
- Michael Kyller is the charge nurse in the cardiac catheterization laboratory at Boston Medical Center, Boston, Mass. He is an American Heart Association Basic Life Support instructor and course coordinator and is Regional Faculty for Basic Life Support and Advanced Cardiac Life Support
| | - Donald Johnstone
- Donald Johnstone is a clinical instructor in the telemetry units at Boston Medical Center, Boston, Mass. He is an American Heart Association Basic Life Support instructor and course coordinator
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Hanefeld C, Lichte C, Mentges-Schröter I, Sirtl C, Mügge A. Hospital-wide first-responder automated external defibrillator programme: 1 year experience. Resuscitation 2005; 66:167-70. [PMID: 16053941 DOI: 10.1016/j.resuscitation.2005.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Revised: 11/18/2004] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
The first year experience with a hospital-wide first-responder automated external defibrillator (AED) programme implemented in a 683-bed University Hospital is reported. Throughout the hospital, 14 "AED access spots" were identified which could be easily reached from all wards and diagnostic rooms within 30s. AEDs were installed (Lifepak 500; Medtronik PhysioControl Corp., Redmond, USA, equipped with a Biolog 3000i portable ECG monitor; Micromedical Industries Ltd., Labrador, Australia). Within 3 months, 120 medical officers, 750 nurses, and 50 administrative or technical staff underwent a 2h training programme. An AED was applied and activated by nurses/medical staff before the cardiac arrest team arrived in 27 of 33 cases (81.8%) of witnessed cardiac arrest. The median time from onset of the emergency call to the activation of the AED (record of ECG) was on average 2.1 min (range 1.0--4.5 min). In 18 of 27 cases in which the AED was installed promptly, the primary arrest rhythm was either VT or VF, and the AED delivered a shock. For this subgroup, the rate of return of spontaneous circulation and the rate of discharge at home were 88.9 and 55.6%, respectively. This encourages us to extend the concept of first-responder AED-defibrillation throughout our hospital.
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Affiliation(s)
- Christoph Hanefeld
- Clinic of Cardiology and Angiology, St. Josef-Hospital, University Hospital of the Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany
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Berg RA. Attenuated adult biphasic shocks for prolonged pediatric ventricular fibrillation: support for pediatric automated defibrillators. Crit Care Med 2004; 32:S352-5. [PMID: 15508658 DOI: 10.1097/01.ccm.0000134225.42482.dc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate published data regarding the treatment of prolonged pediatric defibrillation, with special emphasis on the use of attenuated adult biphasic shocks for pediatric defibrillation. DESIGN Review relevant human and animal literature. RESULTS Rhythm analysis algorithms from two manufacturers of automated external defibrillators can accurately distinguish shockable from nonshockable rhythms in children. Theoretical considerations and transthoracic impedance data from animals and children suggest that pediatric defibrillation doses should not necessarily vary in a simple weight-based manner. Two piglet studies have established that an attenuated adult biphasic dosage can be successfully used for 3.5- to 24-kg animals in ventricular fibrillation. One study established that the attenuated adult biphasic dosage was at least as safe and effective as the standard monophasic weight-based dosing. CONCLUSION This review supports the American Heart Association's new guidelines for pediatric automated external defibrillator usage: "Automated external defibrillators may be used for children 1 to 8 yrs of age who have no signs of circulation. Ideally the device should deliver a pediatric dose. The arrhythmia detection system used in the device should demonstrate high specificity for pediatric shockable rhythms, i.e., it will not recommend delivery of a shock for nonshockable rhythms."
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Affiliation(s)
- Robert A Berg
- University of Arizona Steele Memorial Children's Research Center and Sarver Heart Center, Department of Pediatrics, Tucson, AZ, USA
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Cusnir H, Tongia R, Sheka KP, Kavesteen D, Segal RR, Nowakiwskyj VN, Cassera F, Scherer H, Costello D, Valerio L, Yens DP, Shani J, Hollander G. In hospital cardiac arrest: a role for automatic defibrillation. Resuscitation 2004; 63:183-8. [PMID: 15531070 DOI: 10.1016/j.resuscitation.2004.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Revised: 05/10/2004] [Accepted: 05/10/2004] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Sudden cardiac death (SCD) survival decreases by 10% for each minute of delay in defibrillation, however, survival rates of 98% can be achieved when defibrillation is accomplished within 30s of collapse. Recently, a fully automated external cardioverter-defibrillator (AECD) was approved by the FDA for in-hospital use. The AECD can be programmed to automatically defibrillate when a life threatening ventricular arrhythmia occurs. The purpose of this study was to assess the potential impact of in-hospital AECDs on the critical time to defibrillation in monitored hospital units. METHODS Mock emergency (n = 18) were conducted using simulated ventricular fibrillation in various monitored units. Observers were stationed to record the time staff responded to the arrhythmia, and the time to shock. These times were compared to an AECD protocol that defibrillates automatically in an average of 38.3 s from onset of arrhythmia (n = 18). RESULTS Staff versus AECD response time to arrhythmia (s) was 76.3 +/- 113.7 (CI 19.8-132.8) versus 7.6 +/- 0.6 (CI 7.3-7.9). Staff versus AECD time to shock was 169.2 +/- 103.1 (CI 117.9-220.4) versus 38.3 +/- 0.7 (CI 37.9-38.6). P-values are <0.0001 for differences between the groups. CONCLUSION The use of AECDs on monitored units would significantly reduce the critical time to defibrillation in patients with SCA. We anticipate this would translate to improved survival rates, and better neurologic outcomes.
