Resuscitation Committee Research Articles

Guidelines for appropriate in-hospital emergency team time management: the Brooke Army Medical Center approach.

Successful outcome following cardiac arrest have been reported in the range of 13-59%. It is well established that the time from the onset of a ventricular arrhythmia to successful defibrillation predicts outcome. Recent out of hospital arrest protocols minimizing time to defibrillation have reported significant improvement in outcomes. The Bethesda conference and American Heart Association (AHA) both set standards for defibrillation time for in hospital codes but do not set standards for other interventions. In February 2000, the Brooke Army Medical Center (BAMC) cardiopulmonary resuscitation committee published time guidelines for the initiation of CPR, emergency team arrival, first defibrillation and first medication. We sought to evaluate resuscitation outcomes before and after this intervention. Data on each response time was prospectively collected as was etiology for the event, emergency location, patient age, gender, and emergency outcome for the 7 months prior to the guideline introduction and 15 months afterwards. The mean response times (in minutes) for initiation of CPR (1.3 vs. 0.4), emergency team arrival (1.6 vs. 1.2), first defibrillation (7.8 vs. 6.6) and first medication (4.1 vs. 3.8) demonstrated trends toward improvement. Compliance with the time standards also increased (67-91, 85-95, 67-71 and 93-86%, respectively). Emergency survival trended toward improvement (47 vs. 57%) while discharge survival significantly increased from 3 to 24% (P=0.017). Setting time guidelines for Advanced Cardiac Life Support (ACLS) improved initiation of CPR, emergency team arrival, first defibrillation, and first medication administration. These time reductions were accompanied by improved event survival and a statistically improved survival to discharge.

Cardiac massage: a method rescued from oblivion.

Cardiac massage: a method rescued from oblivion.

Improving resuscitation skills in psychiatric hospitals

There is currently concern that junior psychiatrists lack adequate skill in cardiopulmonary resuscitation. However, little attention has been given to the equally important issues of nurse training, organisation and the provision of equipment and drugs which are appropriate to psychiatric wards. This paper describes the work of the Leicestershire Mental Health Services Resuscitation Committee and makes suggestions as to how these problems may be approached.

Organization and experiences of a cardiac resuscitation service.

The incidence of cardiac arrest occurring in hospital patients away from the operating room or other locations where anaesthetic procedures are carried out is impossible to estimate. Of the patients who suddenly and unexpectedly develop a cardiac arrest, only a few survive. The survival rate is low, for most patients die from their underlying disease. But many are salvageable. The organization and development of resuscitation services in the hospital is an endeavour towards improving techniques and methods so that cardiac arrest may be successfully treated. No success can be possible without the wholehearted support of the administration, the nurses and their supervisors, and especially the members of the Resuscitation Committee. As far as the St. Boniface General Hospital is concerned this essential co-operation has been conspicuous. Table VII summarizes our experience: a total of 63 patients were treated. Twenty-five were temporarily resuscitated and five recovered sufficiently to return home and assume their normal activities. It is felt that even this small number of rescues justified the expense and the tremendous outlay of effort by a large number of interested people, and it is anticipated that the survival rate will climb with continued experience.