Abstract 2687: Implementation of the 2005 American Heart Association Guidelines Together with the Impedance Threshold Device Improves Hospital Discharge Rates after In-Hospital Cardiac Arrest
Background: Survival after in-hospital cardiac arrest (I-HCA) remains low, despite rapid care by trained medical personnel.
Objective: Determine the impact of the 2005 American Heart Association (AHA) resuscitation guidelines and use of an impedance threshold device (ITD) on survival after I-HCA.
Hypothesis: Greater circulation delivered by combining more efficient and effective CPR together with an ITD, recommended in the 2005 AHA Guidelines to increase circulation and return of spontaneous circulation rates during CPR, will increase survival after I-HCA.
Methods: Two community hospitals that are early adopters and track outcomes after I-HCA compared hospital discharge rates from before and after implementation of the new AHA CPR and ITD (ResQPOD TM, Advanced Circulatory Systems, Eden Prairie, MN) protocols. The interventions included and emphasis on the proper ventilation rate, full chest wall recoil, continuous CPR once the patient was intubated, and use of the ITD that included a timing light to guide the rate of positive pressure ventilations and compressions. St. Cloud Hospital tracks outcomes following the National CPR Registry template. IRBs at the respective hospitals approved the study.
Results: St. Cloud Hospital, St. Cloud, Minnesota is a 489 bed hospital with ~12 I-HCA/month. Historical control data were obtained from the prior 18 months (1/2005–6/2006) and the intervention group was for the subsequent 18 mo. In St. Dominic Hospital, Jackson, Mississippi, a 571 bed hospital with ~12 I-HCA/month, historical control data were used the prior 9 months (1/2006 –9/2006) and the intervention group was from the subsequent 11 mo. The combined hospital discharge rate for patients (n=390) with an I-HCA was 23.7% in the control phase verses 35.8% in the intervention phase (n=341 patients) (p<0.001 by Chi square test).
Conclusion: Implementation of improved ways to increase circulation during CPR resulted in a marked increase in hospital discharge rates >50% compared with historical controls in two large community hospitals. These data demonstrate that immediate care with improved means to circulate blood during CPR can significantly reduce hospital mortality rates after in-hospital sudden cardiac arrest.