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Affiliation(s)
- Henry Cusnir
- Division of Cardiology, Maimonides Medical Center, 953 49th Street, Brooklyn, NY 11219, USA
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Abstract
Survival to discharge following a cardiac arrest is dependent on rapid and effective basic and advanced life support. Paramount to a rapid response is access to sufficiently trained health care providers, who have a duty to perform basic life support and initiate early defibrillation. In hospitals, defibrillation remains the domain of specially prepared staff and the type of defibrillator used might be crucial to rapid and effective defibrillation. The advent of automatic external defibrillators has increased the range of people who can use a defibrillator successfully. For nurses, arguably a lack of familiarity about the benefits of and the use of automatic external defibrillators are the greatest barriers to nurse-initiated defibrillation programmes. This paper explores the use of automatic external defibrillators, their relationship to the associated defibrillator waveforms and the benefits of their use by registered nurses within the hospital setting.
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Affiliation(s)
- Trudy Dwyer
- School of Nursing and Health Studies, Central Queensland University, Rockhampton, Queensland, Australia.
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Abstract
BACKGROUND Rural hospitals in Australia, as in many countries, face challenges in ensuring that appropriate, quality services are provided. AIMS The overall aim of this study was to explore the issues that impact on the ability of rural hospitals to provide effective health care. METHODS We used a qualitative descriptive method and purposive sampling, and conducted interviews in hospitals in rural Victoria, Australia. The data collected enabled major issues that impact on hospital service delivery to be identified. Using thematic analysis, global themes were extracted and organized around a thematic network. FINDINGS The workforce was an important theme. Whilst the impact of medical shortages on hospital function has been considered in other studies, little consideration has been given to the rural nursing workforce. The need to maintain an appropriately educated rural nursing workforce emerged as one of the major issues that impact on rural hospital service delivery. In Australia, there has been a great deal of discussion about the educational preparation required for rural nursing practice, with the emphasis on postgraduate study. However, the majority of rural nurses do not have postgraduate qualifications and face significant barriers in obtaining them. Although the vast majority of literature claims that postgraduate preparation is vital for rural nursing practice, this research suggests that the future rural nursing workforce will be recruited from undergraduate courses in regional universities. However, there is a need to include specific theoretical and operational preparation in undergraduate education, to enable nurses to make the transition to rural practice more readily. CONCLUSIONS Rural nurses are central to the delivery of health services in rural hospitals. Future rural nursing recruitment and retention hinges on ensuring that they have the confidence, knowledge and skills to deliver safe, appropriate and effective care.
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Affiliation(s)
- Amanda Kenny
- LaTrobe University Bendigo, PO Box 199, Bendigo, Victoria, Australia.
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Abstract
BACKGROUND The Advanced Life Support (ALS) Provider Course trains healthcare professionals in a standardised approach to the management of a cardiac arrest. In the setting of limited resources for healthcare training, it is important that courses are fit for purpose in addressing the needs of both the individual and healthcare system. This study investigated the use of ALS skills in clinical practice after training on an ALS course amongst members of the cardiac arrest team compared to first responders. METHODS Questionnaires measuring skill use after an ALS course were distributed to 130 doctors and nurses. RESULTS 91 replies were returned. Basic life support, basic airway management, manual defibrillation, rhythm recognition, drug administration, team leadership, peri- and post-arrest management and resuscitation in special circumstances were used significantly more often by cardiac arrest team members than first responders. There was no difference in skill use between medically and nursing qualified first responders or arrest team members. CONCLUSION We believe that the ALS course is more appropriately targeted to members of a cardiac arrest team. In our opinion the recently launched Immediate Life Support course, in parallel with training in the recognition and intervention in the early stages of critical illness, are more appropriate for the occasional or first responder to a cardiac arrest.
