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Santa Cruz Hernando AS, Nieves-Alonso JM, Mjertan A, Gutiérrez Martínez D, Planas Roca A. In-hospital cardiac arrest: Incidence, prognostic factors and results. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:373-380. [PMID: 36940853 DOI: 10.1016/j.redare.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/28/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA. PATIENTS AND METHODS Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year. RESULTS Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm. CONCLUSIONS These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.
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Affiliation(s)
- Alvar Santa Santa Cruz Hernando
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Clínico San Carlos, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Jesús Manuel Nieves-Alonso
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Amadea Mjertan
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Gutiérrez Martínez
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario Puerta de Hierro, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio Planas Roca
- Servicio de Anestesiología y Reanimación, Jefe de Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
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Clemente Vivancos Á, León Castelao E, Castellanos Ortega Á, Bodi Saera M, Gordo Vidal F, Martin Delgado MC, Jorge-Soto C, Fernandez Mendez F, Igeño Cano JC, Trenado Alvarez J, Caballero Lopez J, Parraga Ramirez MJ. National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12627. [PMID: 36231926 PMCID: PMC9565925 DOI: 10.3390/ijerph191912627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Anticipating and avoiding preventable intrahospital cardiac arrest and clinical deterioration are important priorities for international healthcare systems and institutions. One of the internationally followed strategies to improve this matter is the introduction of the Rapid Response Systems (RRS). Although there is vast evidence from the international community, the evidence reported in a Spanish context is scarce. METHODS A nationwide cross-sectional research consisting of a voluntary 31-question online survey was performed. The Spanish Society of Intensive, Critical and Coronary Care Medicine (SEMICYUC) supported the research. RESULTS We received 62 fully completed surveys distributed within 13 of the 17 regions and two autonomous cities of Spain. Thirty-two of the participants had an established Rapid Response Team (RRT). Common frequency on measuring vital signs was at least once per shift but other frequencies were contemplated (48.4%), usually based on professional criteria (69.4%), as only 12 (19.4%) centers used Early Warning Scores (EWS) or automated alarms on abnormal parameters. In the sample, doctors, nurses (55%), and other healthcare professionals (39%) could activate the RRT via telephone, but only 11.3% of the sample enacted this at early signs of deterioration. The responders on the RRT are the Intensive Care Unit (ICU), doctors, and nurses, who are available 24/7 most of the time. Concerning the education and training of general ward staff and RRT members, this varies from basic to advanced and specific-specialized level, simulating a growing educational methodology among participants. A great number of participants have emergency resuscitation equipment (drugs, airway adjuncts, and defibrillators) in their general wards. In terms of quality improvement, only half of the sample registered RRT activity indicators. In terms of the use of communication and teamwork techniques, the most used is clinical debriefing in 29 centers. CONCLUSIONS In terms of the concept of RRS, we found in our context that we are in the early stages of the establishment process, as it is not yet a generalized concept in most of our hospitals. The centers that have it are in still in the process of maturing the system and adapting themselves to our context.
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Affiliation(s)
- Álvaro Clemente Vivancos
- Health Sciences Doctoral Program, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
- Advanced Nursing Practice, Hospital del Mar, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Esther León Castelao
- Simulation Laboratory, School of Medicine and Health Sciences, 08036 Barcelona, Spain
- Clinical Simulation Lab, University of Barcelona, 08036 Barcelona, Spain
| | - Álvaro Castellanos Ortega
- Intensive Care Unit Medical Director, University Hospital La Fe, 46026 Valencia, Spain
- Associate Lecturer, University of Valencia, 46010 Valencia, Spain
| | - Maria Bodi Saera
- Intensive Care Unit, University Hospital Joan XIII, 43005 Tarragona, Spain
- Pere I Virgili Health Research Institute, Rovira I Virgili University, 43003 Tarragona, Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIEBERES), Carlos III Health Institute, 28029 Madrid, Spain
| | - Federico Gordo Vidal
- Intensive Care Unit, University Hospital of Henares, 28822 Madrid, Spain
- Critical Pathology Research Group, Francisco de Vitoria University, 28223 Madrid, Spain
| | - Maria Cruz Martin Delgado
- Intensive Care Unit, Hospital 12th of October, 28041 Madrid, Spain
- Facultad de Medicina, Francisco de Vitoria University, 28223 Madrid, Spain
| | - Cristina Jorge-Soto
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidad de Santiago de Compostela, 15705 Galicia, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15705 Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Felipe Fernandez Mendez
- School of Nursing, Universidade de Vigo, 36310 Pontevedra, Spain
- REMOSS Research Group, Universidade de Vigo, 36310 Pontevedra, Spain
| | | | - Josep Trenado Alvarez
- Intensive Care and High Dependency Unit, Mutua Terrassa Hospital, 08221 Terrasa, Spain
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Jesus Caballero Lopez
- Intensive Care Unit, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
