Abstract 1: Implementing a “Resuscitation Bundle” Decreases Incidence and Improves Outcomes in Inpatient Cardiopulmonary Arrest
Background: Despite recent advances in the understanding of cardiopulmonary arrest (CPA), survival to hospital discharge remains poor. Traditional training models appear inadequate in achieving and maintaining resuscitation competency. In addition, inpatient resuscitation may require an alternative therapeutic approach, while early recognition and intervention may prevent CPA.
Objective: To evaluate the effectiveness of a novel inpatient resuscitation training program.
Methods: This study was conducted in an urban, university-affiliated system with two inpatient facilities. A resuscitation “bundle” was introduced in Spring 2007 and included the following components:
a novel inpatient CPA treatment algorithm;
an institutional education model emphasizing scientific rationale behind the algorithm, provider-specific roles, the use of human patient simulators, and more frequent training sessions with content modification based on performance improvement data;
a rapid response team; and
new defibrillators capable of monitoring real-time CPR process data, ECG filtering, and continuous capnometry.
Our inpatient registry of resuscitation events was used to quantify the rate of CPA and survival to hospital discharge before and after implementation of the resuscitation bundle. Multiple logistic regression analysis was used to adjust for covariates including: age, gender, location, initial rhythm, and comorbidities.
Results: A total of 188 CPA’s in the 24-month pre-bundle period and 138 CPA’s in the 21-month post-bundle period were observed. The incidence of CPA’s in non-ICU inpatient areas decreased from 2.9 to 1.4 per 1,000 patient discharges. The incidence of CPA’s in ICU areas did not change (2.0 per 1,000 patient discharges). Survival to hospital discharge following CPA increased in non-ICU areas from 21% to 42% and in ICU areas from 23% to 31% (p<0.05 for all comparisons). Arrest-related deaths decreased from 2.14 to 0.83 deaths per 1,000 patient discharges in non-ICU areas and 1.57 to 1.40 deaths per 1,000 patient discharges in ICU areas.
Conclusions: A novel, inpatient-specific resuscitation bundle appears to decrease the incidence of CPA and increase survival to hospital discharge.