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Affiliation(s)
- Jonathan Hulme
- Intensive Care Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK
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Abstract
PURPOSE OF REVIEW To examine the literature for new resuscitation science since the publication of the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care. RECENT FINDINGS The two and a half years since the publication of the Guidelines 2000 have seen the advent of a number of new and important resuscitation studies. Such studies highlight the importance of simplification of cardiopulmonary resuscitation techniques and guidelines, including the elimination of the layperson pulse check and the need for a simple form of basic life support cardiopulmonary resuscitation that decreases interruptions of chest compressions. Automatic external defibrillators, even in the hands of nontraditional first responders, are effective and safe. A second prospective, randomized clinical trial of amiodarone for refractory ventricular fibrillation has again shown positive results in improving survival to hospital admission. Finally, mild hypothermia appears to be the first effective therapy at decreasing central nervous system injury when administered after resuscitation. SUMMARY In this report, we review these new studies and discuss how they corroborate or alter the published 2000 guidelines.
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Affiliation(s)
- Lyndon C Xavier
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona 85724, USA
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Affiliation(s)
- Richard Vincent
- Faculty of Health, University of Brighton, Falmer, Brighton BN1 9PH, UK.
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Handley AJ, Handley SAJ. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator. Resuscitation 2003; 57:57-62. [PMID: 12668300 DOI: 10.1016/s0300-9572(02)00400-8] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It has been shown that a computer-based audible feedback system can improve acquisition and retention of basic life support (BLS) skills. This system is being developed to work in association with an automated external defibrillator (AED). AIM To determine if such a feedback system is likely to improve the quality of CPR performed by trained nurses whilst using an AED. METHOD Thirty-six general nurses performed 3 min of BLS on a manikin connected to a laptop computer running an experimental software program. After initial testing they were randomly allocated to control or 'feedback' groups. Both groups then performed a further 3 min of BLS, but those in the feedback group received audible corrective instructions from the computer when errors of technique were detected. RESULTS The group receiving feedback were significantly better than the control group at performing inflations (P=0.004) and achieving the correct depth of chest compression (P<0.0005). CONCLUSIONS The results suggest that if the feedback system were to be incorporated into an AED, it could lead to better performance of CPR during a resuscitation attempt.
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Affiliation(s)
- Anthony J Handley
- Department of Cardiology, Colchester General Hospital, Turner Road, CO4 5JL, Colchester, UK.
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Jesús Simón García M, José López Cid J, Antón Pleite EM, Cosgaya García O, García Alegre E, José Baltasar Sánchez M, Tostado Acero I, Núñez Barragán D, Marín García E, Carlos Martín Benítez J. Formación en reanimación cardiopulmonar básica con desfibrilación precoz a enfermeros/as del área 7 de Madrid. ENFERMERIA INTENSIVA 2003. [DOI: 10.1016/s1130-2399(03)78091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Moule P, Albarran JW. Automated external defibrillation as part BLS: implications for education and practice. Resuscitation 2002; 54:223-30. [PMID: 12204454 DOI: 10.1016/s0300-9572(02)00150-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The latest Adult Basic Life Support (BLS) guidelines support the inclusion of the use of the automated external defibrillator (AED), as part of basic life support (BLS). Emphasis on the provision of early defibrillation as part of BLS acknowledges the importance of this manoeuvre in the successful termination of ventricular fibrillation. The ramifications of such changes for both first responders and organisations implementing the guidelines should not be underestimated. Issues relating to resourcing, content and duration of training and retraining, auditing and evaluation require further exploration. To consider these issues now seems particularly pertinent, given the recent launch of the UK Government's paper on public health, 'Saving Lives-Our Healthier Nation' which seeks to deploy AEDs in busy public places for use by trained members of the lay public. Additionally, defibrillation has been identified as one of the key competencies that all trained nurses and other health care providers should be able to undertake. This paper will consider the background to the current guideline changes, analyse the wider implications of translating the recommendations into practice, and offer possible solutions to address the issues raised. Whilst the analysis is particularly pertinent to the United Kingdom, many of the issues raised have international importance.
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Affiliation(s)
- Pam Moule
- Faculty of Health and Social Care, University of the West of England, Glenside Campus, Blackberry Hill, Stapleton, BS16 1DD, Bristol, UK.
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Helbok CW. Automatic external defibrillators for cardiac arrest in children. Resuscitation 2002; 53:319. [PMID: 12062849 DOI: 10.1016/s0300-9572(02)00029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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