Abstract 164: Breaking the 30% Survival Rate Window: Impact of the 2005 and 2010 American Heart Association Guidelines on In-Hospital Cardiac Arrest Survival With Favorable Neurological Function
Background: In 2005 AHA Guidelines were implemented and emphasized the key changes related to cardiac arrest treatments related to chest compression rate, depth, ventilation:compression frequency, impedance threshold device (ITD) use, defibrillation sequence, and rotation of CPR personnel. Five years later the 2010 AHA Guidelines changes were implemented including: chest compression first before ventilation, emphasis on continuous chest compression as much as possible, delivery of compressions at 100 compressions/minute and at a depth of 2”, a ‘pit crew’ approach, and new Advanced Life Support algorithms. Our goal was to improve survival for all patients in-hospital cardiac arrest to >30%. Our respiratory therapists played a vital role in the prompt initiation and assurance of High-Performance (HP-) CPR, partnering with our nurses and physicians in all resuscitation efforts. We have further increased the utilization of clinical hypothermia over the past 36 months.
Methods: In a medium size (571 bed) hospital we prospectively compared outcomes from prior to implementing the 2005 and 2010 Guideline changes noted above to outcomes following in-hospital cardiac arrest between 2010-2012.
Results: Overall hospital discharge rates increased from 17.2% (27/157) just prior to 2005 to 30.1% (79/262) since implementing new 2005 and 2010 Guidelines (P<0.01). Survival to hospital discharge rates with a cerebral performance category score of <3 consistent with favorable neurological function was 75% from 2010-2012.
Conclusions: Following implementation of the 2005 and 2010 AHA Guidelines, in-hospital cardiac arrest survival rates increased from 17.2 to 30.1%. These findings demonstrate the enormous clinical benefits associated with focusing on provider engagement in effective delivery of CPR including delivery of consistent chest compressions, full chest wall recoil, minimal interruptions, ITD use, and the overall ‘pit crew’ approach.
- © 2013 by American Heart Association, Inc.