Implementing the 2005 American Heart Association Guidelines,Including Use of the Impedance Threshold Device,Improves Hospital Discharge Rate After In-Hospital Cardiac Arrest

Abstract

OBJECTIVE:

To determine the impact of the 2005 American Heart Association cardiopulmonary resuscitation (CPR) guidelines, including use of an impedance threshold device (ITD), on survival after in-hospital cardiac arrest.

METHODS:

Two community hospitals that tracked outcomes after in-hospital cardiac arrest pooled and compared their hospital discharge rate before and after implementing the 2005 American Heart Association CPR guidelines (including ITD) in standardized protocols. In CPR we used the proper ventilation rate, allowed full chest-wall recoil, conducted continuous CPR following intubation, and used an ITD. We compared historical control data from a 12-month period at St Cloud Hospital, St Cloud, Minnesota, to data from a subsequent 18-month intervention phase. We compared historical control data from a 12-month period at St Dominic Hospital, Jackson, Mississippi to a subsequent 12-month intervention phase. 507 patients received CPR during the study period. Patient age and sex were similar in the control and intervention groups.

RESULTS:

The combined hospital discharge rate for patients with an in-hospital cardiac arrest was 17.5% in the control group (n = 246 patients), which is similar to the national average, versus 28% in the intervention group (n = 261 patients) (P = .006, odds ratio 1.83, 95% CI 1.17–2.88). The greatest benefit of the intervention was in patients with an initial rhythm of pulseless electrical activity: 14.4% versus 29.7% (P = .014, odds ratio 2.50, 95% CI 1.15, 5.58). Neurological function (as measured with the Cerebral Performance Category scale) in survivors at hospital discharge was similar between the groups.

CONCLUSIONS:

Implementation of improved ways to increase circulation during CPR increased the in-hospital discharge rate by 60%, compared to historical controls in 2 community hospitals. These data demonstrate that immediate care with improved means to circulate blood during CPR significantly reduces hospital mortality from in-hospital sudden cardiac arrest.

Keywords

cardiac arrest sudden death impedance threshold device cardiopulmonary resuscitation CPR pulseless electrical activity ventricular fibrillation

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