- IRBLleida, 25198 Lleida, Spain
| | - Manuel Jose Parraga Ramirez
- Intensive Care Unit, JM Morales Meseguer, 30008 Murcia, Spain
- Simulation and Clinical Skills Director, UCAM, 30107 Murcia, Spain
- Medical Degree Direction Team, UCAM, 30107 Murcia, Spain
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In-Hospital Cardiac Arrest in the Cardiac Catheterization Laboratory: Effective Transition from an ICU- to CCU-Led Resuscitation Team. J Interv Cardiol 2019; 2019:1686350. [PMID: 31772514 PMCID: PMC6766259 DOI: 10.1155/2019/1686350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution. Background IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Although in-hospital resuscitation teams are often led by an Intensive Care Unit- (ICU-) trained physician and house staff, little is known on the role of a cardiologist in this setting. Methods Between 2012 and 2016, a single-center retrospective cohort study was performed examining 63 adult patients (70 ± 10 years, 60% males) who suffered from a cardiac arrest in the CCL. The ICU-led IHCAs included 19 patients, and the Coronary Care Unit- (CCU-) led IHCAs included 44 patients. Results Acute coronary syndrome accounted for more than 50% of cardiac arrests in the CCL. Pulseless electrical activity was the most common rhythm requiring chest compression, and cardiogenic shock most frequently initiated a code blue response. No significant differences were observed between the ICU-led and CCU-led cardiac arrests in terms of hospital length of stay and 1-year survival rate. Conclusion In the evolving field of Critical Care Cardiology, the transition from an ICU-led to a CCU-lead code blue team in the CCL setting may lead to similar short-term and long-term outcomes.
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Radeschi G, Mina A, Berta G, Fassiola A, Roasio A, Urso F, Penso R, Zummo U, Berchialla P, Ristagno G, Sandroni C. Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region. Resuscitation 2017; 119:48-55. [DOI: 10.1016/j.resuscitation.2017.06.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022]
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Liu ZJ, Yi J, Chen WY, Zhang XH, Huang YG. Comparison of learning performance of 2 intubating laryngeal mask airways in novice: A randomized crossover manikin study. Medicine (Baltimore) 2017; 96:e6905. [PMID: 28489804 PMCID: PMC5428638 DOI: 10.1097/md.0000000000006905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Intubating laryngeal mask airways (LMAs) such as i-gel and Aura-i could serve as rescue devices in resuscitation and further ensure the airway by facilitating trachea intubation without ventilation interruption. But data regarding intubating LMAs in novice are limited and skill degeneration without regular training has not been evaluated. So we designed this prospective randomized crossover manikin study to compare the learning performance of 2 intubating LMAs (i-gel and Aura-i). METHODS In total, 46 novice doctors participated in this study. After standardized training and finishing 3 consecutive successful intubations with both LMAs on manikin, each participant applied intubation with both LMAs in random order for initial evaluation. To evaluate skill retention, participants were reassessed 90 days later on the same manikin without retraining between times. Primary outcome was time to successful ventilation (TTV). RESULTS The TTV for i-gel was significantly shorter than Aura-i (initial evaluation 11.8 ± 2.9 seconds vs 22.4 ± 5.2 seconds, 90-days reevaluation 14.9 ± 3.6 seconds vs 28.9 ± 10.0 seconds, initial evaluation, P = .001; second evaluation, P < .001); during re-evaluation, TTV taken for i-gel and Aura-i were both significantly longer (initial evaluation, P = .001; second evaluation, P < .001) and ease score of insertion both increased profoundly (i-gel P = .025; Aura-i P < .001). In both assessments, participants preferred i-gel as easier alternative (initial evaluation, P = .001; second evaluation, P < .001). There was no difference in successful intubation rate, first attempt success rate, bronchoscopy assessment, and insertion score for 2 LMAs. CONCLUSION Compared with Aura-i, i-gel showed a faster and easier intubation by novice doctors in this manikin study; the skill retention of intubation performance after 3 months was acceptable for both intubating LMAs, but TTV prolonged significantly.
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Price RJ, Garrioch A. Prospective Observational Survey of the Utilisation of Anaesthetists and the Outcome following Cardiac Arrest Calls. Scott Med J 2016; 50:13-4. [PMID: 15792380 DOI: 10.1177/003693300505000105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: We wanted to determine whether the practice of routinely sending an anaesthetist to cardiac arrests is common within Scotland. We also wished to evaluate the interventions performed by our intensive care anaesthetist when responding to cardiac arrest calls. Methods: We performed a telephone survey of the 26 Scottish hospitals with an intensive care unit. We conducted a prospective observational survey over a period of six months in one Scottish teaching hospital. Structured interviews with the anaesthetist who responded to the cardiac arrest call were undertaken. Results: Routine attendance of an anaesthetist at cardiac arrests occurs in 25 of the 26 hospitals surveyed. We analysed 68 of 73 arrest calls. In 28 calls (41%) there was no requirement for anaesthetic intervention. In 40 (59%) the anaesthetist intervened. The interventions were for cardiac arrest procedures in 33 cases and ventilatory failure in the remaining 7 cases. One patient survived to hospital discharge: a mortality of 98%. Conclusions: Patients who remain in cardiac arrest upon the arrival of the anaesthetist have a very high mortality. The practice of routinely sending an anaesthetist to cardiac arrest calls is not justified.
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Affiliation(s)
- R J Price
- Department of Anaesthesia, Management Buildings, Southern General Hospital, 1345 Govan Road, Glasgow.
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Hörner E, Schebesta K, Hüpfl M, Kimberger O, Rössler B. The Impact of Monitoring on the Initiation of Cardiopulmonary Resuscitation in Children: Friend or Foe? Anesth Analg 2016; 122:490-6. [PMID: 26554459 DOI: 10.1213/ane.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The immediate initiation and high quality of basic life support (BLS) are pivotal to improving patient outcome after cardiac arrest. Although cardiorespiratory monitoring could shorten the time to recognize the onset of cardiac arrest, little is known about how monitoring and the misinterpretation of monitor readings could impair the initiation of BLS. In this study, we assessed the speed of initiation and quality of BLS in simulated monitored and nonmonitored pediatric cardiac arrest. METHODS Sixty residents frequently involved in the care of critically ill children were randomly assigned to either the intervention (monitoring) group or the control (nonmonitoring) group. Participants of both groups performed BLS in 1 of 2 clinically identical, unwitnessed simulated cardiac arrest scenarios. Although in 1 scenario cardiorespiratory monitoring (i.e., electrocardiogram) was attached, the other scenario reflected a nonmonitored cardiac arrest. Time to first chest compression was chosen as the primary outcome variable. Adherence to resuscitation guidelines and subjective performance ratings were secondary outcome variables. RESULTS Participants in the monitoring group initiated chest compressions significantly later than those in the nonmonitoring group (91 ± 36 vs 71 ± 26 seconds, hazard ratio, 0.26; 95% confidence interval, 0.14-0.49, P < 0.001). Six members of the monitoring group did not start chest compression within 5 minutes. Furthermore, adherence to the guidelines was better in the nonmonitoring group. Participants who were previously involved in BLS training did not show better performance. CONCLUSIONS The presence of cardiorespiratory monitoring significantly delayed or even prevented the initiation of chest compressions and impaired the quality of BLS in simulated pediatric cardiac arrest. Based on these data, specific training should be conducted for exposed personnel.
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Affiliation(s)
- Elisabeth Hörner
- From the *Medical Simulation and Emergency Management Research Group, Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Austria; and †Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Austria
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Characterization of in-hospital cardiac arrest in adult patients at a tertiary hospital in Kenya. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lauridsen KG, Schmidt AS, Adelborg K, Løfgren B. Organisation of in-hospital cardiac arrest teams – A nationwide study. Resuscitation 2015; 89:123-8. [DOI: 10.1016/j.resuscitation.2015.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
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Je SM, Kim HJ, You JS, Chung SP, Cho J, Lee JH, Lee HS, Chung HS. Assessing safety attitudes among healthcare providers after a hospital-wide high-risk patient care program. Yonsei Med J 2014; 55:523-9. [PMID: 24532527 PMCID: PMC3936643 DOI: 10.3349/ymj.2014.55.2.523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Cardiopulmonary resuscitation (CPR) is commonly performed in high-risk, high intensity situations and is therefore a good procedure around which to develop and implement safety culture strategies in the hospital. The purpose of this study was to evaluate the impact of a hospital-wide quality improvement program on the management of sudden cardiac arrests by assessing healthcare providers' attitudes towards patient safety. MATERIALS AND METHODS This study was designed as a prospective cohort study at a single academic medical center. The comprehensive hospital-based safety program included steps to identify areas of hazard, partner units with the Resuscitation Committee, and to conduct a Safety Attitudes Questionnaire (SAQ). The SAQ evaluated 35 questions in seven domains to assess changes in patient safety culture by comparing the results before and after the hospital- wide high risk patient care improvement program. RESULTS The response rates of the pre- and post-SAQ survey were 489 out of 1121 (43.6%) and 575 out of 1270 (45.3%), respectively. SAQ survey responses revealed significant improvement in all seven domains of the questionnaire (p-values of 0.006 and lower). In a subgroup analysis, doctors and nurses showed improvement in five domains. Both doctors and nurses did not show improvement in the "sharing information" domain. CONCLUSION A hospital-wide quality improvement program for high-risk, high reliability patient care involving CPR care was shown to be associated with a change in healthcare providers' attitudes towards patient safety. Through an immersive and active program on CPR care, change in healthcare providers' attitudes towards patient safety was initiated.
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Affiliation(s)
- Sang Mo Je
- Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea.
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In-hospital cardiac arrest: can we change something? Wien Klin Wochenschr 2013; 125:516-23. [PMID: 23928936 DOI: 10.1007/s00508-013-0409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Cardiac arrest is classified as 'in-hospital' if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient's survival until hospital discharge is very low. The reasons for this are old age, multiple co-morbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams (RTs) and poor organization.The aim of this study was to demonstrate characteristics of in-hospital cardiac arrests and resuscitation measures in University Hospital Osijek. We analysed retrospectively all resuscitation procedures data where anaesthesiology RTs provided cardiopulmonary resuscitation (CPR) during 5-year period.We analysed 309 in-hospital resuscitation attempts with complete documentation. Victims of cardiac arrest were principally elderly patients, neurological (30.4 %), surgical (25.24 %) and neurosurgical patients (15.2 %) with many associated severe diseases. In 85.6 % of the cases, resuscitation was initiated by ward personnel and RTs arrived within 5 min in 67 % of the cases. However, in 14.6 % of the cases resuscitation measures had not been started before RT arrival. We found statistical correlation between lower initial survival rates and length of hospital stay (p = 0.001), presence of cerebral ischemia (p = 0.026) or cardiomyopathy (p = 0.004) and duration of CPR (p = 0.041). Initial survival was very low (14.6 %), and full recovery was accomplished in only eight patients out of 309 (2.59 %).Identification of terminal chronic patients in which the CPR is not reasonable, a better organisation and ward personnel education can contribute to better overall success.
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Sandroni C, Cavallaro F, Antonelli M. Is there still a place for vasopressors in the treatment of cardiac arrest? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:213. [PMID: 22429716 PMCID: PMC3681358 DOI: 10.1186/cc11227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
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Mondrup F, Brabrand M, Folkestad L, Oxlund J, Wiborg KR, Sand NP, Knudsen T. In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study. Scand J Trauma Resusc Emerg Med 2011; 19:55. [PMID: 21978605 PMCID: PMC3197516 DOI: 10.1186/1757-7241-19-55] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/06/2011] [Indexed: 01/22/2023] Open
Abstract
Background Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. Methods A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team. Results Data from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254) and detected initial rhythm after median 311 seconds (283-349). A significant difference in no flow ratio (NFR) was observed between the first responders, median NFR 38% (32-46), and the resuscitation teams, median NFR 25% (19-29), p < 0.001. The difference was significant even after adjusting for pulse and rhythm check and shock delivery. Conclusion The main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient outcome.
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Affiliation(s)
- Frederik Mondrup
- Sydvestjysk Sygehus Esbjerg, Department of Emergency Medicine, Finsensgade 35, DK-6700 Esbjerg, Denmark.
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Herrera M, López F, González H, Domínguez P, García C, Bocanegra C. Resultados del primer año de funcionamiento del plan de resucitación cardiopulmonar del Hospital Juan Ramón Jiménez (Huelva). Med Intensiva 2010; 34:170-81. [DOI: 10.1016/j.medin.2009.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 10/20/2009] [Accepted: 11/10/2009] [Indexed: 11/25/2022]
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Siebig S, Reng M, Gantner M, Langgartner J. [Quality management: implementation of the "in-hospital" emergency protocol into clinical routine]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2009; 104:520-528. [PMID: 19618137 DOI: 10.1007/s00063-009-1111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 03/23/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE Outcome after in-hospital resuscitation with survival rates between 14-17% still remains poor. Structured documentation of in-hospital cardiac arrest especially in Germany is rare and inhomogeneous. Documentation of in-hospital emergency situations (I-ES) may help to develop organizational structures, to collect information of treatment after resuscitation and therefore, improve patient's outcome. The aim of this study was to evaluate the documentation quality and user's acceptance after the implementation of an in-house emergency (IHE) protocol used by the authors' internal medicine emergency team (ET). METHODS Analysis of IHE protocols and discharge letters of 65 patients between August 2004 and December 2007 at a university medical center. RESULTS The IHE protocol was used in 65% of all emergency calls with a completion rate of 80% of all available documentation categories. Especially documentation of drugs given, their dosage and the general course of action was incomplete. In 25% the discharge letters did not contain information about the I-ES. CONCLUSION Implementation of the authors' IHE protocol, designed in close accordance with the DIVI (German Interdisciplinary Association of Intensive Care and Emergency Medicine) out-of-hospital emergency protocol, helps to collect important data in I-ES. Usage of the protocol resulted in better documentation of emergency situations in contrast to the information found in discharge letters alone. Nevertheless, documentation of I-ES still needs to be improved, especially concerning the completeness of records.
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Affiliation(s)
- Sylvia Siebig
- Klinik und Poliklinik für Innere Medizin I, Universität Regensburg, Regensburg.
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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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Hunt EA, Walker AR, Shaffner DH, Miller MR, Pronovost PJ. Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrests: highlighting the importance of the first 5 minutes. Pediatrics 2008; 121:e34-43. [PMID: 18166542 DOI: 10.1542/peds.2007-0029] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data suggest that the quality of basic and advanced life support delivered to adults is low and contributes to poor outcomes, but few data regarding pediatric events have been reported. The objectives of this study were to (1) measure the median elapsed time to initiate important resuscitation maneuvers in simulated pediatric medical emergencies (ie, "mock codes") and (2) identify the types and frequency of errors committed during pediatric mock codes. METHODS A prospective, observational study was conducted of 34 consecutive hospital-based mock codes. A mannequin or computerized simulator was used to enact unannounced, simulated crisis situations involving children with respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest. Assessment included time elapsed to initiation of specific resuscitation maneuvers and deviation from American Heart Association guidelines. RESULTS Among the 34 mock codes, the median time to assessment of airway and breathing was 1.3 minutes, to administration of oxygen was 2.0 minutes, to assessment of circulation was 4.0 minutes, to arrival of any physician was 3.0 minutes, and to arrival of first member of code team was 6.0 minutes. Among cardiopulmonary arrest scenarios, elapsed time to initiation of compressions was 1.5 minutes and to request for defibrillator was 4.3 minutes. In 75% of mock codes, the team deviated from American Heart Association pediatric basic life support protocols, and in 100% of mock codes there was a communication error. CONCLUSIONS Alarming delays and deviations occur in the major components of pediatric resuscitation. Future educational and organizational interventions should focus on improving the quality of care delivered during the first 5 minutes of resuscitation. Simulation of pediatric crises can identify targets for educational intervention to improve pediatric cardiopulmonary resuscitation and, ideally, outcomes.
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Affiliation(s)
- Elizabeth A Hunt
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Overcoming barriers to in-hospital cardiac arrest documentation. Resuscitation 2007; 76:369-75. [PMID: 18023958 DOI: 10.1016/j.resuscitation.2007.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/17/2007] [Accepted: 08/17/2007] [Indexed: 11/21/2022]
Abstract
AIMS (1) To describe the introduction of standardised cardiac arrest documentation to Auckland City Hospital, highlighting how barriers to using the Utstein template were overcome. (2) To determine the adequacy of documentation of cardiac arrest time intervals. METHOD A retrospective audit of cardiac arrest documentation for a 3-year period following the introduction of a standard documentation form. RESULTS There was an initial improvement in use of the template (29% (95%CI 22-37%) to 88% (95%CI 82-92%), p<0.001) after identification of barriers and implementation of tailored strategies. Use of the template declined (77%, 95%CI 69-84%, p=0.023) after the key facilitator left the hospital. Time interval documentation ranged from 66% (95%CI 54-77%) for tracheal intubation to 91% (95%CI 80-93%) for first dose of adrenaline (epinephrine). CONCLUSIONS Designated 'hands-off' senior clinicians were required for accurate documentation of time intervals. Time interval documentation was sub-optimal and further efforts are required to improve this. Transfer of ownership beyond the key facilitator was integral to sustainability of the process. Future reports of in-hospital cardiac arrest outcomes should include baseline information on the adequacy of documentation of time intervals.
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Hou SK, Chern CH, How CK, Wang LM, Huang CI, Lee CH. Is ward experience in resuscitation effort related to the prognosis of unexpected cardiac arrest? J Chin Med Assoc 2007; 70:385-91. [PMID: 17908653 DOI: 10.1016/s1726-4901(08)70025-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the outcome of patients of unexpected cardiac arrest initially resuscitated by first responders with dissimilar experiences under the support of cardiac arrest team (CAT). METHODS All unexpected cardiac arrest patients receiving in-hospital resuscitation with the activation of CAT in a tertiary-care teaching hospital over a 12-month period were recorded according to the Utstein criteria. We prospectively recorded various factors at resuscitation and retrospectively evaluated the outcome. Outcome measures included return of spontaneous circulation (ROSC), survival longer than 24 hours, and survival to discharge. RESULTS Altogether, 76 emergency calls were registered, and among these, 44 calls (58%) were cardiac arrests, including 8 ventricular tachycardia/fibrillation, 15 pulseless electrical activity, and 21 asystole. The rate of ROSC was 61%, the rate of survival longer than 24 hours was 37%, and the rate of survival to discharge was 18%. The response time of our CAT was 271 seconds (4 minutes and 31 seconds) on average. The patients who collapsed in the wards experienced in resuscitation effort received higher rates of appropriate basic and advanced cardiac life support interventions before CAT arrival (79% vs. 44%; p = 0.019), had an increased chance of ROSC (75% vs. 38%; p = 0.014), survival longer than 24 hours (54% vs. 13%; p = 0.007), and survival to discharge (29% vs. 0%; p = 0.036). CONCLUSION Hospital wards with more than 5 cardiac arrests per year have a better patient survival rate than those with fewer arrests. This is despite all ward staff receiving the same level of training.
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Affiliation(s)
- Sen-Kuang Hou
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Scapigliati A, Sanna T, Zamparelli R, Sandroni C, Colizzi C, Fenici P, Arlotta G, Nuzzo C, Bonarrigo C, Bellocci F, Schiavello R, Possati G. The immediate life support (ILS) course – The Italian experience. Resuscitation 2007; 72:451-7. [PMID: 17161900 DOI: 10.1016/j.resuscitation.2006.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 07/20/2006] [Accepted: 07/27/2006] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY The 1-day immediate life support course (ILS) was started in the United Kingdom and adopted by the ERC to train healthcare professionals who attend cardiac arrests only occasionally. Currently, there are no reports about the ILS course from outside the UK. In this paper we describe our initial Italian experience of teaching ILS to nurses. We have also measured the impact that ILS has on the resuscitation knowledge of nurses. METHODS The ILS course materials were translated by Italian ALS instructors who had observed the ILS course previously in the UK. From March to November 2005 nurses from a single hospital department attended the Italian ILS course. Candidate feedback was collected using an evaluation form. The change in knowledge of candidates was measured using a pre- and post-course test. Variables associated with candidate performance on course papers were investigated using multivariate linear regression analysis. RESULTS A total of 119 nurses attended nine ILS courses. All candidates completed the course successfully and gave high evaluation scores. ILS produced a significant increase from pre- to post-course score (10.15+/-2.75 to 13.19+/-2.53, p<0.001). The pre-course score was higher for nurses working in ICU compared with those coming from non-intensive wards, but this difference disappeared in the post-course evaluation (13.89+/-2.18 versus 12.79+/-2.65, p=ns). CONCLUSIONS We have reproduced the ILS course in Italy successfully. ILS teaching resulted in an improvement in resuscitation knowledge of the first group of nurses trained.
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Affiliation(s)
- Andrea Scapigliati
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy.
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Nurmi J, Skrifvars MB, Rosenberg PH, Castrén M. Increase in rapid defibrillation programmes after publication of guidelines. Int J Qual Health Care 2006; 18:446-51. [PMID: 17062820 DOI: 10.1093/intqhc/mzl056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE . To monitor the implementation of in-hospital resuscitation strategies including (i) rapid defibrillation programmes, (ii) the use of amiodarone for prolonged ventricular fibrillation, and (iii) uniform data collection on resuscitation, all recommended by international guidelines published in 2000 and by Finnish national resuscitation guidelines published in 2002. DESIGN In 2004, a questionnaire was sent to the chief anaesthesiologists. The results were compared with those of a previous study performed using similar methods in 2000. SETTING All public hospitals that provide anaesthetic services in Finland. MAIN OUTCOME MEASURES Number of hospitals allowing nurses to perform defibrillation without the presence of physician and number of hospitals using amiodarone as primary antiarrhythmic drug in resuscitation and performing uniform data collection. RESULTS The response rate was 95% (52/55). The proportion of the hospitals with rapid defibrillation programmes on general wards had increased from 15% in 2000 to 67% in 2004, and most (79%) hospitals had obtained automated external defibrillators. Amiodarone was used in 88% of the hospitals. Data collection of resuscitation attempts using definitions provided in the Utstein guidelines was performed only in 22% of the hospitals. CONCLUSIONS Rapid defibrillation programmes have markedly increased, and the use of amiodarone has been established in Finnish hospitals since the publication of the international and the national resuscitation guidelines.
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Affiliation(s)
- Jouni Nurmi
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
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Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2006; 33:237-45. [PMID: 17019558 DOI: 10.1007/s00134-006-0326-z] [Citation(s) in RCA: 433] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 07/20/2006] [Indexed: 12/31/2022]
Abstract
DESIGN Review. OBJECTIVE Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. RESULTS AND CONCLUSIONS The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.
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Affiliation(s)
- Claudio Sandroni
- Intensive Care Unit, Catholic University School of Medicine, Rome, Italy.
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Suraseranivongse S, Chawaruechai T, Saengsung P, Komoltri C. Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country. Resuscitation 2006; 71:188-93. [PMID: 16987585 DOI: 10.1016/j.resuscitation.2006.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 03/24/2006] [Accepted: 04/01/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the outcome and quality of in-hospital cardiopulmonary resuscitation (CPR), and factors affecting the outcome. SETTING A 2300-bed university hospital in Thailand. METHOD A 1-year prospective audit according to the Utstein style. RESULTS A total of 639 cardiac arrests (370 male, 269 female, age 1 day-96 years, mean+/-S.D.=53.3+/-24.12 years) were included. Four hundred and thirty-three cardiac arrests (67.8%) occurred in non-monitored areas and 200 (31.3%) occurred in monitored areas. Five hundred and thirty-six cardiac arrests (84%) were witnessed. The majority of cardiac arrests occurred in medical patients (68.4%) and surgical patients (21.4%). The most common underlying causes of arrest were respiratory failure (24.7%) and septic shock (23.3%). Initial ECG rhythms were ventricular fibrillation 79 (12.4%), asystole 272 (42.6%) with pulseless electrical activity 225 (35.2%). Most patients received basic life support within 1 min (86.7%) and advanced life support (ALS) within 4 min (92.6%) but only 25% of patients received defibrillation within 3 min. Following resuscitation, 394 (61.7%) achieved restoration of spontaneous circulation and 44 patients (6.9%) survived to discharge. Only 162 post-arrest patients were treated in the critical care area. The initial survival rate was not associated with sex, age and time to ALS, but was significantly related to the monitored area. CONCLUSION In our setting, survival to discharge is 6.9%. Initial survival rate was strongly associated with being in a monitored area. Defibrillators and the critical care areas were insufficient.
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Affiliation(s)
- Suwannee Suraseranivongse
- Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Gombotz H, Weh B, Mitterndorfer W, Rehak P. In-hospital cardiac resuscitation outside the ICU by nursing staff equipped with automated external defibrillators—The first 500 cases. Resuscitation 2006; 70:416-22. [PMID: 16908093 DOI: 10.1016/j.resuscitation.2006.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 02/07/2006] [Accepted: 02/08/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Since nursing staff in the hospital are frequently the first to witness a cardiac arrest, they may play a central role in the effective management of in-hospital cardiac arrest. In this retrospective study the first 500 in-hospital cardiac arrests in non-monitored areas, which were treated initially by nursing staff equipped with automated external defibrillators (AEDs) are reported. METHODS AND RESULTS Between April 2001 and December 2004, 500 in-hospital cardiac arrest calls were made: there were false arrests in 61 patients, so a total of 439 patients (88%) were evaluated using the Utstein style of data collection. ROSC occurred in 256 patients (58%), 125 (28%) were discharged from hospital and 95 (22%) were still alive 6 months after discharge. Among the 73 patients with VF/VT 63 (86%) had ROSC, 34 (47%) were discharged from hospital and 28 (38%) were alive after 6 months. The chance of survival was not influenced by the time between the call of the arrest team and the 1st defibrillation but was slightly higher with physicians as in-hospital first responders (p=0.078). In contrast, 366 patients with non-VF/VT, 193 (53%) had ROSC, but only 91 (25%) were discharged from hospital and 67 (18%) were alive after 6 months. The risk of dying was significantly higher in patients with non-VF/VT (p<0.001), and there was a trend to a higher risk ratio in patients older than 65 years and in patients with non-witnessed cardiac arrest (p=0.056 and 0.079, respectively). CONCLUSION This observational study supports the concept of hospital-wide first responder resuscitation performed by nursing staff before the arrival of the CPR-team. Among these patients survival rate was higher in those with VF/VT defibrillated at an early stage. Consequently, it may be assumed that patients may die unnecessarily due to sudden cardiac arrest if proper in-hospital resuscitation programmes are not available.
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Affiliation(s)
- H Gombotz
- Department of Anaesthesiology and Intensive Care, General Hospital Linz, Austria.
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Einav S, Shleifer A, Kark JD, Landesberg G, Matot I. Performance of department staff in the window between discovery of collapse to cardiac arrest team arrival. Resuscitation 2006; 69:213-20. [PMID: 16563596 DOI: 10.1016/j.resuscitation.2005.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 09/13/2005] [Accepted: 09/14/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Guideline-directed therapy during the first minutes of resuscitation may be life saving. This study assessed the performance of American Heart Association (AHA) guidelines by trained departmental staff in the period between discovery of collapse and emergency team arrival. METHODS Over a period of 24 months, departmental performance prior to the arrival of the emergency team (median 180 s) was assessed by debriefings conducted within 24h of each event in a 740-bed tertiary hospital with a dedicated certified resuscitation team. Outcome measures were failure to meet AHA treatment recommendations (primary) and return of spontaneous circulation (ROSC)/survival to hospital discharge (secondary). RESULTS Two hundred and forty four events were included (216 patients). Mean age was 69+/-17 years; 45% were women. The underlying causes of collapse were mainly cardiac (39%) or respiratory (32%). Residents conducted most of the resuscitations (69%) prior to the arrival of the emergency team. Basic diagnostic measures such as assessments of pulse and rhythm were not performed in 19 and 33% of events. Therapeutic measures such as positive pressure ventilation, chest compressions and defibrillation were not provided according to the guidelines in 17, 12 and 44% of the events. ROSC occurred in 62% of events; 54% of VF/VT, 30% of asystole, 22% of PEA and 76% of bradyarrhythmias/severe bradycardias. Survival to hospital discharge was 37% overall and 41% for patients found in VF/VT (n=33). CONCLUSIONS Trained departmental staff performed poorly in the moments between patient discovery and arrival of the emergency team. Since patient outcomes were comparable to those described in the literature, poor resuscitation performance may be commonplace in hospitals where ward personnel are expected to deliver advanced life support prior to arrival of the emergency team.
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Affiliation(s)
- Sharon Einav
- Intensive Care Unit, Shaare Zedek Medical Centre, P.O. Box 3235, Jerusalem 91031, Israel.
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Skrifvars MB, Saarinen K, Ikola K, Kuisma M. Improved survival after in-hospital cardiac arrest outside critical care areas. Acta Anaesthesiol Scand 2005; 49:1534-9. [PMID: 16223402 DOI: 10.1111/j.1399-6576.2005.00847.x] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND The in-hospital Utstein Guidelines may be used to evaluate resuscitation strategies. This study utilized the Utstein template prospectively to examine changes in outcome and outcome-related factors after resuscitation outside critical care areas over a 10-year period. METHODS Seinäjoki Central Hospital (460 beds) is a secondary hospital in Finland with acute care activities. In 1993, the in-hospital cardiac arrest management was remodelled; an intensive care unit-based resuscitation team was formed and prospective data collection began (modified according to the Utstein Guidelines in 1997). An analysis of resuscitation attempts outside critical care areas between 1993 and 2002 was performed. To monitor developments, the patients were divided into two groups (first period, 1993-97; second period, 1998-2002). Variables independently associated with survival were identified using multiple logistic regression analysis. RESULTS During the 10-year period, resuscitation was attempted in 183 patients. Survival to discharge was 6% during the first period and 16% during the second (P = 0.048). The corresponding figures for survival at 1 year from the event were 3% and 10% (P = 0.064). Independent predictors of survival were ventricular fibrillation or ventricular tachycardia as the initial rhythm [odds ratio (OR), 9.8; confidence interval (CI), 3.2-30.3] and cardiac arrest occurring during the second period (OR, 3.3; CI, 1.1-10.1). CONCLUSION Prospective Utstein style data collection proved to be a valuable tool for the evaluation of management and outcome following in-hospital cardiac arrest. Increased survival was seen over 10 years outside critical care areas. Organizational changes, including cardiopulmonary resuscitation training for ward personnel and standardized resuscitation management, may have contributed to this change.
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Affiliation(s)
- M B Skrifvars
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Sandroni C, Ferro G, Santangelo S, Tortora F, Mistura L, Cavallaro F, Caricato A, Antonelli M. In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation 2004; 62:291-7. [PMID: 15325448 DOI: 10.1016/j.resuscitation.2004.03.020] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Revised: 03/15/2004] [Accepted: 03/23/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the factors affecting the outcome of in-hospital cardiac arrest. SETTING A 1400-bed tertiary care teaching hospital with a dedicated cardiac arrest team (CAT). The CAT was immediately available in monitored areas (intensive care unit and emergency room). In the wards the staff had only BLS skills and automated external defibrillation was not available. METHODS A 2-year prospective audit according to the Utstein style. RESULTS A total of 114 cardiac arrests (37 with VF/VT and 77 with non-VF/VT) were included. Fifty-two cardiac arrests (46%) occurred in monitored areas, 62 (54%) occurred in non-monitored areas. The CAT arrival time in non-monitored areas was 3.98+/-1.73 min. Thirty-seven patients (32%) survived to hospital discharge. Cardiac arrests occurring in monitored areas had a significantly better outcome than those occurring in the wards. Patient survival in the wards was significantly higher when the CAT arrival time was less than 3 min. No patient whose CAT arrival time was longer than 6 min survived. CAT arrival time was significantly shorter (1.30+/-1.70) in survivors than in non-survivors (2.51+/-2.37; P<0.005). Sex, age and presence of bystanders were not significantly associated with survival. CONCLUSIONS In our setting, where bystander defibrillation was not available, the survival of patients having cardiac arrest in non-monitored areas strongly depends on advanced life support provided by the CAT. A faster CAT response and early defibrillation from the ward staff are the most important improvements necessary to increase cardiac arrest survival in our setting.
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Affiliation(s)
- Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Gemelli 8, 00168 Rome, Italy
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