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.

Near death experiences, cognitive function and psychological outcomes of surviving cardiac arrest.

Cardiac arrest is associated with a number of cognitive processes as well as long term psychological outcomes. Recent studies have indicated that approximately 10-20% of cardiac arrest survivors report cognitive processes, including the ability to recall specific details of their resuscitation from the period of cardiac arrest. In addition it has been demonstrated that these cognitive processes are consistent with the previously described near death experience and that those who have these experiences are left with long term positive life enhancing effects. There have also been numerous studies that have indicated that although the quality of life for cardiac arrest survivors is generally good, some are left with long term cognitive impairments as well as psychological sequelae such as post-traumatic stress disorder. This paper will review near death experiences, cognitive function and psychological outcomes in survivors of cardiac arrest.

Long-term survival and residual hazard after in-hospital cardiac arrest.

AIM: The purpose of this study was to determine long-term survival after in-hospital cardiac arrests and to explore if and when the excess mortality risk imposed by the index event reaches that of an age and sex matched general population. METHOD: A retrospective analysis of data from 1,571 in-hospital cardiac arrests between the calendar years 1997 and 2002 inclusive was performed. Two hundred and fifty-nine people survived until hospital discharge, 220 of which were residents in England and included in the study. Kaplan-Meier curves were constructed for the survivors and an age and sex matched comparator population, and survival compared with a one-sample log rank test. Smoothed hazard curves were constructed for the two populations. Differences in outcome from year of index event were also sought. RESULTS: 16.5% of patients survived to hospital discharge. Patients continue to experience a mortality rate greater than that of the comparator population during the first 200 days, with overall 70 deaths versus 18.7 as predicted from life tables (p < 0.0001). The hazard is greatest after resuscitation and falls thereafter until about 2 years where it is not very different to that of the comparator population and then subsequently rises. No evidence was found of a difference in the first year survival between patients resuscitated in different calendar years (p > 0.3 for all tests). CONCLUSION: The residual risk to an individual cardiac arrest survivor's life is greatest during the first year of survival, but declines progressively during the first 2 years after the event, subsequently approaching the risk experienced by the general population.

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.