Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests.

OBJECTIVE: To determine the retention of Advanced Cardiac Life Support training of internal medicine residents as a function of the time since successfully completing ACLS training. DESIGN: Prospective, consecutive sample of patients who underwent a cardiopulmonary resuscitation effort directed by physicians who successfully completed ACLS. SETTING: Eastern community teaching hospital. PATIENTS: 180 consecutive patients over the age of 18 years who sustained a cardiopulmonary arrest and whose resuscitation efforts were directed by physicians who successfully completed ACLS. Forty-five additional resuscitative efforts hospital wide were led by non-ACLS-trained physicians during the study period. OUTCOME MEASURES: Correctness of the diagnosis of rhythms and treatment of the rhythms diagnosed were assessed, as per ACLS protocols in effect at the time of the study, in 1991. INTERVENTION: None. RESULTS: Chi-squares were used for analysis. Seventy-six of the resuscitative efforts were run by medical residents with a 13.2% error rate. The error rate in the first 6 months after ACLS completion among residents was 5.1%, as compared with 21.6% in the next 6 months (p = 0.033), with no impact on actual survival rate. During the study period, error rates among other groups were 8.8% in Emergency Department physicians and 17.8% among non-ACLS-trained physicians. CONCLUSIONS: The error rate found was lower than in previous studies evaluating retention of ACLS education. It is important to have regular updates in ACLS to ensure proper protocol use.

Biochemical changes associated with thermal biofeedback treatment of hypertension.

Fifty-two hypertensive patients whose blood pressure (BP) was controlled on two medications received either 16 sessions of thermal biofeedback (n = 30) for hand warming or 8 sessions of progressive muscle relaxation (n = 22) prior to medication withdrawal. A number of biochemical measures, including plasma norepinephrine (NEPI) (supine and standing), plasma renin activity, plasma aldosterone, and urinary sodium and potassium, were taken before treatment and after treatment while medication remained constant. Results for the biofeedback-treated patients showed significant reductions in mean arterial pressure as well as in both supine and standing NEPI, while the other biochemical measures were unchanged. There were no significant changes on any variable for the relaxation-treated patients. Although the group data support a reduction in peripheral sympathetic tone as associated with the decrease in BP for the thermal biofeedback condition, dose-response relations were not significant.