Monitoring of in-hospital cardiac arrest events with the focus on Automated External Defibrillators – a retrospective observational study

Abstract

BackgroundPatients with cardiac arrest have lower survival rates, when resuscitation performance is low. In In-hospital settings the first responders on scene are usually nursing staff without rhythm analysing skills. In such cases Automated External Defibrillators (AED) might help guiding resuscitation performance. At the Wuerzburg University Hospital (Germany) an AED-program was initiated in 2007.Aim of the presented study was to monitor the impact of Automated External Defibrillators on the management of in-hospital cardiac arrest events.MethodsThe data acquisition was part of a continuous quality improvement process of the Wuerzburg University Hospital. For analysing the CPR performance, the chest compression rate (CCR), compression depth (CCD), the no flow fraction (NFF), time interval from AED-activation to the first compression (TtC), the time interval from AED-activation to the first shock (TtS) and the post schock pause (TtCS) were determined by AED captured data. A questionnaire was completed by the first responders.ResultsFrom 2010 to 2012 there were 359 emergency calls. From these 53 were cardiac arrests with an AED-application. Complete data were available in 46 cases. The TtC was 34 (32–52) seconds (median and IQR).The TtS was 30 (28–32) seconds (median and IQR) . The TtCS was 4 (3–6) seconds (median and IQR) . The CCD was 5.5 ± 1 cm while the CCR was 107 ± 11/min. The NFF was calculated as 41 %.ROSC was achieved in 21 patients (45 %), 8 patients (17 %) died on scene and 17 patients (37 %) were transferred under ongoing CPR to an Intensive Care Unit (ICU).ConclusionThe TtS and TtC indicate that there is an AED-user dependent time loss. These time intervals can be markedly reduced, when the user is trained to interrupt the AED’s “chain of advices” by placing the electrode-paddles immediately on the patient’s thorax. At this time the AED switches directly to the analysing mode. Intensive training and adaption of the training contents is needed to optimize the handling of the AED in order to maximize its advantages and to minimize its disadvantages.

Real-time tablet-based resuscitation documentation by the team leader: evaluating documentation quality and clinical performance

“…Considering clinical performance, the data showed no difference between the current documentation method and the Application in relation to deviations from recommended defibrillation and adrenaline administration rhythms and time to first defibrillation. Considering the no-flow fraction, the value for the HIS system (22.44 %) was similar or even better compared to data from actual resuscitations by emergency teams (24 %) [ 19 ], ward nurses using a Automated External Defibrillator (40 %) [ 20 ], and simulated resuscitations (25 %) [ 21 ]. More interesting, using the Application resulted in a reduction of the no-flow fraction of 5.53 to 16.91 %.…”

Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: a prospective observational study

“…(2) immediate activation of emergency responses to IHCAs, to provide early high-quality advanced life support (ALS) [17]; (3) a high-performing hospital-wide rapid response system consisting of a cardiac arrest team and/or medical emergency team that are organised, well trained, and available 24 h per day, 7 days a week [18][19][20][21]; (4) state-of-the-art post-resuscitation care [22]; (5) performance-driven debriefings [23,24]; and (6) recording of the institution resuscitation success, with reporting of the results. These measures contribute to further optimisation of local procedures and maintain adherence to current guidelines [5,21].…”

Distribution and use of automated external defibrillators and their effect on return of spontaneous circulation in Danish hospitals

“…Another study found an AED-user dependent time loss when the user awaits the entire “chain of advice” instead of placing the defibrillation electrodes immediately, suggesting that lacking user-skills attenuates the benefit of AEDs. 25 Further, a study indicated that suboptimal use of AEDs are common, which may be due to long retraining intervals combined with low exposure to IHCA among ward nurses. 14 Finally, the interruption in chest compressions during rhythm analysis and shock delivery is generally prolonged when using an AED compared to a manual defibrillator which decreases survival.…”