In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link What is known about this topic?The evaluation of outcomes from in-hospital cardiac arrests focuses on immediate survival expressed as ROSC and survival to hospital discharge. These clinical outcomes have not improved substantially over the last two decades. What does this paper add?This paper identifies the factors that are related to ROSC and survival to discharge following the implementation of the ARC 2006 guidelines which included a refocus on providing quality CPR with minimal interruptions. What are the implications for practitioners?Given that multiple factors can influence clinical outcomes following an in-hospital cardiac arrest, focusing on maximising a range of factors surrounding CPR is essential to improve outcomes.

Patient physiological status during emergency care and rapid response team or cardiac arrest team activation during early hospital admission

“…Our findings support those of other studies that show that 32-34% of patients who require RRT review die in the hospital [24][25][26] and that in-hospital mortality of patients with in-hospital cardiac arrest is 64-77% [37,38]. The relationship between ICU admission from wards and in-hospital death is also well established [39][40][41][42], and ED patients who were admitted to the ICU from the wards had significantly higher mortality than patients who did not require ICU care (37 vs. 3.0%, P <0.001) [39].…”

The epidemiology of in‐hospital cardiac arrests in Australia and New Zealand

“…ROSC was higher in monitored arrests (64.3 vs 36.4%, Cohn et al P = 0.038 and 66.1 vs 42.8%, Jones et al P < 0.001) and in witnessed or monitored arrests (71.8 vs 21.4%, Boyde et al P < 0.001). Smith et al report that patients in monitored areas were more likely to have shockable rhythms (48.3%) than those in non‐monitored areas (19.4%, P = 0.022).…”

“…An initial shockable rhythm (VT or VF) was associated with greater rates of ROSC in two studies (66.3 vs 24.4%, Smith et al, P < 0.0001 and 81.5 vs 41.7%, Boyde et al, P < 0.001), and greater survival to discharge (56.4 vs 15.6%) Jones et al reported that survivors had shorter CPR (6.4 vs 20.4 min, P ≤ 0.001). No asystolic unwitnessed events survived in the study by Cohn et al …”

“…reported median times to cardiopulmonary resuscitation (CPR) (0.5 min), to defibrillation (1 min), to adrenaline (4 min) and to intubation (8 min). Two studies reported on time intervals from collapse to ROSC and one on automated external defibrillator (AED) use . The median time from collapse to ROSC was reported as 10 min (interquartile range (IQR) 3–20) by Jones et al .…”

“…The median time from collapse to ROSC was reported as 10 min (interquartile range (IQR) 3–20) by Jones et al . and 12 min (IQR 4–26) by Boyde et al No studies reported on the number of DC‐shocks or other details of medications used.…”