Abstract 297: Performance-Improvement Based Resuscitation Training Decreases Cardiopulmonary Arrests and Improves Survival

Abstract

Background: Despite recent advances in cardiopulmonary arrest resuscitation, survival remains poor. Traditional training models have difficulty achieving and maintaining resuscitation competency. The UCSD Advanced Resuscitation Training (ART) Program, a performance-improvement based resuscitation program, has led to a sustained increase in survival to discharge after inpatient cardiac arrest from 21% to 45%. Objective: To evaluate the effectiveness of the ART program on survival after inpatient cardiac arrest and hospital mortality at the Veterans’ Affairs (VA) Hospital System in San Diego. Methods: This was a prospective, observational study conducted in an urban, university-affiliated VA. All inpatient cardiopulmonary arrest (CPA) victims without an active "Do Not Attempt Resuscitation" order from October 2006 to June 2012 were included. The ART program was implemented in Summer 2007 and included a unique treatment algorithm constructed around the capabilities of our providers and resuscitation equipment, a rapid response team, a training program with flexible format and content including early recognition concepts, and a comprehensive approach to performance improvement feeding directly back into training. Our inpatient resuscitation registry and electronic patient care records were used to quantify arrest rates and survival-to-hospital discharge yearly after ART program implementation. Results: A total of 476 CPAs were included (176 within the Intensive Care Unit (ICU) and Emergency Department (ED), and 300 outside of the ICU/ED). Arrest incidence decreased yearly from an initial rate of 10.3 to 2.7 CPA per 1,000 patient discharges in non-ICU inpatient units. Survival-to-discharge rates at the VA were comparable to those documented at UCSD (44% versus 45%, p=NS). Conclusions: Implementation of the ART program at the Veterans Affairs Medical Center resulted in a decrease in the incidence of CPA with high survival-to-discharge rates.