Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: an observational study over 6 years.

BACKGROUND: The Resuscitation Council (UK) Immediate Life Support (ILS) course provides training in the prevention and management of cardiac arrest. This course was introduced at our institution and we subsequently undertook an analysis to determine its impact on the incidence and outcome of in-hospital cardiac arrest. METHODS: A 6-year prospective audit of 3126 in-hospital emergency alert calls within a multi-site 1200 bedded London teaching hospital following the organisation-wide adoption of the ILS course. Key measures used to detect improvement were the incidence of emergency alert calls, in particular the proportion of calls which were pre-arrest versus cardiac arrest calls, episodes of resuscitations without return of spontaneous circulation, survival to hospital discharge; the proportion of clinical staff who were ILS trained was an important organisational measure. RESULTS: The total number of emergency alert calls showed no significant change. We observed a reduction in the proportion of calls for cardiac arrests (p<0.0001; from 85% in 2002 to 45% in 2007), a corresponding increase in the proportion of 'pre-arrest' calls (p<0.0001; from 15% in 2002 to 55% in 2007), a reduction in deaths at cardiac arrest (p=0.0002) and an increased survival to hospital discharge following an emergency call from 28% in 2004 to 39% in 2007. There was a temporal relationship between the proportion of staff who were ILS trained and outcome. CONCLUSION: The introduction of a simple and widespread educational programme was associated with a reduction in both the number of in-hospital cardiac arrests and unsuccessful cardiopulmonary resuscitation attempts.

Automated external defibrillation in cardiac surgery.

Revision open heart surgery may be impeded by a dense network of pericardial adhesions rendering cardiac mobilization laborious or incomplete, and internal defibrillation impossible. External defibrillation, the current alternative to internal defibrillation, may result in myocardial stunning secondary to the delivery of escalating, monophasic, high-energy shocks. Automated external defibrillation, by delivering consecutive, non-escalating, impedance-compensated, low-energy, biphasic electric shocks to the myocardium, may provide a more effective and safer option whilst reducing the risk of myocardial stunning.

Early defibrillation and the chain of survival in 'in-hospital' adult cardiac arrest; minutes count.

OBJECTIVE: To report the outcomes from and the impact of the chain of survival in 'in-hospital' cardiac arrest where the presenting rhythm was VF/VT, the arrest was witnessed, defibrillation was conducted rapidly and no other resuscitation interventions were required. OUTCOME MEASURES: Any return of spontaneous circulation and discharge from hospital. METHODS: A 2-year prospective resuscitation audit using the Utstein style was conducted within a major London NHS Hospital Group. RESULTS: There were 124 patients who had primary VF/VT arrest. Eight were excluded from the study and 14 had non-witnessed cardiac arrest. Twenty one patients had witnessed VF/VT arrest but with delayed defibrillation, 81 patients had witnessed VF/VT arrest with rapid defibrillation, 69 patients had witnessed VF/VT arrest with rapid defibrillation, CPR and other additional interventions. There were 15 patients that had witnessed cardiac arrest with a presenting rhythm of VF/VT, who received rapid defibrillation and had no ventilation or chest compression prior to or following defibrillation. All 15 patients achieved a return of spontaneous circulation, and 12 were discharged alive. CONCLUSIONS: Rapid defibrillation prior to any other resuscitation intervention is associated with increased survival from witnessed VF/VT arrest in in-hospital cardiac arrest victims, and that the time to first shock is critical in enhancing the prospects of long-term survival in these patients.