Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience

Abstract

Introduction: High quality cardiopulmonary resuscitation (CPR) performed according to international guidelines has a vital impact on survival of cardiac arrest. Objective: To investigate different variables affecting return of spontaneous circulation (ROSC) and survival to discharge (STD) after in-hospital cardiac arrest (IHCA) and evaluate adherence to CPR guidelines using a modified Utstein-style template. Methods: A prospective observational study of 126 IHCA out of 5479 admissions to cardiology units of 3 Cairo University hospitals. Results: CPR was not attempted in 7 futile cases. ROSC was achieved in 50.4%, while STD was achieved in only 7.6% of 119 attempted resuscitations. CPR was started by a physician in 114 cases (95.8%) and by the on duty nurse in only 5 cases. The initial rhythm was shockable rhythm (SR) in 19 cases; 13 (68.4%) of whom achieved ROSC and 6 (31.6%) STD and non SR (pulseless electric This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). activity/asystole) in 100 cases; 47 (47%) of whom achieved ROSC and 3 (3%) STD. Chest compressions were observed appropriate P100/min, P2 inches deep and interrupted <10 s in 99.2%, 92.4% and 48.7% of cases respectively. Initial SR and duration of CPR were independently associated with ROSC (both P = 0.01) and STD (P = 0.008 and 0.02 respectively). A cut-off value for CPR duration of 22.5 min had a sensitivity of 86.7% and a specificity of 81.4% in predicting ROSC by receiver-operator characteristics analysis. Conclusion: The poor STD despite a relatively good ROSC calls for improvement of CPR education and training for hospital personnel and better post CA care.

Cardiopulmonary resuscitation during the COVID-19 pandemic: a scientific statement on CPR management protocol of Kasr Al-Ainy University Hospital is presented

“…Prior to the COVID-19 pandemic, survival from cardiac arrest (CA) had steadily improved in the cardiology department, at Faculty of Medicine, Cairo University, thanks to the continuous cardiopulmonary resuscitation (CPR) training and quality improvement measures including auditing CPR outcomes as well as morbidity and mortality (M & M) meetings [ 1 ].…”

Studying the Extent of Compliance with the Standard Principles of Cardiopulmonary Resuscitation in the Selected Educational Centers of Mazandaran University of Medical Sciences 2016 - 2017

“…In the study of Barimjejad et al chest compression with inappropriate depth was 12% in the intervention group and 45.8% in the control group, inappropriate hand placement in the intervention group was 40% and in the control group was 76.8%, and inappropriate hand angle was 32.17% in the intervention group and 51.8% in the control group (8). In the study of Hesham et al, the number of compression ≥100/min was 99/2%, depth ≥ 2 inches was 92/4%, and pause more than 10 seconds to check pulse was 48/7% (15). In the study of Pourmirezakalhori et al, nurses' knowledge and skills regarding correct compression depth was 87.9%, correct placement of hands 82.6%, and compliance with the proper ratio of compression to ventilation 30:2 was 72.2% (16).…”

“…Chest compression is effective if it has the following three characteristics: -Chest compression more than 100 /min -Chest compression with a depth of more than two inches (6-5 cm) -Interruptions at intervals of less than 10 seconds compression (15).…”

Evaluation of İn-hospital Cardiac Arrest Patients

“…Çalışmamızın verileri doğrultusunda bulduğumuz en önemli sonuçlar şunlardır: (8) çalışmasında, yaş ortalaması 56.4±14.8, %63.5 erkek, %36.5 kadın, Shao ve ark (9) 'da yaş ortalaması 61.6±14.6, %67.8 erkek, %32.2 kadın olarak belirtmiştir.…”

“…Hastane içi arrestlerde en sık NEA ve asistoli ritimleri görülmektedir (7)(8)(9)(10)(11) . Şok uygulanabilir ritimler (nVT,VF) görülen olgularda hastaların resüsitasyona yanıtı şok uygulanamaz ritimlere göre daha iyidir (7,9,12) .…”