Deviations from ACLS guidelines and outcomes of in-hospital cardiac arrests
CCCF ePoster library. Honarmand K. Oct 26, 2015; 114769; P8
Dr. Kimia Honarmand
Dr. Kimia Honarmand
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
P8


Topic: Retrospective or Prospective Cohort Study


Deviations from ACLS guidelines and outcomes of in-hospital cardiac arrests



Kimia Honarmand, C. Mepham, C. Ainsworth, Z. Khalid

Internal Medicine, McMaster University, Hamilton, Canada | Critical Care, St. Joseph's Healthcare, Hamilton, Canada | Cardiology and Critical Care, McMaster University, Hamilton, Canada | Internal Medicine, McMaster University, Hamilton, Canada

Introduction:

Cardiac arrest in hospitalized patients is associated with low rates of survival (1-3). The quality of resuscitation provided during in-hospital cardiac emergencies is one of the modifiable factors that may affect patient outcomes. Advanced Cardiac Life Support (ACLS) guidelines published by the AHA (4) are intended to provide clinicians with best practices for the management of patients with life-threatening arrhythmias and cardiac arrest. Although the effects of specific components of the ACLS guidelines have been reported (5-8), whether adherence to ACLS algorithms in their entirety has any influence on patient outcomes remains unclear.



Objectives:

The objective of this retrospective analysis was to determine the effect of deviations from ACLS guidelines during in-hospital cardiac arrests on return of spontaneous circulation (ROSC) and survival to hospital discharge or transfer.



Methods:

We conducted a retrospective review of all pulseless cardiac arrests at St. Joseph’s Healthcare, a tertiary care center in Hamilton, Ontario. All cardiac arrests between January 2010 and June 2014 that were lead by the Internal Medicine team were included. Records that were incomplete were excluded. Demographic and arrest-related variables were recorded for each patient. All deviations from ACLS guidelines were recorded for each cardiac arrest, including administration of therapy not indicated for the algorithm, omissions of required actions or medications, excess administration of indicated medications, as well as excessive or delayed pulse and rhythm checks. The total number of deviations from ACLS guidelines was recorded. The primary outcome variables included ROSC and survival to hospital discharge or transfer.



Results:

Sixty-five cardiac arrest events were included in the analysis. Among these, 36 (55.4%) had ROSC, and 11 (16.9%) survived to hospital discharge or transfer. The average number of deviations from ACLS guidelines for patients who had ROSC was 3.56 (SD=2.60, n=36), compared with 7.48 deviations (SD=5.70, n=29) for those who did not have ROSC (p= .000). The average number of deviations from ACLS guidelines for those who survived to hospital discharge or transfer was 4.00 (SD=2.65, n=54), compared with 5.57 (SD=5.00, n=11) for those who did not survive (p= .312). Duration of code among those who had ROSC was 30.67 minutes (SD=27.56) and 30.68 minutes (SD=18.07) among those who did not survive the event (p=1.00). Duration of code was also similar among those who survived to hospital discharge or transfer (Mean=28.0, SD=18.36) compared to those who did not (Mean 31.24, SD=24.84, p= .623).



Conclusion:

We found that non-adherence to ACLS guidelines was associated with less likelihood of ROSC but not survival to hospital discharge or transfer. This raises the possibility that although adherence to ACLS guidelines may improve the chances of patient survival in the short-term, long-term outcomes are not significantly affected by strict adherence to ACLS guidelines. Prospective studies are required to further delineate the components of ACLS guidelines that are important in improving long-term survival.



References:

1. Amer MS, Abdel Rahman TT, Aly WW, Ahmad NG. Cardiopulmonary resuscitation: outcome and its predictors among hospitalized elderly patients in Egypt. Geriatr Gerontol Int 2014;14(2):309-314.

2. Kantamineni P, Emani V, Saini A, Rai H, Duggal A. Cardiopulmonary resuscitation in the hospitalized patient: Impact of system-based variables on outcomes in cardiac arrest. Am J Med Sci 2014;0(0):1-5.

3. Nolan JP et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation 2014;85(8):987-992.

4. Field JM et al. Part 1: Executive Summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S640-656.

5. Vandycke C, Martens P. High dose versus standard dose epinephrine in cardiac arrest—a meta-analysis. Resuscitation 2000;45:161-166.

6. Stiell IG, Hebert PC, Wells GA, Vandemheen KL, Tang AS, Higginson LA, Dreyer JF, Clement C, Battram E, Watpool I, Mason S, Klassen T, Weitzman BN. Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 2001;358:105-109.

7. Donnino et al. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ 2014; 348.

8. Dumot JA, Burval DJ, Sprung J, Waters JH, Mraovic B, Karafa MT, Mascha EJ, Bourke DL. Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of “limited” resuscitations. Arch Intern Med 2001;161:1751–1758.

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings