Academic journal article Australian Health Review

In-Hospital Cardiac Arrests: Effect of Amended Australian Resuscitation Council 2006 Guidelines

Academic journal article Australian Health Review

In-Hospital Cardiac Arrests: Effect of Amended Australian Resuscitation Council 2006 Guidelines

Article excerpt

Introduction

Survival rates from in-hospital cardiac arrests have remained poor with no substantial change over the last two decades despite advances in resuscitation training and the introduction of automatic external defibrillators.1,2 Concerns that poor performance of cardiopulmonary resuscitation (CPR) impairs haemodynamic status and affects survival rates have led to an extensive evaluation of adult basic and advanced life support (ALS) guidelines by the International Liaison Committee on Resuscitation at the International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science in 2005.3 The Australian Resuscitation Council (ARC) followed this with the release of the ARC 2006 guidelines4 as summarised in Table 1.

Previous guidelines resulted in too much 'hands-offtime' and contributed to poor-quality CPR,3 with suboptimal chest compression and ventilation rates5 correlated with poor post-resuscitation survival rates.6 ARC Cardiopulmonary Resuscitation Guideline 7 was amended to increase the number and rate of compressions, minimise interruptions to compressions and prevent excess ventilation. The ARC ALS guidelines 11.1-11.11 were also amended.7 The major changes included refocusing on providing quality CPR with minimal interruptions, minimising the potential harm associated with hyperventilation, initiating a one-shock strategy to replace the sequence of three stacked shocks and setting a default energy level of 200 J for biphasic defibrillators.8 The change from the three stacked shock sequence to one shock aimed to decrease inappropriate delays to recommencement of compressions.

These amended guidelines with fewer pauses and increased chest compressions aimed to improve the effectiveness of circulation to essential organs during CPR and led to the development of the present study. The aim of our study was to evaluate clinical outcomes (return of spontaneous circulation (ROSC) and survival to discharge) from in-hospital cardiac arrests after hospital-wide implementation of the ARC 2006 guidelines in a large tertiary referral hospital in Australia. ROSC is defined as restoration of spontaneous circulation that is sustained for 20 min or longer.9

Methods

Setting

This study was undertaken at a 740-bed adult tertiary referral hospital providing all speciality services, with the exception of gynaecology and obstetrics, in Brisbane, Australia.

Cardiac arrest management

Within this hospital setting first responders to cardiac arrests are medical and nursing staffwho commence basic life support including defibrillation with a semi-automatic defibrillator for patients in a shockable rhythm. A designated cardiac arrest team (CAT) attends each cardiac arrest to provide ALS. The CAT comprises ALS-trained staffincluding a medical registrar, an intensive care registrar, a medical resident and a registered nurse from a critical care area (Coronary Care Unit, Intensive Care Unit or the Emergency Department). A designated Resuscitation Co-ordinator and Resuscitation Committee are responsible for overseeing all resuscitation policies, procedures and resuscitation training throughout the hospital.

Data collection and sample

A retrospective study of all consecutive adult in-hospital cardiac arrests during a 3-year phase before implementation (PRE) and a 3-year phase after implementation (POST) of the ARC 2006 Guidelines was conducted. Power analysis showed that 330 patients were required in each group to detect a 10% difference in survival to discharge with an a of 0.5 and with 80% power calculated using the PRE survival to discharge rate of 25%.

During November and December 2006 an intensive training program based on these amended guidelines was implemented throughout the hospital to ensure that all appropriate staffwere trained before the implementation date of 1 January 2007. The updated hospital policy and procedures for basic life support and ALS were implemented in January 2007; they remained unchanged throughout the 3-year POST data-collection phase. …

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