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
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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


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.


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.


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.


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).


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.


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