Abstract 226: Nurses' Retention of BLS and ACLS Skills Improves Survival from In-Hospital Cardiac Arrest

Abstract

OBJECTIVE: To evaluate whether nurses' retention of BLS and ACLS skills improves survival from in-hospital cardiac arrest (IHCA). METHODS: A prospective interventional cohort study was performed. All of 24 registered nurses in a general ward were assigned to 6 groups after training of BLS and ACLS. At immediately and 9 months after training, the 6 groups were evaluated by skill performance tests based on the American Heart Association 2005 BLS and ACLS tools in simulated environment. Survival from IHCA after resuscitation efforts by nurses as first responders was classified after-training term (2010) and before-training term (2008-2009) and examined the outcome. RESULTS: The evaluation in 9 month after training resulted that core skills of chest compression were well-retained. Delivering 30 compressions and 2 ventilations, pressing first shock button of AED < 90 seconds from AED arrival and management of drug use were also well-retained in 6 groups, whereas both first 2 ventilations with bag-valve-mask were done in only one group. Checking carotid pulse or checking breathing was little done for at least 5 seconds but no more than 10 seconds. As concerns survival from IHCA, 53 patients (67.8 yr, M/F=35/18) received resuscitation efforts by nurses as first responders in 2008-2009, and 6 patients (77.4 yr, M/F=4/2) received resuscitation in ward in 2010. The outcome of in-ward cardiac arrest after training improved significantly compared with that of IHCA before training. The return of spontaneous circulation rate increased from 38% to 83% (P=0.04), 7-day survival increased from 19% to 83% (P=0.003), 30-day survival increased from 15% to 67% (P=0.01), and cerebral performance category 1 at hospital discharge increased from 11% to 50% (P=0.04). CONCLUSIONS: Registered nurses had well retained BLS and ACLS skills for 9 months. The nurses' retention of those skills improved survival from IHCA. Contrary to other skills, the skills of assessment for breathing and circulation were little retained. This assessment may not affect on the outcome, and thus, our results may support validity that “look, listen and feel for breathing” was removed from assessment step of the 2010 algorithm, as well as that “A-B-C” changed to “C-A-B”.